Gastro-Oesophageal Reflux Disease (GORD)

K21.0/K21.9/K22.7

DESCRIPTION

A disorder which develops as a consequence of the reflux of gastric and duodenal contents into the oesophagus. It is usually characterised by heartburn and regurgitation.

Intermittent indigestion, heartburn or dyspepsia may be associated with:

  • use of NSAIDs e.g. aspirin, ibuprofen, pain powders
  • spicy food, alcohol, carbonated drinks
  • smoking

Complications that may develop in severe disease are strictures, ulceration, Barrett’s oesophagus and adenocarcinoma of the oesophagus. Two thirds of patients have a normal endoscopy which is termed non-erosive reflux disease (NERD).

GENERAL MEASURES

  • Stop smoking.
  • Limit alcohol intake.
  • Eat small frequent meals.
  • Avoid late night meals.
  • Check haemoglobin.
  • Stop the use of potential ulcerogenic medicines e.g. NSAIDs.

All patients with alarm symptoms, i.e. weight loss, haematemesis or melaena, dysphagia, or anaemia, chest pain or older than 45 years of age should have an endoscopy.

MEDICINE TREATMENT

Proton pump inhibitors (PPIs)

A trial with a PPI confirms acid-related disease. Only if no alarm symptoms:

LoEI [5]

  • PPI, e.g.:
  • Lansoprazole, oral, 30 mg daily for 4 weeks.
    • Ensure adherence to promote healing.

LoEI [6]

Recurrence of symptoms

After endoscopic confirmation of disease:

  • PPI, e.g.:
  • Lansoprazole, oral, 30 mg daily.
    • Decrease dose of PPI after 4 weeks, e.g: omeprazole, oral, 10 mg daily.

Barrett’s oesophagus K22.7

Restart PPI:

  • PPI, e.g.:
  • Lansoprazole, oral, 30 mg daily.

Note:

  • These patients usually need maintenance PPI therapy.
  • There is no convincing evidence that long-term treatment of Barrett’s oesophagus with PPIs reduces dysplasia or progression to malignancy.

REFERRAL

Discuss with a specialist:

  • young patients who are PPI dependent and will require life-long therapy;
  • patients unable to take PPIs;
  • patients requiring high doses of PPIs;
  • patients with large hiatus hernias and “volume reflux”;
  • a rolling hiatus hernia with obstructive symptoms requires surgery;
  • Alarm features that may be suggestive of gastrointestinal malignancy:
    • New onset dyspepsia in patient >60 years,
    • Evidence of gastrointestinal bleeding,
    • Iron deficiency anaemia,
    • Anorexia,
    • Unexplained weight loss,
    • Dysphagia,
    • Odynophagia (painful swallowing),
    • Persistent vomiting,
    • Gastrointestinal cancer in a first-degree relative.