See osce notes: GORD Management

Think of it as a spectrum from gastro-esophageal reflux → gastro-esophageal reflux disease

• Diagnosis and Investigations

  <aside> ⚠️ Severity of symptoms is not a reliable indicator of the severity of disease

  </aside>

  • 🍒GORD is considerd to be present if:
  • 🍒Is endoscopy useful for diagnosis of GORD?
  • 🍒What are the indications for endoscopy in patients with suspected GORD

• Management

  • Gastro-oesophageal reflux
    • Mild intermittent symptoms (1 or 2 episodes per week)
      • Diet and lifestyle modifications might be sufficient to control symptoms
        • Diet: Reflux symptoms are commonly induced by high-fat meals, alcohol, coffee, chocolate, citrus fruit, tomato products, spicy foods and carbonated beverages
          • Limiting specific foods may improve symptoms, but this should only be continued if effective; advise patients to avoid food restrictions that do not improve symptoms
        • Weight loss can be effective for improving reflux symptoms in patients who are overweight; even modest weight loss can be beneficial
        • Smaller meals
        • Eat slowly
        • Avoiding lying down after eating
        • Avoiding eating or drinking for 2 to 3 hours before bedtime
        • Positional therapy device (e.g. wedge pillow) or elevating the head of the bed
        • Stopping smoking
      • If symptoms are sufficiently troublesome; on-demand antacid therapy:
        • 🍒What is the management of mild intermittent gastrointestinal reflux
  • Gastro-oesophageal reflux disease
    • Proton pump inhibitors (PPIs) are generally preferred to H2-receptor antagonists for initial therapy of GORD because they are more effective at standard doses.
    • 🍒What is the management for gastrointestinal reflux disease
    • 🍒How should patients time when they take their PPI in the management of GORD
    • 🍒What is the management for gastrointestinal reflux disease with extra-oesophageal symptoms

Risk of ulcers and H. pylori

• NSAIDs
• Nocturnal cough
• Sleep disturbance
• Frequency of symptoms (>2-3/day) → GORD therapy
• Blood

urea breath test → if positive then endoscopy → antibiotics NP7

Lifestyle

• Weight reduction
• Waiting before meals and sleeping
• Smaller meals
• Spicy and fatty decrease
• 4-5 Coffees/day
• Better sleep
  • nocturnal cough can be improved by elevating head with pillow

GORD therapy