Diagnosis of gastro-oesophageal reflux disease (GORD) is clinical. The classic symptoms are heartburn and regurgitation. A therapeutic trial of a proton-pump inhibitor (PPI) can serve for both diagnosis and initial treatment.
Upper endoscopy is indicated to evaluate for complications; for atypical, persistent, or relapsing symptoms; or for alarm features (e.g., weight loss, anaemia).
High rate of relapse upon stopping treatment.
Serious complications of GORD include stricture, Barrett's oesophagus, or oesophageal carcinoma.
Typical symptoms are heartburn and acid regurgitation. Extra-oesophageal symptoms include cough, laryngitis, asthma, or dental erosion. Atypical symptoms include dyspepsia, epigastric pain, nausea, bloating, and belching.
GORD may occur with or without oesophageal inflammation (oesophagitis). If erosions are present on endoscopic examination, the condition is called erosive reflux disease (ERD); if there are no erosions, it is called non-erosive reflux disease (NERD).
History and exam
Key diagnostic factors
- presence of risk factors
- acid regurgitation
Other diagnostic factors
- bloating/early satiety
- enamel erosion
- family history of heartburn or GORD
- older age
- hiatus hernia
- lower oesophageal sphincter (LOS) tone-reducing drugs
- psychological stress
- non-steroidal anti-inflammatory drugs (NSAIDs)
- alcohol consumption
- per-oral endoscopic myotomy (POEM)
- dietary factors
1st investigations to order
- proton-pump inhibitor (PPI) trial
Investigations to consider
- oesophagogastroduodenoscopy (OGD)
- ambulatory pH monitoring
- oesophageal manometry
- combined impedance-pH testing
- barium swallow
- oesophageal capsule endoscopy
- endoluminal functional lumen imaging probe
incomplete response to proton-pump inhibitor
- Acute coronary syndrome
- Stable angina
- Functional oesophageal disorder/functional heartburn
- American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures
- AGA clinical practice update on de-prescribing of proton pump inhibitors: expert review
GORD: questions to ask your doctorMore Patient leaflets
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