GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)

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. 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

Dietary advice by dietician.

Weight reduction is recommended if overweight.

All patients with alarm symptoms, i.e. weight loss, haematemesis and

melaena, dysphagia, and anaemia, should have an endoscopy at the

earliest opportunity.

MEDICINE TREATMENT

Empiric treatment only if there are no alarm symptoms, i.e. no weight loss,

no haematemesis and under 45 years of age:

Ranitidine, oral, 150 mg 12 hourly for 4 weeks.

Proton pump inhibitors (PPIs)

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

Omeprazole, oral, 40 mg daily for 4 weeks.

Recurrence of symptoms

After endoscopic confirmation of disease:

Omeprazole, oral, 20 mg daily.

o Decrease to 10 mg daily after 4 weeks.

Barretts’ oesophagitis

Restart PPI:

Omeprazole, oral, 20 mg daily.

Note:

These patients usually need maintenance PPI therapy.

There is no convincing evidence that long-term treatment of Barrett’s

oesophagitis reduces dysplasia or progression to malignancy.

REFERRAL

For consideration of surgery in:

» young patients who are PPI dependent and will require life-long

therapy;

» patients unable to take PPIs;

» patients requiring high doses of PPIs with significant expense;

» patients with large hiatus hernias and “volume reflux”;

» a rolling hiatus hernia with obstructive symptoms requires surgery.

Reference and further reading

Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition

Naijablog