Gastro-Oesophageal Reflux Disease (GORD)

• Diagnosed when heartburn or regurgitation occur ≥2 times weekly and impair quality of life or lead to oesophageal injury (e.g. oesophagitis)

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Symptoms

• Heartburn described as a burning sensation behind the sternum, often after meals or when lying down

• Regurgitation of acidic or bitter fluid, especially at night

• Possible extra-oesophageal manifestations such as chronic cough, sore throat, or hoarseness

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Red Flags

• Unintentional weight loss

• Haematemesis or melaena

• Dysphagia or odynophagia

• Inadequate response to standard treatment

• Iron deficiency anaemia

• New or changing upper GI symptoms in patients over 50

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Management

• Lifestyle Measures

  • Avoid trigger foods including spicy, fatty foods, chocolate, caffeine, alcohol

  • Eat smaller portions and avoid lying flat for 2–3 hours after meals

  • Elevate the head of the bed

  • Encourage weight reduction if overweight and smoking cessation

• Pharmacological Therapy

  • Mild symptoms (<2 episodes/week) can be managed with occasional antacids or alginates

  • Moderate to severe symptoms (≥2 episodes/week) are usually treated with a proton pump inhibitor (e.g. pantoprazole 40 mg daily or esomeprazole 20 mg daily) for 4–8 weeks, increasing dose or frequency if needed

  • Step-down to the lowest effective dose once symptom control is achieved

  • H2 receptor antagonists (e.g. ranitidine) may be considered if PPIs are contraindicated or not tolerated

• Follow-Up

  • Reassess in 4–8 weeks to evaluate symptom resolution and ensure adherence

  • Investigate for red flags or persistent symptoms that may warrant endoscopy

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Endoscopy

• Indicated for alarm features such as significant weight loss, GI bleeding, progressive dysphagia, or persistent symptoms failing PPI therapy

• Recommended in patients over 50 with new or changing reflux symptoms

• Aids in detecting oesophagitis, strictures, or Barrett’s oesophagus

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Complications

• Chronic oesophagitis leading to ulceration or strictures

• Barrett’s oesophagus with risk of progression to oesophageal adenocarcinoma

• Ongoing reflux symptoms impacting quality of life and sleep