Gastro-oesophageal Reflux Disease (GORD) &
Achalasia
Definition abnormal reflux where acid Achalasia
from stomach oesophagus Definition: failure of oesophageal
subsequently damaging the squamous peristalsis and a relaxation of LOS due
oesophageal lining to degenerative loss of ganglia from
Pathophysiology: LOS dysfunction Auerbach’s plexus i.e. LOS contracted,
reflux of gastric contents oesophagitis oesophagus above dilated
Aetiology Typically presents in middle age, M = F
Genetic- angle of LOS
Oesophagitis Signs + symptoms
Sliding hiatus hernia Dysphagia of BOTH solids and
Rolling hiatus hernia liquids
RF smoking, alcohol, obesity, Typically variation in the severity
pregnancy, drugs (e.g. anti-AchM, CCBs, of symptoms
TCAs) Heartburn
Signs + Symptoms Regurgitation of food- may lead to
Heartburn cough, aspiration, pneumonia etc.
Acid taste in mouth- regurgitation Note malignant change in small number
Water brash (excess salivation) of patients
Odynophagia
Nocturnal asthma Ix
Chronic cough Manometry excessive LOS tone, which
Laryngitis/sinusitis doesn’t relax on swallowing- most
important diagnostic test
Barium swallow grossly expanded
oesophagus, fluid level- ‘birds beak’
Investigation appearance
< 55 CXR wide mediastinum, fluid level
> 55 yrs ‘ALARMS’
yrs
symptoms Mx
Proceed Send to Anorexia Intra-sphincteric injection of botulinum
to Rx endoscop Loss of weight toxin
Unless y Anaemia Heller cardiomyotomy
ALARMS 24hr pH Recent onset of Balloon dilatation
sympto monitorin progressive Sx Drug therapy has a role but is limited by
ms g Masses + its side-effects
malaena
Swallowing
difficulty
Mx
GORD = symptoms of oesophagitis secondary to reflux
GORD not Ix by endoscopy Rx via dyspepsia guidelines
Endoscopically proven oesophagitis
Full dose PPI 1-2 months Response? Y low dose Rx as required; N Double
dose for 1 month
Endoscopically negative
Full dose PPI for 1 month Response? Y low dose Rx as required; N H2RA e.g.
Ranitidine
Surgical Nissen fundoplication- mobile gastric fundus + wrap around LOS + close any
diaphragmatic hernia
Complications Barrett’s oesophagus: squamous columnar epithelium, pre-malignant
lesion
Achalasia
Definition abnormal reflux where acid Achalasia
from stomach oesophagus Definition: failure of oesophageal
subsequently damaging the squamous peristalsis and a relaxation of LOS due
oesophageal lining to degenerative loss of ganglia from
Pathophysiology: LOS dysfunction Auerbach’s plexus i.e. LOS contracted,
reflux of gastric contents oesophagitis oesophagus above dilated
Aetiology Typically presents in middle age, M = F
Genetic- angle of LOS
Oesophagitis Signs + symptoms
Sliding hiatus hernia Dysphagia of BOTH solids and
Rolling hiatus hernia liquids
RF smoking, alcohol, obesity, Typically variation in the severity
pregnancy, drugs (e.g. anti-AchM, CCBs, of symptoms
TCAs) Heartburn
Signs + Symptoms Regurgitation of food- may lead to
Heartburn cough, aspiration, pneumonia etc.
Acid taste in mouth- regurgitation Note malignant change in small number
Water brash (excess salivation) of patients
Odynophagia
Nocturnal asthma Ix
Chronic cough Manometry excessive LOS tone, which
Laryngitis/sinusitis doesn’t relax on swallowing- most
important diagnostic test
Barium swallow grossly expanded
oesophagus, fluid level- ‘birds beak’
Investigation appearance
< 55 CXR wide mediastinum, fluid level
> 55 yrs ‘ALARMS’
yrs
symptoms Mx
Proceed Send to Anorexia Intra-sphincteric injection of botulinum
to Rx endoscop Loss of weight toxin
Unless y Anaemia Heller cardiomyotomy
ALARMS 24hr pH Recent onset of Balloon dilatation
sympto monitorin progressive Sx Drug therapy has a role but is limited by
ms g Masses + its side-effects
malaena
Swallowing
difficulty
Mx
GORD = symptoms of oesophagitis secondary to reflux
GORD not Ix by endoscopy Rx via dyspepsia guidelines
Endoscopically proven oesophagitis
Full dose PPI 1-2 months Response? Y low dose Rx as required; N Double
dose for 1 month
Endoscopically negative
Full dose PPI for 1 month Response? Y low dose Rx as required; N H2RA e.g.
Ranitidine
Surgical Nissen fundoplication- mobile gastric fundus + wrap around LOS + close any
diaphragmatic hernia
Complications Barrett’s oesophagus: squamous columnar epithelium, pre-malignant
lesion
