MRCS / FRCS Exam - Gastro-Oesophageal Reflux Disease, or GORD, a condition that’s not only a frequent topic in the FRCS exam but also a significant clinical issue affecting millions worldwide. We’ll explore the key aspects of GORD, from understanding its underlying mechanisms and recognising its varied presentations to diagnosing it accurately and managing it effectively.

Gastro-Oesophageal Reflux Disease (GORD): Key Information

• What is it? GORD is a condition where stomach acid frequently flows back up into the esophagus (the tube connecting the mouth to the stomach). This backflow (reflux) irritates the lining of the esophagus.

• The Lower Esophageal Sphincter (LES): The LES is a ring of muscle at the bottom of the esophagus that acts like a valve. It opens to allow food and drink into the stomach and closes to prevent stomach acid from refluxing. In GORD, the LES doesn't function properly – it may be weak or relax at inappropriate times.

• Causes of LES Dysfunction:

  • Hiatal Hernia: Part of the stomach pushes up through the diaphragm and into the chest cavity, weakening the LES.
  • Obesity: Increased abdominal pressure can contribute to reflux.
  • Pregnancy: Hormonal changes and increased abdominal pressure can affect the LES.
  • Certain Medications: Some medications can relax the LES.
  • Lifestyle Factors: Smoking, alcohol, and a high-fat diet can worsen symptoms.

• Common Symptoms:

  • Heartburn: A burning sensation in the chest.
  • Regurgitation: Backflow of stomach contents into the mouth.
  • Chest Pain: Can sometimes mimic a heart attack.

• Less Common/Atypical Symptoms:

  • Chronic Cough
  • Hoarseness
  • Sore Throat
  • Asthma-like Symptoms
  • Laryngitis