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

FRCS Exam - Anatomy and physiology of the oesophagus, providing a solid foundation for understanding its function and the diseases that affect it.

The oesophagus is much more than just a "food pipe"—its intricate structure and coordinated physiology are vital for swallowing, preventing reflux, and maintaining homeostasis. By the end of this episode, you’ll have a clear understanding of its layers, sphincters, blood supply, lymphatic drainage, and the essential role of the vagus nerve.

Barrett’s Oesophagus – an important topic, particularly for those preparing for their FRCS exams I’m your host, Major Munish Chauhan, and I am a General Surgery Registrar in the British Army and Oxford deanery. I am also a Senior Research Fellow at the Centre for Army Leadership

Barrett's oesophagus is a precancerous condition where the lining of the lower oesophagus changes, primarily due to long-term gastro-oesophageal reflux disease (GORD).

This change, called intestinal metaplasia, increases the risk of developing oesophageal adenocarcinoma. Diagnosis involves endoscopy and biopsies, with severity graded by dysplasia. Treatment options range from medication and endoscopic therapies (such as radiofrequency ablation) to surgery (esophagectomy), depending on the stage and severity of the condition. Regular surveillance is crucial for early detection and management, improving prognosis and reducing mortality. Risk factors include male gender, age, obesity, and smoking.