Gastro-oesophageal reflux

Gastro-oesophageal reflux disease (GORD) is defined as symptoms or mucosal damage produced by abnormal reflux of gastric content into the oesophagus (1)

There is a poor correlation between pathological and symptomatic severity of GORD. In other words, the relationship between reflux symptoms, endoscopic findings, and exposure of the oesophagus to acid is not straightforward (2)

Pressure and acid manometry studies show that gastro- oesophageal reflux occurs in normal situations, such as belching. It is quite difficult in some situations to decide when it is abnormal.

This condition may be investigated by endoscopy, barium swallow or by 24 hour pH monitoring.

It may cause reflux oesophagitis; thus, the oesophagitis occurs with the same aetiological factors as reflux, but occurs when the problem is severe or chronic.

Antireflux lifestyle (AL) interventions and symptoms of GORD

• study evidence (3) found that adherence to AL interventions, even among regular users of PPIs and/or H2RAs linked to decreased risk of symptoms (HR 0.50; 95% CI, 0.42-0.59 for those with 5 vs no adherence to AL factors) and may prevent approximately 40% of symptoms that occur at least weekly
  • in this study the the five antireflux lifestyle factors were normal weight (BMI >=18.5 and <25.0); never smoking; moderate-to-vigorous physical activity for at least 30 minutes daily; no more than 2 cups of coffee, tea, or soda daily; and a prudent diet (top 40% of dietary pattern score)

Reference:

• (1) Kenneth R., et al.Updated guidelines for the diagnosis and treatment of Gastroesophageal reflux disease .American journal of gastroenterology 2005;100:190-200
• (2) Mark Fox And Ian Forgacs. Gastro-Oesophageal Reflux Disease:Clinical Review.BMJ 2006; 332: 88 - 93
• (3) Mehta RS et al. Association of Diet and Lifestyle With the Risk of Gastroesophageal Reflux Disease Symptoms in US Women. JAMA Intern Med. Published online January 4, 2021. doi:10.1001/jamainternmed.2020.7238