Feature Article

Gastro-oesophageal reflux disease: mechanisms and management

Feature Article

Gastro-oesophageal reflux disease: mechanisms and management

Christopher S Pokorny

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Abstract

Gastro-oesophageal reflux disease is common and its symptoms often have a significant impact on an individual’s quality of life. Management generally involves attention to lifestyle factors and individualised medical treatment. Surgery may be required for a small number of cases.

Key Points

  • Gastro-oesophageal reflux disease (GORD) is common and tends to run a chronic and relapsing course.
  • The most common symptoms of GORD are heartburn and regurgitation. Atypical presentations include a chronic cough, hoarseness, sore throat, asthma and atypical chest pain.
  • Helicobacter pylori does not cause GORD.
  • Treatment of GORD, including endoscopy-negative reflux, involves attention to lifestyle modification and acid suppressant therapy.
  • Therapy is best commenced with a proton pump inhibitor and a step-down approach should then be adopted. In the long term, maintenance treatment can be given on either a continuous or on-demand basis.
  • Antireflux surgery should be considered for patients who have failed medical therapy and patients who have regurgitation as a predominant symptom. It should also be considered as an alternative to lifelong medical therapy in young patients with severe oesophagitis.