Gastro-oesophageal reflux disease (GORD)
Gastro-oesophageal reflux is the presence of stomach contents within the oesophagus (gullet). A degree of gastro-oesophageal reflux is a normal phenomenon but the protective mechanisms of the oesophagus generally ensure episodes are short lived. However, the lining of the oesophagus is more easily damaged than that of the stomach and in addition is very sensitive therefore frequent and excessive exposure to gastric juice may lead to irritation, inflammation and symptoms of heartburn.
There is clearly a spectrum of severity of gastro-oesophageal reflux, at one end of the spectrum most people have experienced a degree of heart burn after over eating. It is estimated that one third of the adult population will experience gastro-oesophageal reflux symptoms every few days. In approximately 10% of adults symptoms will be severe enough to require medications and in a significant proportion symptoms will be severe or frequent enough to affect quality of life. In only a very small minority of patients will complications arise which may lead to serious medical problems i.e. stricture formation or ulceration. Treatment is, therefore, targeted according to a patient’s symptoms.
There are a range of therapeutic options available for the treatment of GORD and it is important to match these to the severity of symptoms and a patient’s individual life style. Treatment would usually begin with the least invasive procedures consistent with control of symptoms and escalate to the more invasive options i.e.:
- Life style modifications such as avoiding food that triggers reflux, losing weight, modification of medications likely to precipitate symptoms.
If these measures are unsucessful
- Intermittent treatment with drugs likely to reduce acid reflux
If frequent recurrences or symptoms persist
- Continuous medical treatment and increased doses of drugs
If symptoms are not controlled
- Endoscopic or surgical fundoplication.
In addition diagnostic endoscopy and pH and manometry may be required to determine optimal treatment for patients with GORD.
Other Swallowing Disorders
Difficulty swallowing may be associated with many disease processes in general these commonly relate to :
- Narrowing of the oesophagus or gullet
- Spasm of the muscle of the oesophagus
- External pressure on the oesophagus from an adjacent organ.
Symptoms of swallowing difficulties should be taken seriously and investigated with a diagnostic endoscopy to establish the diagnosis. Thereafter further treatment will be dependent on the underlying disease process
