Genetic factors

Figure A

Figure B

Figure C

References

Factors associated with the development of gastro-oesophageal reflux disease (brackets indicate inconsistent or preliminary evidence)

Genetic factors

Positive family history

Reflux disease or symptoms in a relative

Personal factors

Age

Pregnancy

Obesity

Behavioural factors

Smoking

(Alcohol consumption)

(Coffee consumption)

Dietary factors

Large volume meals

Rich energy dense meals

(High fat meals)

(Rapid intake of meals)

(High salt intake)

Low dietary fibre

Environmental

Helicobacter pylori—may inhibit or exacerbate GORD depending on effects on gastric acid secretion (little overall effect)

Drug therapy

Drugs that relax the lower oesophageal sphincter:

Calcium channel blockers

Anticholinergic drugs

Aminophylline

Nitrates

Drugs that slow gastrointestinal transit:

Opiates

Steroids

Non-steroidal anti-inflammatory drugs

(Oral contraceptives or hormone replacement therapy may be protective)

Fig A (Top) Incidence of Barrett’s columnar lined oesophagus in Tayside 1980-95. Adapted from Todd et al.w27 (Bottom) Incidence of oesophageal adenocarcinoma of the cardia and oesophagus, 1975-2001. Data from National Cancer Institute’s surveillance epidemiology and end results programme. Adapted from Pohl and Welchw28


 

Fig B Management flow chart for patients with reflux symptoms after endoscopy. Adapted from National Institute for Health and Clinical Excellence guideline 17 (www.nice.org.uk)

Fig C Investigation of chronic cough using a nasogastric catheter with inbuilt pH (acid), impedance (fluid movement), and manometry (pressure) sensors. These measurements clearly distinguish between reflux events that trigger coughing (left) and coughing that triggers reflux (right). Adapted from Sifrim et alw37


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