Clinical Review

Gastro-oesophageal reflux disease

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7533.88 (Published 12 January 2006) Cite this as: BMJ 2006;332:88
  1. Mark Fox, specialist registrar gastroenterology (ian.forgacs@kcl.ac.uk)1,
  2. Ian Forgacs, consultant gastroenterologist1
  1. 1 King's College Hospital, Denmark Hill, London SE5 9RS
  1. Correspondence to: I Forgacs
  • Accepted 29 November 2005

Introduction

Gastro-oesophageal reflux disease (GORD) is present when the passage of gastric contents into the oesophagus causes symptoms or damages the mucosa. Potent suppression of gastric acid secretion with proton pump inhibitors is a highly effective and safe treatment for many patients with symptoms associated with reflux. It would be wrong to conclude, however, that proton pump inhibitors had solved the problem of GORD. The relation between reflux symptoms, endoscopic findings, and exposure of the oesophagus to acid is not straightforward. Some patients with a convincing history of heartburn fail to respond well to proton pump inhibitors. Although symptoms may be severe, at endoscopy the oesophagus is often found to be normal, and pH studies may not disclose the cause of symptoms that persist despite treatment for acid suppression.

Apart from typical symptoms of reflux many other problems have been linked to GORD, including dysphagia, hoarseness, non-cardiac chest pain, and chronic cough. It can, however, be difficult to identify those patients who will benefit from antireflux treatment. Most serious is the increased risk of oesophageal adenocarcinoma in patients with reflux symptoms, in particular those with Barrett's columnar lined oesophagus. Since the 1980s the incidence of oesophageal carcinoma has increased sixfold, more rapidly than any other common cancer.

Summary points

Gastro-oesophageal reflux disease (GORD) is common, causes a variety of symptoms, and is associated with important diseases, including asthma and oesophageal adenocarcinoma

Genetic influences and lifestyle factors such as smoking, obesity, and dietary behaviour may be involved in the development of GORD

The structure and function of the gastro-oesophageal junction is of key importance in reflux disease—as the condition becomes more severe, the risk of reflux during transient relaxations of the lower oesophageal sphincter rises and the volume of refluxate increases

Routine endoscopy is not required for reflux symptoms in the absence of features …

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