Learning > The art of GORD treatment

GORD: progress in clinical understanding. Eamonn M M Quigley MD Professor of medicine and Human Physiology and Head of the Medical School National University of Ireland, Cork

Progress through the module by clicking on the navigation bar below

 

Gastro-oesophageal reflux disease (GORD) has recently emerged as one of the most common gastrointestinal disorders seen by the primary care physician and gastroenterologist alike. While improved recognition of the many manifestations and presentations of GORD may, in part, explain this phenomenon, there is also clear evidence for a true rise in prevalence and incidence, which some have referred to as the "GORD epidemic." What is new in GORD? One of the most fundamental shifts in our understanding of GORD has been the recognition of non-erosive, or negative-endoscopy, reflux disease (NERD); indeed it is now appreciated that, in the community, NERD constitutes at least 60 % of all GORD. NERD is not a trivial issue; these patients have the same symptoms and experience a similar degree of impairment of quality of life as erosive GORD. Acid exposure, in the traditional sense, may not explain symptoms for all NERD patients; acid sensitivity, psychological factors and non-acid components may all contribute. Therapy has its challenges in NERD; perhaps reflecting a significant overlap with functional dyspepsia, the response to proton pump inhibitors (PPI's) may not be as good as in erosive disease. For the majority who do well on PPI's an on-demand approach may well be appropriate and, ultimately, more cost-effective. A PPI with a rapid onset of action may be especially appropriate in this respect. Barrett's oesophagus remains a topic of great concern and controversy. This consequence of GORD is certainly common; the precise risk for change into adenocarcinoma still remains to be clarified. Barrett's also offers a unique opportunity for advancing our understanding of the biology of carcinogenesis. The basic pathophysiology of GORD continues to attract much interest and investigation. The lower oesophageal sphincter remains the focus of investigation, emphasis having shifted in recent years from sustained hypotension to the transient lower oesophageal relaxation (TLOSR). The physiology and pharmacology of the TLOSR are now topics of intense interest and may produce novel therapies for GORD. The hiatus hernia has also re-emerged and its role in the pathophysiology of GORD has been greatly clarified. Non-acid factors are also being reassessed using novel technologies. For the patient with GORD the future looks bright; we understand many aspects of his/her disease much more thoroughly and, of even greater importance for the patient, have effective medical and surgical therapies to offer.   View the Keyslides: Text and slides Broadband video

 

Need help using Gastro-Pro? All contents copyright© GastroHOPES Ltd unless otherwise noted. GastroHOPES Ltd and Gastro-Pro do not sell products or services. The contents of this website are intended for access by healthcare professionals only. This website is not intended for patient education. Minors and those of a sensitive nature might find some sounds and images on this site distressing. Visitors are invited to read our privacy policy and full legal notice. Last updated 30.10.03