GORD: Investigating and managing an increasingly prevalent condition

• Published in: Irish Medical Times 2019-11, p.4-6
• Main Authors: O'Connell, Jim, Farrell, Richard
• Format: Article
• Language: English
• Subjects: Acids; Alcohol; Anemia; Asymptomatic; Caffeine; Cancer; Carcinogens; Disease; Dysphagia; Endoscopy; Gastroenterology; Gastroesophageal reflux; Hernias; Histamine; Larynx; Lifestyles; Protons; Quality of life
• ISSN: 0047-147X

[...]patients aged 50 years or older or those with alarm symptoms or red flags including unintentional weight loss, anaemia/signs of GI bleeding, dysphagia, odynophagia, family history in first-degree relative of upper GI malignancy, persistent vomiting, and abnormal imaging suggestive of organic disease should be referred for an urgent endoscopy. [...]it often presents with dyspeptic symptoms. In patients with dyspepsia or GORD who have had H. pylori ruled out and are non-responsive to lifestyle modification, it is reasonable to start a trial of acid suppression therapy - a four-week treatment period with high-dose PPI therapy followed by a stepdown to the lowest dose that keeps symptoms under control. Some patients whose symptoms persist despite an adequate trial of high-dose PPI therapy may benefit from the addition of antacids like Gaviscon, fast-acting histamine antagonists like famotidine and prokinetic agents like Motilium to increase oesopha-geal peristalsis and gastric clearance of acid.