Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Hernias
- Dysphagia: gastro-oesophageal reflux disease (GORD)
- Dysphagia: oesophageal neoplasia
- Dysphagia: oesophageal dysmotility syndromes
- Gastric disease: peptic ulcer disease (PUD)
- Gastric disease: gastric neoplasia
- Hepatobiliary disease: jaundice
- Hepatobiliary disease: gallstones and biliary colic
- Hepatobiliary disease: pancreatic cancer
- Hepatobiliary disease: liver tumours
- The spleen
- Inflammatory bowel disease: Crohn's disease
- Inflammatory bowel disease: ulcerative colitis
- Inflammatory bowel disease: infective colitis
- Inflammatory bowel disease: non-infective colitis
- Colorectal disease: colorectal cancer
- Colorectal disease: colonic diverticular disease
- Perianal: haemorrhoids
- Perianal: anorectal abscesses and fistula in ano
- Perianal: pilonidal sinus and hidradenitis suppurativa
- Perianal: anal fissure
- Chronic limb ischaemia
- Abdominal aortic aneurysms
- Diabetic foot
- Carotid disease
- Raynaud's syndrome
- Varicose veins
- General aspects of breast disease
- Benign breast disease
- Breast cancer
- The thyroid gland
- Parathyroid
- Adrenal pathology
- Multiple endocrine neoplasia (MEN)
- Obstructive urological symptoms
- Testicular lumps and swellings
- Haematuria
- Brain tumours
- Hydrocephalus
- Spinal cord injury
- Superficial swellings and skin lesions
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Dysphagia: gastro-oesophageal reflux disease (GORD)
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Hernias
- Dysphagia: gastro-oesophageal reflux disease (GORD)
- Dysphagia: oesophageal neoplasia
- Dysphagia: oesophageal dysmotility syndromes
- Gastric disease: peptic ulcer disease (PUD)
- Gastric disease: gastric neoplasia
- Hepatobiliary disease: jaundice
- Hepatobiliary disease: gallstones and biliary colic
- Hepatobiliary disease: pancreatic cancer
- Hepatobiliary disease: liver tumours
- The spleen
- Inflammatory bowel disease: Crohn's disease
- Inflammatory bowel disease: ulcerative colitis
- Inflammatory bowel disease: infective colitis
- Inflammatory bowel disease: non-infective colitis
- Colorectal disease: colorectal cancer
- Colorectal disease: colonic diverticular disease
- Perianal: haemorrhoids
- Perianal: anorectal abscesses and fistula in ano
- Perianal: pilonidal sinus and hidradenitis suppurativa
- Perianal: anal fissure
- Chronic limb ischaemia
- Abdominal aortic aneurysms
- Diabetic foot
- Carotid disease
- Raynaud's syndrome
- Varicose veins
- General aspects of breast disease
- Benign breast disease
- Breast cancer
- The thyroid gland
- Parathyroid
- Adrenal pathology
- Multiple endocrine neoplasia (MEN)
- Obstructive urological symptoms
- Testicular lumps and swellings
- Haematuria
- Brain tumours
- Hydrocephalus
- Spinal cord injury
- Superficial swellings and skin lesions
- Section 4 Surgical oncology
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Definition
Reflux of gastro-duodenal contents into the oesophagus, causing symptoms that are sufficient to interfere with quality of life.
Incidence
20 to 25% of population have symptoms of GORD, oesophagitis is detected in 25 to 40% of gastroscopies performed on symptomatic patients. It is thought to be predisposed to by obesity, smoking and alcohol. Dietary factors such as excess fat, caffeine and citrus fruits; drugs such as atropine, calcium channel blockers and anti-histamines, various hormones and prostaglandins have also been described.
Aetiology and pathophysiology
Incompetence of lower oesophageal sphincter (LOS) due to predisposing factors or distortion of the acute angle of His as in hiatal hernia as well as absence of adequate length of intra-abdominal segment of oesophagus (< 2cm), destroyed mucosal rosette and deficient diaphragmatic crural mechanism. Finally, diminished oesophageal clearance by peristalsis and lowered mucosal resistance, normally maintained by its histological and biochemical properties; all these factors lead to reflux of gastric secretions into lower oesophagus exposing the mucosa to harmful gastric acid.
Natural history
90% asymptomatic. 10% of asymptomatic individuals develop complications such as reflux oesophagitis, ulceration and peri-oesophagitis; strictures and webs (Shatski's ring), which if severe can cause intermittent total obstruction (Steakhouse syndrome); columnar metaplasia (Barrett's oesophagus), where 10% of these progress to dysplasia which is precancerous.
Symptoms
Heartburn, regurgitation, water brash and dysphagia. Symptoms are aggravated with posture and are greater at night. Severity can be assessed by DeMeester scoring system which grades each of heartburn, regurgitation and dysphagia 0–3 according to severity. Clinical examination is usually performed to exclude other pathologies.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 360 - 364Publisher: Cambridge University PressPrint publication year: 2009