Gastro-oesophageal reflux disease (GORD)

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Last updated: August 24, 2026Bookmark

Gastro-oesophageal reflux disease (GORD) is the reflux of stomach acid and bile into the oesophagus due to excessive relaxation of the lower oesophageal sphincter. It is the most common cause of epigastric pain.

It peaks between the ages of 60 and 60, and affects men more than women.

Risk factors
- Obesity
- Smoking
- Alcohl
- Coffe
- Drugs that relax the lower oesophageal sphincter
  - Tricyclic antidepressants
  - Anticholinergics
  - Nitrates
  - Calcium channel blockers
  - Aspirin
- Fatty meals: Fat delays gastric emptying
- Hiatus hernia: This promotes lower oesophageal sphincter dysfunction
- Pregnancy
- Wearing tight clothing
- Surgery for achalasia
Pathophysiology
- Lower oesophageal sphincter abnormalities and transient relxation of the lower oesophageal sphincter → gastric acid, bile and pancreatic enzymes reflux into the oesophagus → mucosal injury
Signs and symptoms
- Substernal or Epigastric pain
  - Radiates along the track of the esophagus
  - Described as “burning” or “heart burn”
  - Worse when lying down
  - Aggravated by eating large amounts of food
- “Sore throat”
- Hoarseness due to irritation of the vocal coards
- Chronic cough
  - GORD is associated with asthma. The symptoms may be triggred by lying down
- Wheeing
- “Waterbrash”
  - Bad metallic taste in the mouth
- Poor dentition
- Vomiting
- Alarming symptoms (these change treatment)
  - Anaemia
  - Age > 45y
  - Loss of weight (uninended)
  - Anorexia (or early satiety)
  - Recently progressive sx
  - Melena/Hematemesis
  - Symptoms for > 6 months, odynophagia, or dysphagia
Differentials
- Oesophagitis due to infection
  - Candida
  - CMV
  - HSV
  - HIV
- Oesophagitis due to corrosives
  - NSAIDs
- Duodenal or gastric ulcers
Investigations
- Electrocardiography and cardiac enzymes if there is chest pain
- Oesophago-gastroduodenoscopy (OGD) for patients with alarming symptoms or > 45 years old
  - The Savary-Miller or Los Angeles grading systems may be used in endoscopy
- Barium swallow for dysphagia or to rule out hiatus hernia
- 24 pH monitoring is expensive and cumbersome test that is used to distinguish GORD from other causes if symptoms persist
Treatment
- Weight loss
- Avoid food or water at least three hours before lying at night
- Avoid acidic foods and other triggers such as chocolate, caffeine, nicotine, and fatty foods
- Sleep propped up or in the left lateral decubitus position
- Avoid drugs which affect oesophagela motility or damage the mucosa
- Proton pump inhibitors (PPIs)
- H2 receptor antagonists if PPIs are ineffective
- Surgery for persistent symptoms, Barret’s oesophagus, or younger patients
  - Fundoplication
    - Partial fundoplication (Toupet)
    - Total fundoplication (Nissen)
Complications
- Oesophagitis
- Strictures
- Barret’s oesophagus
- Oesophageal adenocarcinoma
- Chronic cough
- Asthma exacerbations
- Laryngoesophageal reflux disease
- Laryngitis
- Recurrent pneumonia
- Complications of surgery
  - Perforation of the stomach or oesophagus
  - Fullness
  - Dysphagia
  - Post-prandial discomfort
  - Adhesions which increase the risk of bowel strangulation
  - Continued dysphagia

Investigations for GORD

Category	NO alarming symptoms	Alarming symptoms present
< 45 years with clear GORD	Start medical treatment	OGD
Inconclusive GORD	24h pH test + manometry	OGD
All patients > 45	OGD	OGD
Persistent symptoms despite treatment	24h pH test + manometry	OGD

Reference Intervals ›

Biochemistry

ACTH	P: <80 ng/L
ALT	P: 5–35 U/L
Albumin	P: 35–50 g/L
Aldosterone	P: 100–500 pmol/L
Alk. phosphatase	P: 30–130 U/L
α-Amylase	P: 0–180 IU/dL
α-Fetoprotein	S: <10 kU/L
Angiotensin II	P: 5–35 pmol/L
ADH	P: 0.9–4.6 pmol/L
AST	P: 5–35 U/L
Bicarbonate	P: 24–30 mmol/L
Bilirubin	P: 3–17 μmol/L
BNP	P: <50 ng/L
CRP	P: <10 mg/L
Calcitonin	P: <0.1 mcg/L
Calcium (ionized)	P: 1.0–1.25 mmol/L
Calcium (total)	P: 2.12–2.60 mmol/L
Chloride	P: 95–105 mmol/L
Cholesterol	P: <5.0 mmol/L
VLDL	P: 0.128–0.645 mmol/L
LDL	P: <2.0 mmol/L
HDL	P: 0.9–1.93 mmol/L
Cortisol AM	P: 450–700 nmol/L
Cortisol Midnight	P: 80–280 nmol/L
CK ♂	P: 25–195 U/L
CK ♀	P: 25–170 U/L
Creatinine	P: 70–100 μmol/L
Ferritin	P: 12–200 mcg/L
Folate	S: 2.1 mcg/L
FSH	P: 2–8 U/L ♂; >25 menopause
GGT ♂	P: 11–51 U/L
GGT ♀	P: 7–33 U/L
Glucose (fasting)	P: 3.5–5.5 mmol/L
Growth hormone	P: <20 mu/L
HbA1C (DCCT)	B: 4–6%
HbA1C (IFCC)	B: 20–42 mmol/mol
Iron ♂	S: 14–31 μmol/L
Iron ♀	S: 11–30 μmol/L
Lactate (venous)	P: 0.6–2.4 mmol/L
Lactate (arterial)	P: 0.6–1.8 mmol/L
LDH	P: 70–250 U/L
LH	P: 3–16 U/L
Magnesium	P: 0.75–1.05 mmol/L
Osmolality	P: 278–305 mosmol/kg
PTH	P: 0.8–8.5 pmol/L
Potassium	P: 3.5–5.3 mmol/L
Prolactin ♂	P: <450 U/L
Prolactin ♀	P: <600 U/L
PSA	P: 0–4 mcg/mL
Protein (total)	P: 60–80 g/L
Red cell folate	B: 0.36–1.44 μmol/L
Renin (erect)	P: 2.8–4.5 pmol/mL/h
Renin (recumbent)	P: 1.1–2.7 pmol/mL/h
Sodium	P: 135–145 mmol/L
TBG	P: 7–17 mg/L
TSH	P: 0.5–4.2 mU/L
T4	P: 70–140 nmol/L
Free T4	P: 9–22 pmol/L
TIBC	S: 54–75 μmol/L
Triglycerides	P: 0.50–2.3 mmol/L
T3	P: 1.2–3.0 nmol/L
Troponin T	P: <0.1 mcg/L
Urate ♂	P: 210–480 μmol/L
Urate ♀	P: 150–390 μmol/L
Urea	P: 2.5–6.7 mmol/L
Vitamin B12	S: 0.13–0.68 nmol/L
Vitamin D	S: 50 nmol/L

Arterial Blood Gases

pH	7.35–7.45
PaCO₂	4.7–6.0 kPa
PaO₂	>10.6 kPa
Base excess	±2 mmol/L

Urine

Cortisol (free)	<280 nmol/24h
Hydroxyindole acetic acid	16–73 μmol/24h
Hydroxymethylmandelic acid	16–48 μmol/24h
Metanephrines	0.03–0.69 μmol/mmol cr.
Osmolality	350–1000 mosmol/kg
17-Oxogenic steroids ♂	28–30 μmol/24h
17-Oxogenic steroids ♀	21–66 μmol/24h
17-Oxosteroids ♂	17–76 μmol/24h
17-Oxosteroids ♀	14–59 μmol/24h
Phosphate (inorganic)	15–50 mmol/24h
Potassium	14–120 mmol/24h
Protein	<150 mg/24h
Protein/creatinine ratio	<3 mg/mmol
Sodium	100–250 mmol/24h

Haematology

WCC	4.0–11.0 ×10⁹/L
RBC ♂	4.5–6.5 ×10¹²/L
RBC ♀	3.9–5.6 ×10¹²/L
Hb ♂	130–180 g/L
Hb ♀	115–160 g/L
PCV ♂	0.4–0.54 L/L
PCV ♀	0.37–0.47 L/L
MCV	76–96 fL
MCH	27–32 pg
MCHC	300–360 g/L
RDW	11.6–14.6%
Neutrophils	2.0–7.5 ×10⁹/L (40–75%)
Lymphocytes	1.0–4.5 ×10⁹/L (20–45%)
Eosinophils	0.04–0.44 ×10⁹/L (1–6%)
Basophils	0–0.10 ×10⁹/L (0–1%)
Monocytes	0.2–0.8 ×10⁹/L (2–10%)
Platelets	150–400 ×10⁹/L
Reticulocytes	0.8–2.0% / 25–100 ×10⁹/L
Prothrombin time	10–14 s
APTT	35–45 s

Paediatric

Pulse Rate (bpm)
Neonate	140–160
Infant <1yr	120–140
1–5 years	110–130
5–12 years	80–120
>12 years	70–100
Respiratory Rate (tachypnoea)
0–2 months	≥60/min
2–12 months	≥50/min
1–5 years	≥40/min
>5 years	≥30/min
Blood Pressure (mmHg)
Term	65/45
1 year	75/50
4 years	85/60
8 years	95/65
10 years	100/70
Weight Formulas
3–12 months	(a + 9)/2 kg
1–6 years	2a + 8 kg
>6 years	(7a − 5)/2 kg
Haemoglobin (g/dL)
Term newborn	13–20
1 month	11–18
2 months	10–15
1–2 years	10–13
>2 years	11–14
MUAC (6 months–5 years)
Obese	>17.5 cm
Normal	13.5–17.4 cm
At risk	12.5–13.4 cm
Moderate malnutrition	11.5–12.4 cm
Severe malnutrition	<11.5 cm
Developmental Milestones
Social smile	1.5 months
Head control	4 months
Sits unsupported	7 months
Crawls	10 months
Stands unsupported	10–12 months
Walks	12–13 months
Talks	18 months
CSF WBC (/mm³)
Term newborn	0–25
>2 weeks	0–5

Calculator ›

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