Editing GORD (section)

== '''Symptoms''' - oesophageal, extra-oesophageal and complications ==

* '''Typical''' symptoms: heartburn,     regurgitation, water brash
** Volume reflux which is worse      lying down and responds to PPIs
** Heartburn - epigastric or      retrosternal caustic or stinging sensation, which does not typically      radiate to the back, and is not described as a pressure sensation
** Water brash - sour taste      described as either acid or bile
** Regurgitation - generally of      digested food. Regurgitation of undigested food suggests oesophageal      diverticulum or achalasia.
* Differentiate between     pathological and physiological:
** Physiological - short-lived,      asymptomatic, post-prandial, not during sleep
** Pathological - often occurs      nocturnally. A/w symptoms or mucosal injury
* Atypical symptoms: consider     GORD in dysphagia, chest pain,      globus, odynophagia, cough/hoarseness/wheeze, sometimes nausea
** Dysphagia occurs with      reflux-associated inflammatory processes of the oesophageal wall      (Schatzki ring, diffuse distal oesophageal inflammation, peptic stricture      - pathognomic for long-standing reflux). Can functionally shorten the      oesophagus, making operations harder.
* Extra-oesophageal symptoms:
** Laryngeal -      hoarseness/dysphonia, throat clearing, throat pain, globus, choking,      post-nasal drip, laryngeal and tracheal stenosis, laryngospasm, contact      ulcers.
** Pulmonary - cough, shortness      of breath, wheezing, pulmonary disease (asthma)
*** Patients with asthma and       GORD can see an improvement rate of 90% of children and 70% of adults in       their asthma symptoms after anti-reflux surgery
*** Idiopathic pulmonary       fibrosis is possibly caused by GORD in some cases (as many as 94% of       patients with IPF have been shown to have GORD)
** Occur due to
*** Proximal oesophageal reflux       and micro-aspiration of gastroduodenal contents causing direct caustic       injury to the larynx and lower respiratory tract
*** Distal oesophageal acid       exposure triggering a vagal cough/bronchospasm reflux, due to common       vagal innervation of trachea and oesophagus
** Variable response to PPI,      even if these symptoms are due to GORD
** Need to thoroughly evaluate      these patients for other causes (?ENT/resp referral). If no other cause      found, Sabiston says anti-reflux surgery has a 70% success rate.
* Alarm symptoms     (complications): dysphagia, early satiety, haematemesis, melaena,     vomiting, weight loss