Epidemiology of GORD

Gastro-oesophageal Reflux Disease - considered a common disease in the West.

The study of the epidemiology of GORD is restricted by the lack of consensus over the basic definition of the disease. To review the global epidemiology of GORD is currently problematic as there is no internationally applied definition.

An approximate prevalence of 10–20% was identified for GORD, defined by at least weekly heartburn and/or acid regurgitation in the Western world while in Asia this was lower, at less than 5%.

The disease is more common in the Western world than in Asia. This appears to be related to the high fat diet typically consumed by Westerners.

There is little difference between the prevalence of GORD (as defined by heartburn and/or acid regurgitation at least weekly) in North America (19.8–20%, n = 2) and in Europe (9.8–18%, n = 3). There is some indication that the prevalence may be lower in Southern than Northern Europe. There is a definite trend, however, towards a lower prevalence of GORD in Asia (2.5–4.8%, n = 2).

The incidence in the Western world was approximately 5 per 1000 person year. No data available from Asia. The low rate of incidence relative to prevalence reflects its chronicity.

Studies have shown a positive relationship between obesity and gastro-oesophageal reflux symptoms. This may explain the high prevalence of GORD in the USA compared with the rest of the world.

Contributed by John Lee

Sources:

http://gut.bmj.com/cgi/content/full/54/5/710
Dent J., El-Serag H.B., Wallander M-A. & Johansson S. 2005,
‘Epidemiology of gastro-oesophageal reflux disease: a systematic review’, Gut 2005, 54:710-717.

http://www.emedicine.com/radio/topic300.htm - Gastroesophageal Reflux

Signs & Symptoms

Heart Burn – Signs and Symptoms

• A burning feeling that starts in the chest, just behind the breastbone (the sternum). It usually occurs just after eating and can last a few minutes to several hours.
• Chest pain, especially after bending over, lying down or eating, more frequent or worse at night
• A burning feeling in the throat
• Sour or bitter taste in the throat/mouth
• Feeling of food “sticking” in the middle of the chest or throat

Gastro esophageal reflux disease

• Heart burn
• Difficulty swallowing
• Belching (burping)
• Chronic coughing
• Hoarseness
• Loss of voice for no apparent reason
• Wheezing or other asthma-like symptoms
• In babies, spitting up or throwing up almost after every meal.

Symptoms of heartburn are often mistaken for signs of a heart attack. Pain from a heart condition is usually made worse by physical activity, but heartburn is not usually caused by physical activity. However, if you think you are having a heart attack, or you're not sure, it's important that you go to the emergency room immediately.

Possible signs of heartburn that could be mistaken for a heart attack include:

• A sharp, burning sensation just below the breastbone or ribs.
• Pain generally does not radiate to the shoulders, neck, or arms, but it can.
• Pain usually comes after meals, when lying on the back, when exercising or when experiencing anxiety.
• Symptoms usually respond quickly to antacids.
• Rarely accompanied by a cold sweat.

Possible signs of angina (severe pain in chest area) or heart attack:

• A feeling of fullness, tightness, or dull pressure or pain generally in the center of the chest.
• The feeling of a belt being tightened around your chest.
• Sudden chest pain or pressure that worsens.
• Dizziness.
• Pain may spread to the shoulders, neck, jaw or arms.
• Pain often responds quickly to nitroglycerin.
• Shortness of breath.
• Often accompanied by a cold sweat.

(Posted by: Vivian)

Gastro-esophageal reflux disease

Gastro-oesophageal Reflux Disease(GORD/GERD)
prepared by: Ji Keon Looi
for pcl 9 Empty Nest

Introduction
•GOR is a normal physiologic event. However excessive exposure of the esophagus to stomach contents can lead to symptoms of complications (GORD)

Definition
•symptoms or mucosal damage (oesophagitis) resulting from the exposure of the distal oesophagus to refluxed gastric contents
•NB symptoms =/= mucosal damage

Pathophysiology
•Failure of the antireflux barrier
–Lower esophageal sphincter (LoS)
–Crural diaphragm (ext sphincter)
•Postprandial à Gastric distention àTransient relaxations of the LoS à Reflux episodes
•Decreased pressure of LoS (caffeine, nicotine, alcohol, fatty foods, chocolate)
Other factors
•Delayed gastric emptying
•Impaired oesophageal clearance
•Decreased salivary production

A myraid of causes
•Hiatus hernia (discussed later)
•Oesophagitis
–Acute inflammatory process in esophagus
•H. pylori
–Distal (antral) gastritis increases the production of gastric acid

Hiatus Hernia
•Part of the stomach protrudes through the oesophageal hiatus in the diaphragm
Hiatus hernia
•Most cases asymptomatic
•Impairs LoS function, increases likelihood of reflux
•large volumes of gastric contents pass unimpeded into the hiatal sac
•increased abdominal pressure on straining and even deep breathing may be enough to force refluxate into the oesophagus

Take home message
•The structure and function of the gastro-oesophageal junction is of key importance in reflux disease—as the condition becomes more severe, the risk of reflux during transient relaxations of the lower oesophageal sphincter rises and the volume of refluxate increases

•Fox M, Forgacs Ian, GORD, ; BMJ 2006

Labelling our posts

To avoid confusion to differentiate between pcl materials from MED2031 and MED2042 since we start with Week 1 again this semester, I would suggest that we label our work according to the title of the week.

I have entered all the pcl titles under this post and they should appear when you type in the first letter into the label slot. Alternatively, click on Show all to display all the pcl title.

Thanks.

Ji Keon