26 | Nursing in Practice | Summer 2023
CLINICAL
Gastro-oesophageal reflux
disease ( GORD ) in adults
The latest clinical guidance in general practice and community nursing nursingin practicelearning . co . uk
1.5 CPD HOURS
Key points
• GORD is a chronic condition involving a complex of symptoms .
• Risk factors include stress , smoking and alcohol , trigger foods ( coffee , chocolate , fatty foods ), obesity , pregnancy , family history , hiatus hernia and the side-effects of some drugs including NSAIDs and antihypertensives .
• Patients who are over 55 and have weight loss combined with upper abdominal pain , reflux or dyspepsia should have an endoscopy within two weeks .
• Treatment for H . pylori and lifestyle changes will often be effective , but refractory symptoms despite optimal treatment should prompt retesting for Helicobacter and consideration of referral .
• Long-term use of PPIs can cause problems , and deprescribing should be considered where appropriate .
Gastro-oesophageal reflux disease ( GORD ) is a complex of symptoms ; NICE guidelines , on which much of this module is based , include it in the broader category of dyspepsia . 1 NICE defines dyspepsia as ‘ a complex of upper gastrointestinal tract symptoms typically present for four or more weeks , including upper abdominal pain or discomfort , heartburn , acid reflux , nausea and / or vomiting ’. It is common , experienced by around 40 % of adults each year . 2 GORD describes a chronic condition whereby stomach contents reflux into the oesophagus , causing a feeling often described as heartburn .
For those who have clinical GORD and go on to require an endoscopy , around 40 % will have findings such as erosions or gastritis ; the remainder are said to have ‘ endoscopy-negative reflux disease ’, or ‘ functional / non-ulcer dyspepsia ’. As always , the lack of a positive test doesn ’ t make the symptoms any less real to the patient so it is important to communicate this sensitively .
For the sake of brevity , the term dyspepsia will be used in this article to cover the broad symptom complex .
It is said that 80 % of any diagnosis is in the history 3 and GORD is no different . You are looking to do several things : confirm the diagnosis ; rule out other benign conditions , rule out alarm features that might make you consider an urgent referral via the two-week wait cancer pathway ; and find out if there are any obvious causes that might be amenable to change .
Box 1 Possible alternative diagnoses for symptoms of GORD 1
• Gallbladder disease
• Pancreatic disease ( chronic pancreatitis or pancreatic cancer )
• Ischaemic heart disease
• Gastroenteritis
• Coeliac disease
• Inflammatory bowel disease
• Irritable bowel syndrome
• Small intestinal bowel overgrowth
• Abdominal aortic aneurysm ( rare )
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