Gastro-Oesophageal Reflux Disease (GORD) and Dyspepsia
Description General Measures Medicine Treatment Referral ICD-10 code: K21.0/K21.9/K22.7/K30 DESCRIPTION GORD is a disorder which develops as a consequence of the reflux of gastric and duodenal contents into the oesophagus. It is usually characterised by heartburn and regurgitation. Dyspepsia is the sensation of epigastric discomfort. It may be a feature of potentially severe diseases such as pept
ICD-10 code: K21.0/K21.9/K22.7/K30
DESCRIPTION
GORD is a disorder which develops as a consequence of the reflux of gastric and duodenal contents into the oesophagus. It is usually characterised by heartburn and regurgitation.
Dyspepsia is the sensation of epigastric discomfort. It may be a feature of potentially severe diseases such as peptic ulcer disease or gastric cancer. It may also be a symptom of H. pylori gastritis or NSAID gastritis.
Intermittent indigestion, heartburn or dyspepsia may be associated with:
- use of NSAIDs e.g. aspirin, ibuprofen, pain powders.
- spicy food, alcohol, carbonated drinks.
- smoking.
Complications that may develop in severe GORD are strictures, ulceration, Barrett’s oesophagus and adenocarcinoma of the oesophagus. Two thirds of patients have a normal endoscopy which is termed non-erosive reflux disease (NERD) or non-ulcer dyspepsia (NUD) depending on the predominant symptom.
GENERAL MEASURES
- Stop smoking.
- Limit alcohol intake.
- Eat small frequent meals.
- Avoid late night meals.
- Avoid fatty meals.
- Avoid carbonated beverages.
- Lose weight if overweight.
- Sleep with upper body elevated.
- Sleep on the left side.
- Avoid excessive exercise.
- Stop the use of potential ulcerogenic medicines, e.g. NSAIDs.
- If pale, check haemoglobin, and refer if anaemic.
All patients with alarm symptoms, i.e. weight loss, haematemesis or melaena, dysphagia, or anaemia, chest pain, or patients older than 60 years of age with new onset dyspepsia should have an endoscopy.
MEDICINE TREATMENT
New onset symptoms
Empiric therapy with a proton pump inhibitor (PPI) may be initiated in the absence of alarm symptoms (see referral section). Improvement of symptoms confirms acid-related disease.
- PPI, e.g.:
- Pantoprazole, oral, 40 mg daily for 4 weeks.
- Ensure adherence to promote healing.
Recurrence of symptoms
After endoscopic confirmation of disease:
- PPI, e.g.:
- Pantoprazole, oral, 40 mg daily.
- Decrease dose of PPI after 4 weeks, e.g: pantoprazole, oral, 20 mg daily except for severe endoscopic GORD (Grade C or D LA classification) and Barret’s oesophagus or specific advice from the endoscopist.
Barrett’s oesophagus
ICD-10 code: K22.7
- Restart PPI, e.g.:
- Pantoprazole, oral, 40 mg daily.
Note:
- Patients with Barrett’s oesophagus usually need maintenance PPI therapy.
- There is no convincing evidence that long-term treatment of Barrett’s oesophagus with PPIs reduces dysplasia or progression to malignancy.
REFERRAL
Discuss the following with a specialist:
- young patients who are PPI dependent and will require life-long therapy;Patients unable to take PPIs;
- patients unable to take PPIs;Patients with large hiatus hernias and "volume reflux";
- patients requiring high doses of PPIs;Alarm features that may be suggestive of gastrointesinal malignancy:
- patients with large hiatus hernias and “volume reflux”;
- a rolling hiatus hernia with obstructive symptoms – requires surgery
- All patients with alarm symptoms:
- Evidence of gastrointestinal bleeding,
- Iron deficiency anaemia,
- Anorexia,
- Unexplained weight loss,
- Dysphagia,
- Odynophagia (painful swallowing),
- Persistent vomiting, haematemesis, and/or melaena
- Gastrointestinal cancer in a first-degree relative.
Click here for the NEMLC Recommendations for medicine amendments (2020-4 review cycle).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level, 2020-4_Version 1_July 2024
Chapter 1: Alimentary tract; 1.1 Gastrointestinal Disorders; 1.1.3 Gastro-Oesophageal Reflux Disease (GORD) and Dyspepsia