Gastro-Oesophageal Reflux Disease (GORD)

•    Caused by lower oesophageal sphincter (LOS) incompetence

•    Symptoms: heartburn, acid regurgitation, chest discomfort, worse on lying/bending

•    Risk factors: obesity, smoking, alcohol, pregnancy, hiatus hernia

•    Diagnosis: clinical; consider OGD if red flags (dysphagia, anaemia, weight loss)

•    Treatment:

o    First-line: proton pump inhibitors (PPIs)

o    Lifestyle: weight loss, raise head of bed, avoid triggers (caffeine, alcohol)

Reflux Oesophagitis

•    Inflammation secondary to acid reflux

•    Graded endoscopically (Los Angeles classification: A–D)

•    May cause erosions, ulcers, strictures if severe

•    Management: long-term acid suppression (PPI), reassess for Barrett’s if chronic

Barrett’s Oesophagus

•    Metaplasia of distal oesophageal squamous epithelium to intestinal-type columnar epithelium

•    Risk factor: chronic GORD

•    Significance: ↑ risk of oesophageal adenocarcinoma

•    Surveillance: regular endoscopy with biopsies (based on degree of dysplasia)

•    Treatment:

o    No dysplasia: high-dose PPI, surveillance

o    Dysplasia: endoscopic ablation (e.g. RFA), resection

Achalasia

•    Failure of LOS relaxation + absent peristalsis

•    Symptoms: dysphagia to solids and liquids, regurgitation, weight loss

•    Diagnosis:

o    Barium swallow: classic bird-beak appearance

o    Manometry: absent peristalsis, ↑ LOS tone

o    OGD to exclude malignancy

•    Management:

o    Pneumatic balloon dilatation

o    Heller’s myotomy ± fundoplication

o    Botulinum toxin (temporary relief)

Oesophageal Cancer

•    Squamous cell carcinoma:

o    Affects upper/middle third

o    Risk: smoking, alcohol, achalasia, caustic injury

•    Adenocarcinoma:

o    Affects lower third, arises from Barrett’s

o    Increasing incidence in Western countries

•    Features: progressive dysphagia, weight loss, hoarseness, cough

•    Diagnosis: OGD + biopsy

•    Staging: CT, PET-CT, EUS

•    Treatment: surgery ± chemoradiotherapy (depends on stage)

Other Types of Oesophagitis

•    Candida oesophagitis:

o    White plaques on OGD

o    Common in immunosuppressed

o    Rx: oral fluconazole

•    Herpes simplex virus (HSV):

o    Volcano-like ulcers

o    Rx: aciclovir

•    Pill-induced oesophagitis:

o    Local irritation (e.g. doxycycline, bisphosphonates)

o    Prevent by taking pills upright with water

•    Eosinophilic oesophagitis:

o    Young adults with atopy/allergies

o    Food bolus obstruction, dysphagia

o    OGD: trachealisation/rings; biopsy confirms eosinophils

o    Rx: topical steroids, dietary exclusion