Gastro-oesophageal reflux disease (GORD) is a common condition occurring when reﬂux of gastric contents causes troublesome symptoms and/or complications. It is classified into two subtypes: with (Erosive Reflux Disease, ERD) and without (Non-Erosive Reflux Disease, NERD) oesophageal mucosal damage.
GORD is mainly caused by failure of the endogenous mechanisms that limit the amount of the stomach content entering the oesophagus or rapidly clear the material from the oesophagus, with the lower oesophageal sphincter playing a key role. Other causes include hiatal hernia, impaired oesophageal clearance and delayed gastric emptying.
Lifestyle factors such as obesity, sedentary lifestyle, smoking, caffeine, alcohol and fatty foods are key factors contributing to increased reflux. Other factors include a family history of upper gastrointestinal disease, pregnancy, irritable bowel syndrome, social deprivation, some drugs and hormones.
Among the oesophageal GORD symptoms are heartburn, acid regurgitation, dysphagia and dyspepsia, usually diagnosed in primary care. Endoscopy allows establishing the type of disease and the presence of Barrett’s oesophagus (BO), a precancerous condition sometimes following GORD. It is uncertain whether NERD, ERD and BO are separate categories or constitute a continuous spectrum of GORD.
Geographically, GORD is more prevalent in the Western world and significantly less prevalent in East Asia.
GORD is treated using non-invasive (lifestyle modification), pharmacological (antacids, motility agents, H2 receptor antagonists, proton-pump inhibitors) and invasive (various surgical techniques) methods. Serious complications are rare with symptoms properly controlled. NERD can progress to severe oesophageal erosions, ulcerations and haemorrhage. BO is associated with oesophageal adenocarcinoma. Among the extra-oesophageal complications are non-cardiac chest pain, upper airway manifestations (globus, hoarseness) and pulmonary problems (asthma, chronic cough). Comorbidities include hypertension, hypercholesterolaemia, obesity, type II diabetes, depression.
The Epiomic™ database contains a forecast of the prevalent case load for GORD in males and females, patient population broken down into ERD and NERD types, as well as populations with certain comorbidities.