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GORD Pathophysiology - Part 1

Daniel Sifrim, Kornilia Nikaki

Summary

AI Generated

An online course examines the multifactorial pathophysiology of gastro-oesophageal reflux disease by following the path of the refluxate through the stomach, antireflux barrier, clearance mechanisms, mucosa and symptom perception.

  • The pathophysiology of GORD is now understood to be multifactorial, evolving from earlier views that equated GORD with oesophagitis and hiatal hernia to include transient lower oesophageal sphincter relaxations, different phenotypes and microscopic features.
  • The course covers individual pathophysiological components including the stomach, antireflux barrier, refluxate, clearance mechanisms, mucosa and symptom perception.
  • A key learning objective is that patients with different GORD phenotypes may have different underlying pathophysiological mechanisms and may require different treatments even when presenting with similar symptoms.
  • The course is suitable for gastroenterologists in training, physicians and surgeons in other disciplines, nurses, biotechnicians and advanced-years medical students with an interest in gastroenterology.
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Overview

The diagnosis and treatment of gastro-oesophageal reflux disease (GORD) have been driven by our knowledge of its pathophysiology. From equating GORD with oesophagitis and hiatal hernia to identifying the role of transient lower oesophageal sphincter relaxations, different GORD phenotypes and microscopic features, the pathophysiology is now understood to be multifactorial.

This online course covers the different components that contribute to the pathophysiology of GORD by following the path of the refluxate. The role of the stomach, antireflux barrier, refluxate, clearance mechanisms, mucosa and symptom perception are each considered in turn.  

Learning objectives

  • To understand that the pathophysiology of GORD is multifactorial
  • To become familiar with each of the individual pathophysiology abnormalities
  • To realize that patients with different GORD phenotypes may have different underlying pathophysiological mechanisms
  • To recognize that treatment of GORD should be designed to modify the specific pathophysiology
  • To appreciate that patients with GORD who have similar symptoms but different pathophysiology mechanisms may need different treatments

Target audience

This course is suitable for gastroenterologists in training, but is also appropriate for physicians and surgeons in other disciplines, as well as nurses, biotechnicians and advanced-years’ medical students who have an interest in gastroenterology. 

Reviewed & updated February 2023

Event

GORD Pathophysiology Part 1

Topics

Neurogastroenterology & Motility Oesophagus

Accreditation status

accredited

Duration

1 hour

Published

2018

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GORD Pathophysiology - Part 2

Edoardo Savarino, Ahsen Ustaoglu

Summary

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Summary is not available for this content yet.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Overview

This course builds on foundational concepts to examine contemporary mechanisms driving GORD phenotypes. We revisit key epidemiological and clinical distinctions before exploring gastric physiology, including postprandial acid–bile dynamics, H. pylori-related acid output, motility patterns, obesity-related changes, and post-surgical anatomy. Oesophagogastric junction competence (LES pressure, TLESRs, hiatal hernia) and refluxate characteristics (acidic to gaseous; PPI-modified) are discussed with emphasis on symptom generation. We detail epithelial biology, micro- and macroinflammatory responses across NERD and erosive disease, and advances in nociceptive signalling, receptor expression, central modulation, and hypervigilance. Key clinical studies, cytokine-driven pathways, and emerging therapeutic approaches are highlighted. The course concludes with implications for diagnosis, phenotype-guided management, and outstanding research questions.

Event

GORD Pathophysiology Part 2

Topics

Neurogastroenterology & Motility

Accreditation status

accredited

Duration

1 hour

Published

2026

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UEG Online Course
accredited
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GORD Diagnosis

Daniel Sifrim, Kornilia Nikaki

Summary

AI Generated

Summary is not available for this content yet.

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Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Overview

Gastro-oesophageal reflux disease (GORD) is a highly prevalent condition that negatively impacts quality of life and confers considerable healthcare costs. Although various symptoms are associated with GORD, none are characteristic for diagnosis of the disease.

This online course covers needs in the diagnosis of GORD, symptoms and questionnaires, the PPI test, endoscopy and biopsies, reflux monitoring, oesophageal manometry, barium studies and other biomarkers. Conclusive, inconclusive and paediatric GORD are also considered. 

Learning objectives

  • To understand how to reach a conclusive diagnosis of GORD
  • To know how to reach a conclusive diagnosis of no GORD
  • To understand how to deal with an inconclusive diagnosis

Target audience

This course is suitable for gastroenterologists in training and physicians and surgeons in other disciplines, as well as nurses, biotechnicians and advanced-years’ medical students who have an interest in gastroenterology. 

Reviewed & updated February 2023

Event

GORD Diagnosis

Topics

Neurogastroenterology & Motility Oesophagus

Accreditation status

accredited

Duration

1 hour

Published

2018

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UEG Podcast Episode
UEG Podcast
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EoE with Alex Straumann - Part 1

Alex Straumann, Egle Dieninyte - Misiune

Summary

AI Generated

Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Oesophagus

Published

2026

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UEG Mistakes In Articles
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Mistakes in gastro-oesophageal reflux disease diagnosis and how to avoid them

Francois Mion, Sabine Roman

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

According to the Montreal definition, “[gastro-oesophageal reflux disease (GORD)] is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.”1 GORD has a negative effect on quality of life and is frequently encountered in clinical practice, with an estimated prevalence of around 24% in Europe. In the US, GORD-related healthcare costs account for $9 billion per year. A variety of symptoms are associated with GORD—heartburn and regurgitation are typical symptoms, while chest pain, cough and sore throat are considered atypical symptoms—but none is pathognomonic

Topics

Neurogastroenterology & Motility Oesophagus

Citation

Roman S and Mion F. Mistakes in gastro-oesophageal reflux disease and how to avoid them. UEG Education 2017; 17: 24–26.

Published

2024

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Ahsen Ustaoglu Ahsen Ustaoglu, Edoardo Savarino

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Francois Mion Francois Mion, Sabine Roman

All GORD symptoms are not the same: How may a better understanding of pathophysiology change the diagnostic approach?

All GORD symptoms are not the same: How may a better understanding of pathophysiology change the diagnostic approach?

Daniel Sifrim Daniel Sifrim

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RISK FACTORS OF PANCREATIC EXOCRINE INSUFFICIENCY ASSOCIATED AFTER ACUTE PANCREATITIS – A SYSTEMATIC REVIEW AND META-ANALYSIS

Maria Bucur Maria Bucur, Mahmoud Obeidat, Stefania BUNDUC CHIRILOV, Peter Hegyi, Andrea Szentesi, Peter Banovcin, Balint Eross, Marie Anne Engh, Ádám Zolcsák, Anett Rancz, Orsolya Eperjesi

UEG Presentation
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All GORD symptoms are not the same: How may a better understanding of pathophysiology change the diagnostic approach?

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All GORD symptoms are not the same: How may a better understanding of pathophysiology change the diagnostic approach?

Daniel Sifrim 1

Affiliations

1 Queen Mary University London, Blizard Institute, London, United Kingdom

Summary

AI Generated

Summary is not available for this content yet.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Event

UEG Postgraduate Teaching Programme Vienna 2024

Topics

Education & Training Neurogastroenterology & Motility Oesophagus Primary Care Stomach & H. Pylori Surgery

Session

Management of GORD in 2024

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Ahsen Ustaoglu Ahsen Ustaoglu, Edoardo Savarino

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Francois Mion Francois Mion, Sabine Roman

All GORD symptoms are not the same: How may a better understanding of pathophysiology change the diagnostic approach?

All GORD symptoms are not the same: How may a better understanding of pathophysiology change the diagnostic approach?

Daniel Sifrim Daniel Sifrim

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RISK FACTORS OF PANCREATIC EXOCRINE INSUFFICIENCY ASSOCIATED AFTER ACUTE PANCREATITIS – A SYSTEMATIC REVIEW AND META-ANALYSIS

Maria Bucur Maria Bucur, Mahmoud Obeidat, Stefania BUNDUC CHIRILOV, Peter Hegyi, Andrea Szentesi, Peter Banovcin, Balint Eross, Marie Anne Engh, Ádám Zolcsák, Anett Rancz, Orsolya Eperjesi

UEG Poster
Standard Poster
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RISK FACTORS OF PANCREATIC EXOCRINE INSUFFICIENCY ASSOCIATED AFTER ACUTE PANCREATITIS – A SYSTEMATIC REVIEW AND META-ANALYSIS

Orsolya Eperjesi 1, Maria Bucur 2, Anett Rancz 2, Ádám Zolcsák 3, Marie Anne Engh 2, Mahmoud Obeidat 2, Balint Eross 4, Peter Banovcin 5, Andrea Szentesi 6, Peter Hegyi 7, Stefania BUNDUC CHIRILOV 8

Affiliations

1 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Department of Internal Medicine, Toldy Ferenc Hospital, Cegléd, Hungary

2 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary

3 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary

4 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

5 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Department of Pharmacology and Pharmacotherapy, Medical Faculty, Semmelweis University, Budapest, Hungary

6 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

7 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary

8 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary|||Carol Davila University of Medicine and Pharmacy, Bucharest, Romania|||Digestive Disease and Liver Transplant Center, Fundeni Clinical Institute, Bucharest, Romania

Summary

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

96-98% of patients survive acute pancreatitis (AP), but in the post-AP phase, patients are at high risk of morbidity and mortality. It has been shown that pancreatic exocrine insufficiency can occur after AP.

Aims & Methods

We aimed to investigate the rate, risk factors, and the effect of pancreatic enzyme replacement therapy (PERT) for PEI in patients with AP. The study protocol was registered on PROSPERO (CRD42024516403). We conducted a systematic search on 5 February 2024 in three databases (PubMed, EMBASE, and CENTRAL). We included in the analysis studies reporting on risk factors and PERT efficacy in PEI associated with AP. Pooled proportion and odds ratios (OR) with a 95% confidence interval (CI) were calculated using a random effect model.

Results

Fifty-six articles were included in our meta-analysis. Among 17896 patients with AP, the pooled proportion of PEI was 20 % ([CI]: 15–26). The odds of PEI development were two-fold higher in severe acute pancreatitis (OR=2.44, [CI]: 0.98–6.11) compared with mild or moderate AP and three times higher after necrosectomy compared to patients without necrosectomy (OR=3.26, [CI]: 1.6–6.64). There was no significant difference between the odds of PEI among AP patients with necrosis (OR=1.43, [CI]: 0.32–6.45) and those without necrosis. However, the odds of PEI were twice as high in patients with infected necrosis (OR=2.13, [CI]: 0.93–4.87) than in patients with sterile necrosis. Pancreatic enzyme replacement therapy was prescribed for 22% ([CI]: 16–30) of patients after AP.

Conclusion

One in five patients with AP develops PEI. The rate is higher in patients with severe AP, infected necrosis, or who need necrosectomy. Patients with AP should be screened for PEI to allow timely PERT administration.

Conference

UEG Week Vienna 2024

Topics

Pancreas

Submission format

Abstract

Session

PANCREAS (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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