Gastro-Oseophageal Reflux Disease (GERD) (GORD) (reflux)

What is GORD?

Gastro-oesophageal reflux disease (GORD) happens when stomach acid leaks from your stomach and moves up into your oesophagus (food pipe). This is also known as ‘reflux’ or ‘acid reflux’.

Almost everyone gets heartburn due to acid reflux from time to time. GORD is when reflux occurs more than twice a week. It can eventually lead to more serious health problems and impact your wellbeing and quality of life.

GORD can affect everyone, even children, but mostly affects people aged over 40 years.

What are the symptoms of GORD?

The most common symptoms of GORD are:

• heartburn
• regurgitation
• difficulty swallowing

Heartburn

Heartburn is the main symptom of GORD. It feels like discomfort or burning pain in your chest. This pain can rise up and sometimes spread to your:

• neck
• throat
• jaw

Heartburn is often worse:

• after eating heavy meals
• lying down
• when bending over

Is it heartburn or a heart attack?

Chest pain is a very common reason for people to go to the hospital emergency department. While many people are suffering from a heart attack, some have severe heartburn.

It’s quite difficult to tell heartburn and heart attack apart. In fact, a heart attack can only be confirmed by medical tests.

Males are more likely to have chest pain as a heart attack symptom. Females are more likely to experience the other symptoms listed above.

If you are unsure about whether your symptoms are heartburn or a heart attack.

Regurgitation

Regurgitation is also called reflux. This is when stomach acid and other stomach contents come up into your throat and mouth. It causes an unpleasant, sour taste in your mouth.

Difficulty swallowing

If you have GORD, you might have difficulty swallowing (dysphagia), especially when eating solids such as:

• meat
• bread
• pastry

It can also feel like you have a lump in your throat.

Other symptoms of GORD

GORD can also cause other problems such as:

• vomiting (throwing up)
• a persistent cough, which may be worse at night
• chest pain
• wheezing
• tooth decay
• laryngitis (inflammation of the voice box)
• bad breath
• bloating and belching (burping)

Some people may also find swallowing painful. This is caused by ulcers in your oesophagus (food pipe).

What causes GORD?

Most cases of GORD are caused by a problem with your lower oesophageal sphincter.

The lower oesophageal sphincter is the muscle around at the bottom of your food pipe that stops the contents of the stomach from rising back up into your throat.

If your lower oesophageal sphincter becomes weak, it may not close properly. This allows acid to leak up into your oesophagus, causing symptoms such as heartburn.

It’s not always clear why the lower oesophageal sphincter becomes weakened, but it’s more likely to happen in people who:

• are overweight or obese
• are pregnant
• are feeling stressed
• smoke
• take certain medicines, such as ibuprofen

If you are pregnant changes in your hormone levels can also relax your lower oesophageal sphincter. This, along with increased pressure on your stomach during pregnancy, can also cause GORD symptoms.

Some conditions can also impact your lower oesophageal sphincter, such as:

• hiatus hernia, where part of your stomach pushes up through your diaphragm (the sheet of muscle which separates your abdomen from your chest)
• diabetes
• connective tissue disorders

Some conditions that you are born with can also increase your risk of GORD, such as:

• cerebral palsy
• scoliosis
• Down syndrome

Large meals and some foods can trigger symptoms of GORD. These are:

• fatty foods
• tomatoes
• hot drinks
• spicy foods
• alcohol
• tobacco

When should I see my doctor?

You should see your doctor if:

• you have severe chest pain
• your symptoms get worse
• your symptoms prevent you from eating, drinking or sleeping
• you are losing weight
• you have repeated vomiting or are vomiting blood

How is GORD diagnosed?

In most cases, your doctor will be able to diagnose GORD by asking you questions about:

• your symptoms
• how your respond to any medicines you are taking

If your symptoms don’t improve, your doctor may order some tests. The most common test for GORD is an endoscopy. This involves a long, thin flexible tube that has a light source and video camera attached. This tube is inserted down your throat to examine and take images of the inside of your oesophagus (food pipe) and stomach.

How is GORD treated?

If your GORD is caused by an underlying condition, that will need to be treated. There are also ways to treat and manage GORD symptoms.

Lifestyle changes

Making changes to your lifestyle are essential to manage and prevent GORD symptoms.

Lose weight if you are overweight or obese — even a small amount of weight loss can help your symptoms.

Diet and nutrition

Most people with GORD find that their symptoms are influenced by what they eat and drink, as well as how and when they eat.

It is a good idea to work out which foods trigger your symptoms so you can avoid them. The foods will be different for everyone, so only cut out the ones that are a problem for you. You don’t have to restrict your diet unnecessarily.

For many people, problem foods include:

• coffee
• alcohol
• fatty or spicy foods and pepper
• drinks containing caffeine
• soft drinks
• citrus fruit juices
• chocolate
• peppermint

You could also try to avoid:

• battered or fried foods
• pastries
• rich cakes and biscuits
• fatty food such as hamburgers, fried chicken and pizza

You can also make these changes to your eating habits:

• eat smaller, more frequent meals
• eat your evening meal at least 2 to 3 hours before going to bed
• avoid lying down soon after eating

Stop smoking

Tobacco smoke irritates your digestive system and makes your symptoms worse. Quitting smoking has been shown to significantly improve symptoms in people who are taking medication for GORD.

Cut back on alcohol

Alcohol irritates the stomach and relaxes the muscles around the oesophagus, allowing stomach acid to reflux. Cutting back can relieve symptoms in some people.

Raise the bed head

Safely raising the head of your bed by about 20cm with something strong such as a piece of wood or wooden blocks, or using a pillow to wedge the mattress, can help if you have reflux symptoms at night. Try not to lie down after you eat.

You can also ask your doctor or pharmacist to review any medicines you are taking. They can check that they aren’t making your symptoms worse.

If your symptoms get worse at night, you can try sleeping on your back with your head at a slight angle. To do this, you can raise the head of your bed using some extra pillows.

Medicines

Sometimes lifestyle changes are all you need to manage your GORD. If lifestyle changes don’t help control your symptoms, you may need to take medicines.

You can buy medicines without a prescription from a pharmacy (over-the-counter medicines) that help control the amount of acid produced in your stomach. These include :

• antacids
• H2-receptor antagonists (blockers)
• proton pump inhibitors (PPIs)

Talk to your pharmacist about which medicine is best for you and always follow the instructions. Let your doctor know what over-the-counter medicines you are taking.

If your symptoms don’t go away, see your doctor. Your doctor may prescribe you a proton pump inhibitor (PPI) for 4 to 8 weeks. These medicines work more strongly to reduce the acid in your stomach.

Proton pump inhibitors should not be taken long term if you don’t need them. If your symptoms are well managed or improving, talk to your doctor about reviewing your medicine. Your doctor may slowly reduce your medicine or limit it to when you have symptoms. After you have stopped taking a proton pump inhibitor, lifestyle changes become even more important to control your symptoms.

Surgery

Surgery is only required for a small number of people who:

• have severe symptoms
• have symptoms that don’t get better with medicines
• don’t want to take long-term medicines
• have a hiatus hernia

It is performed through a ‘key-hole’ approach called laparoscopy.

Can GORD be prevented?

By making lifestyle changes, you can prevent the symptoms and complications of GORD.

Complications of GORD

For most people, GORD is a fairly straightforward condition. But for some, it can eventually lead to complications such as

• Barrett’s oesophagus
• oesophageal stricture
• oesophageal cancer

If your doctor thinks you may be at risk of developing GORD complications, they may refer you for an endoscopy.

Barrett’s oesophagus

Long-term GORD can damage the cells lining the lower part of your food pipe. This condition is called Barrett’s oesophagus, which occurs in around 1 in 10 people with GORD.

It can also cause inflammation (oesophagitis) and cause oesophageal ulcers to form. Barrett’s oesophagus is usually diagnosed by an endoscopy and can increase your risk of oesophageal cancer.

Oesophageal stricture

If the lining of your food pipe is continuously damaged, scar tissue can form. If the scar tissue builds up, it can cause your throat to become narrow and can make swallowing difficult. This is an oesophageal stricture.

It’s possible to have a surgical procedure to widen your food pipe.

Oesophageal cancer

In some people Barrett’s oesophagus can develop into oesophageal cancer. The symptoms of oesophageal cancer are:

• pain and difficulty swallowing
• heartburn and reflux
• unexplained weight loss
• vomiting and vomiting blood
• tiredness (fatigue)
• black or bloody stool (poo)