Gastro-oesophageal Reflux Disease (GORD)

Introduction

Gastro-oesophageal reflux disease, commonly known as GORD (or GERD in the US), is a very common digestive condition where acid from the stomach leaks up into the oesophagus (the gullet).

While most people experience occasional heartburn, GORD is diagnosed when this acid reflux happens regularly—usually at least twice a week—or causes significant discomfort or damage. It is a long-term condition that affects roughly 1 in 5 adults in the UK.

Symptoms

The symptoms of GORD often worsen after eating, when lying down, or when bending over.

• Common Symptoms:
  • Heartburn: A burning sensation in the middle of the chest.
  • Acid Regurgitation: An unpleasant sour or bitter taste in the mouth.
  • Dyspepsia: Indigestion or upper abdominal pain.
  • Difficulty Swallowing: (Dysphagia) feeling like food is stuck in the throat.
  • Chronic Cough: A persistent dry cough, especially at night.
• Severe Symptoms:
  • Hoarseness or laryngitis.
  • Frequent dental erosions from stomach acid.
  • Disturbed sleep due to reflux.
• Red-Flag Symptoms:
  • Unintentional weight loss.
  • Persistent vomiting.
  • Difficulty swallowing or food getting stuck.
  • Blood in vomit or black, tarry stools.

Causes and Risk Factors

GORD occurs when the ring of muscle at the bottom of the oesophagus (the lower oesophageal sphincter) becomes weakened or relaxes inappropriately.

• Main Causes:
  • Hiatus Hernia: When part of the stomach pushes up through the diaphragm.
  • Increased Intra-abdominal Pressure: Often caused by pregnancy or obesity.
• Common Triggers:
  • Fatty, spicy, or acidic foods (citrus/tomatoes).
  • Caffeine, alcohol, and carbonated drinks.
  • Large meals eaten late at night.
• Risk Factors:
  • Smoking: Relaxes the oesophageal muscle.
  • Medicines: Such as NSAIDs (ibuprofen), calcium channel blockers, or nitrates.
  • Stress: Can exacerbate the perception of symptoms.

Types or Classification

• Non-Erosive Reflux Disease (NERD): Reflux symptoms exist, but no visible damage is seen in the oesophagus.
• Erosive Oesophagitis: Reflux has caused visible inflammation or ulcers in the gullet lining.
• Laryngopharyngeal Reflux (LPR): Also called “Silent Reflux,” where acid reaches the voice box or throat.

Diagnosis

• Medical History: A GP or pharmacist can often diagnose GORD based on symptoms alone.
• PPI Trial: A doctor may prescribe a “trial” of acid-suppressing medicine to see if symptoms improve.
• Endoscopy (Gastroscopy): A thin camera is passed down the throat to look for inflammation or a hiatus hernia.
• pH Monitoring: A 24-hour test to measure how much acid is entering the oesophagus.

Treatment

Medications

• Antacids (e.g., Gaviscon, Rennie): Provide quick, short-term relief by neutralising stomach acid.
• Alginates: Form a “raft” on top of stomach contents to physically block acid from rising.
• Proton Pump Inhibitors (PPIs) (e.g., Omeprazole, Lansoprazole): The “gold standard” for GORD. They reduce the amount of acid the stomach produces.
• H2 Blockers (e.g., Famotidine): An alternative to PPIs that also reduces acid production.

Non-Medication Treatment

• Weight Loss: Reducing pressure on the stomach is the most effective long-term fix.
• Dietary Changes: Identifying and avoiding trigger foods.
• Small, Frequent Meals: Avoid eating large meals, especially 3–4 hours before bed.
• Elevate the Head of the Bed: Using a wedge pillow or blocks under the bed frame (not just extra pillows) uses gravity to keep acid down.

Advanced or Hospital Treatment

• Laparoscopic Fundoplication: Surgery to tighten the valve between the oesophagus and stomach.
• LINX Procedure: A ring of magnetic beads placed around the sphincter to keep it closed.

Complications

Untreated chronic GORD can lead to:

• Oesophagitis: Painful inflammation and ulcers.
• Oesophageal Stricture: Scar tissue that narrows the gullet, making swallowing difficult.
• Barrett’s Oesophagus: Changes to the cells of the gullet lining, which slightly increases the risk of Oesophageal Cancer.

When to See a Doctor

• If lifestyle changes and pharmacy medicines haven’t helped after 3 weeks.
• If symptoms return as soon as you stop taking medication.
• If you are over 55 and have persistent indigestion.

Emergency Signs

Seek urgent help if you experience:

• Chest pain that feels heavy, tight, or spreads to the arms/jaw (could be a heart attack).
• Severe difficulty swallowing.
• Vomiting blood.

Prevention

• Eat Mindfully: Chew thoroughly and avoid rushing meals.
• Quit Smoking: Helps the oesophageal valve function correctly.
• Wear Loose Clothing: Tight waistbands increase pressure on the stomach.
• Manage Stress: High stress can increase acid production.

Prognosis and Recovery

GORD is usually a chronic condition but is highly manageable. Most people find total relief through a combination of PPI medication and weight management. If triggers are avoided, many patients can eventually step down their medication.

Quick Patient Advice

• Do: Sleep on your left side; this position makes it harder for acid to escape the stomach.
• Do: Keep a food diary to find your specific triggers.
• Avoid: Lying down immediately after eating.
• When to seek help: If you are using antacids every single day.

FAQ

1. Is GORD the same as Heartburn? Heartburn is a symptom; GORD is the name of the condition when heartburn happens frequently.
2. Can GORD cause a sore throat? Yes, “Silent Reflux” often presents as a persistent sore throat or the feeling of a “lump” in the throat.
3. Why is my reflux worse at night? Lying flat removes the benefit of gravity, allowing acid to flow easily into the gullet.
4. Are PPIs like Omeprazole safe for long-term use? Generally yes, but long-term use should be reviewed annually by a pharmacist or GP to monitor bone density and magnesium levels.
5. Can GORD cause shortness of breath? Yes, acid can sometimes be inhaled in tiny amounts, irritating the airways and causing asthma-like symptoms.
6. Does drinking milk help GORD? It can provide temporary relief but the fat in full-fat milk may actually trigger more acid production later.
7. Is GORD hereditary? There is evidence that a tendency toward a weak oesophageal valve can run in families.
8. Can stress cause GORD? Stress doesn’t cause the physical reflux, but it makes the oesophagus much more sensitive to acid.
9. What happens if I stop my PPI suddenly? You may experience “rebound acid hypersecretion.” It is best to taper the dose down slowly.
10. Can pregnancy cause permanent GORD? Usually, the reflux disappears after birth, but some women may have a lingering hiatus hernia.