Introduction
- Gastro-oesophageal reflux disease (GORD) occurs when stomach acid frequently flows back into the oesophagus, irritating its lining.
- Symptoms include heartburn, regurgitation, and difficulty swallowing.
- While occasional reflux is common, persistent symptoms may require medical management.
- Effective treatment includes lifestyle modifications, medications, and, in severe cases, surgery.
Causes of GORD
- Weak Lower Oesophageal Sphincter (LOS)
- Allows stomach contents to flow back into the oesophagus.
- Hiatal Hernia
- Stomach bulging into the chest through the diaphragm, affecting LOS function.
- Obesity
- Increased abdominal pressure contributes to reflux.
- Dietary Triggers
- Spicy foods, caffeine, alcohol, and fatty foods.
- Medications
- NSAIDs, calcium channel blockers, and certain sedatives.
Symptoms of GORD
- Classic Symptoms
- Heartburn: Burning sensation in the chest, often after eating or lying down.
- Regurgitation: Sour or bitter-tasting acid backing up into the throat or mouth.
- Atypical Symptoms
- Chronic cough or hoarseness.
- Difficulty swallowing (dysphagia) or sensation of a lump in the throat.
- Chest pain mimicking cardiac pain.
- Complications (Advanced Cases)
- Oesophagitis: Inflammation of the oesophagus.
- Barrett’s Oesophagus: Precancerous changes in oesophageal lining.
- Strictures or ulcers in the oesophagus.
Diagnosis of GORD
- Clinical Assessment
- Based on symptoms and response to empirical treatment with acid suppressants.
- Diagnostic Tests
- Endoscopy: Visualizes oesophageal inflammation, ulcers, or Barrett’s Oesophagus.
- 24-hour pH Monitoring: Measures acid levels in the oesophagus.
- Manometry: Assesses oesophageal motility and LOS function.
- Barium Swallow X-Ray: Evaluates structural abnormalities like hiatal hernia.
Treatment Options for GORD
1. Lifestyle Modifications
- Dietary Adjustments
- Avoid trigger foods like spicy meals, chocolate, and caffeine.
- Eat smaller, frequent meals rather than large meals.
- Behavioural Changes
- Avoid lying down within 2–3 hours of eating.
- Elevate the head of the bed by 6–8 inches.
- Weight Management
- Reducing body weight can significantly improve symptoms in overweight individuals.
- Smoking Cessation and Alcohol Reduction
- Both contribute to LOS weakening and increased acid production.
2. Medications
Drug Class | Example | Brand Name | Manufacturer | Cost Range |
---|---|---|---|---|
Antacids | Aluminium Hydroxide | Gaviscon | Reckitt Benckiser | $5–$15 per bottle |
H2 Receptor Blockers | Ranitidine | Zantac | GlaxoSmithKline | $10–$20 per pack |
Proton Pump Inhibitors (PPIs) | Omeprazole | Prilosec | AstraZeneca | $10–$25 per pack |
Esomeprazole | Nexium | AstraZeneca | $15–$30 per pack | |
Prokinetics | Domperidone | Motilium | Johnson & Johnson | $10–$20 per pack |
3. Surgical Options
- Fundoplication
- Wrapping the upper part of the stomach around the LOS to strengthen it.
- LINX Device
- A ring of magnetic beads placed around the LOS to prevent reflux.
- Bariatric Surgery
- Weight-loss surgery may help obese patients with refractory GORD.
4. Alternative Therapies
- Herbal Remedies
- Ginger tea or chamomile to soothe the digestive tract.
- Acupuncture
- May provide symptomatic relief in some patients.
Monitoring Parameters
- Symptom improvement with lifestyle changes or medications.
- Monitoring for side effects of medications (e.g., PPIs can cause nutrient malabsorption).
- Regular endoscopy for patients with Barrett’s Oesophagus or severe symptoms.
Patient Counseling Points
- Explain the chronic nature of GORD and the importance of adherence to lifestyle changes and medications.
- Discuss potential triggers and how to avoid them.
- Emphasize the importance of long-term follow-up for those with complications like Barrett’s Oesophagus.
- Educate on the appropriate use of antacids and other over-the-counter medications.
Use in Children
- Commonly presents as regurgitation or vomiting; treatment includes thickened feeds, dietary changes, and medications like PPIs or H2 blockers.
Use in Pregnancy
- Often resolves postpartum. Safe treatments include antacids and H2 blockers; avoid PPIs unless necessary.
Use in Elderly
- Monitor for atypical symptoms like chest pain or silent reflux.
FAQs About GORD
Q1: What causes GORD?
- Weakness in the lower oesophageal sphincter, hiatal hernia, obesity, and dietary triggers.
Q2: Can GORD be cured?
- It can be managed effectively, but chronic cases may require long-term treatment.
Q3: What foods should I avoid with GORD?
- Spicy foods, citrus fruits, caffeine, chocolate, and carbonated drinks.
Q4: How is GORD diagnosed?
- Through symptom history, endoscopy, and pH monitoring.
Q5: Are antacids safe for long-term use?
- Short-term use is safe, but prolonged use may not address underlying causes.
Q6: Can GORD lead to cancer?
- Chronic GORD can lead to Barrett’s Oesophagus, which increases oesophageal cancer risk.
Q7: Is surgery necessary for GORD?
- Only for severe or refractory cases that do not respond to medication.
Q8: Can stress worsen GORD symptoms?
- Yes, stress can exacerbate symptoms.
Q9: How do PPIs work?
- They reduce stomach acid production, relieving symptoms and healing oesophagitis.
Q10: Can children develop GORD?
- Yes, especially infants, but most cases resolve as they grow.
Q11: Does lying down after eating worsen GORD?
- Yes, it increases the likelihood of acid reflux.
Q12: Can weight loss improve GORD symptoms?
- Absolutely, especially in overweight or obese individuals.
Q13: Is milk good for GORD?
- Milk may provide temporary relief but can stimulate acid production.
Q14: Can GORD cause bad breath?
- Yes, due to acid regurgitation and bacterial growth in the oesophagus.
Q15: Are herbal remedies effective for GORD?
- Ginger and chamomile may provide mild relief but are not substitutes for medical treatment.