Gastro-oesophageal reflux

Also known as reflux, GORD or GERD

Gastro-oesophageal reflux disease describes inflammation of the lining of the oesophagus due to stomach acid leaking up (refluxing) from the stomach. It is commonly referred to as GORD or GERD (American spelling).

It is important to seek treatment for GORD, as untreated acid reflux can lead to serious complications. A combination of medication and lifestyle changes are used to treat GORD.


Key points

  1. GORD is diagnosed when heartburn is experienced consistently two or more times a week.
  2. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, those who are overweight and those aged between 35 and 64 years.
  3. Heartburn is caused by stomach acid leaking up from the stomach to the oesophagus. This 'acid reflux' can cause damage to the lining of the oesophagus.
  4. Treatment for GORD is primarily by medication; lifestyle changes may also be necessary.
  5. Untreated GORD can lead to serious complications.

Causes

After food enters your mouth it travels down your oesophagus undefinedinto your stomach. Where the oesophagus meets the stomach there is a ring of muscle called the lower oesophageal sphincter. This sphincter acts as a valve between the oesophagus and the stomach, preventing stomach acid from backing up the oesophagus.

GORD occurs when there is a weakness or defect in the oesophageal sphincter. When the valve fails, it allows acid to flow (reflux) into the oesophagus. This is known as acid reflux.

Frequent or persistent acid reflux can lead toinflammation of the lining of the oesophagus. This is known as oesophagitis.

Risk factors for GORD

One of the main risk factors for GORD is obesity. As your body mass index (BMI) increases, so does your risk of developing GORD. This is thought to be due to extra pressure being put on the lower oesophageal sphincter by the stomach.

Other risk factors include:

Pregnancy. Many women experience heartburn during later stages of pregnancy, when the womb pushes up against the stomach. This normally goes away at the end of the pregnancy.

Smoking. Nicotine can cause the muscles of the lower oesophageal sphincter to relax which may allow reflux to occur. GORD in smokers is also thought to be caused by coughing and straining leading to hiatal hernia (where the upper part of the stomach is pushed up into the upper chest cavity through a hole in the diaphragm, disrupting the functioning of the lower oesophageal sphincter).

Abnormalities of the oesophagus. These may lead to reflux of stomach contents including acid and sometimes bile into the oesophagus.

Eating certain foods can also make the symptoms of GORD worse. They include:

  • spicy foods
  • acidic fruits and vegetables, like citrus or tomatoes
  • mint or chocolate
  • caffeine
  • alcohol
  • garlic and onions
  • fried or fatty food.

Symptoms

Heartburn is the main symptom of GORD. This is a burning feeling which rises from the upper stomach or lower chest up towards the neck. Other common symptoms include:

  • pain in the upper abdomen and chest
  • feeling sick
  • an acid taste in the mouth
  • indigestion (dyspepsia)
  • burning pain when you swallow hot drinks.

These symptoms tend to be worse after a meal.

Less common symptoms caused by refluxed acid irritating the windpipe include:

  • a persistent cough, particularly at night
  • asthma symptoms of cough and wheeze
  • other mouth and throat symptoms such as gum problems, bad breath, sore throat or hoarseness
  • severe chest pain which may be mistaken for a heart attack.

When to see a doctor

See your doctor if you are experiencing heartburn on a regular basis or over a prolonged period of time.

Diagnosis

To make a diagnosis of GORD, your doctor with take your medical history and conduct a physical examination. A diagnosis of GORD is highly likely if persistent heartburn is your primary complaint.

If your doctor suspects GORD, you may be prescribed a medication called a proton-pump inhibitor. This type of medication blocks stomach acid and helps the oesophagus to heal.

Further tests may be required to determine how severe your GORD is or if there is any damage to your oesophagus.

These tests may include:

  • Endoscopy – which involves having an endoscope (a flexible tube with a tiny video camera and light at one end) passed through your mouth down into your stomach to examine the lining of your digestive tract.
  • pH monitoring – which involves using an acid monitor (a thin tube with a sensor at one end) to measure acidity levels in your oesophagus.

Treatment

It is important to begin treating GORD as soon as possible after diagnosis. Left untreated, acid reflux will continue to damage to the oesophagus and create other complications.

There are three main categories of medications used to treat GORD. The type of medication prescribed will depend on how severe your symptoms are. Medications from mildest to strongest are:

  • Antacids neutralise stomach acids and provide rapid relief of symptoms especially in those with mild disease. They do not help to heal existing oesophageal damage or prevent heartburn from happening again. Antacid brands include Mylanta, Eno, Quick Eze and Gaviscon.
  • H2-receptor blockers reduce the production of stomach acid and give adequate relief in many people, especially those with less severe GORD. They are slower acting than antacids but provide longer term symptom relief. For many people, this treatment allows the oesophagus to heal and relieves the symptoms entirely. Includes: ranitidine and cimetidine.
  • Proton-pump inhibitors (PPIs) block stomach acid production and help to heal the oesophagus. They are recommended for severe GORD symptoms. Includes: omeprazole and lansoprazole.

After your oesophagus has had a chance to heal and your symptoms begin to improve, the strength of medication prescribed will be reduced. Eventually, you may only need to take medication when symptoms occur. For some people with severe disease, the lowest effective dose of medication may need to be continued.

Medications are effective in treating GORD but they are only part of the solution. To help prevent symptoms of GORD recurring, you may need to make some important lifestyle changes.

Self care

There are a number of lifestyle changes you make that might help reduce heartburn and acid reflux:

  • If you are overweight, try losing weight. Excess weight puts pressure on the stomach, causing acid to back up the oesophagus.
  • Watch what you eat and how much you eat. Avoid foods that trigger your heartburn and try not to overfill your stomach.
  • If you smoke, quit. Smoking affects the functioning of the oesophageal sphincter
  • reduce alcohol and caffeine intake.
  • Remain upright after a meal and use gravity to help keep stomach acids down. Wait at least 3 hours after eating before lying down or going to bed.
  • If symptoms occur often or at night, raise the head of your bed by 10cm (thus lifting your head slightly higher than your stomach).
  • Avoid or reduce the use of non-steroidal anti-inflammatory drugs.

Learn more

Heartburn Australia 
Gastro-info NZ

Credits: Health Navigator Team, June 2014.