Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet). The main symptoms of gastro-oesophageal reflux disease (GORD) are heartburn and acid reflux.
Introduction
Acid Reflux (Gord) and Heartburn usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened.
GORD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth. It may just be an occasional nuisance for some people, but for others it can be a severe, lifelong problem.
GORD can often be controlled with self-help measures and medication. Occasionally, surgery to correct the problem may be needed.
Some History
The earliest historians can detect the diagnosis of heartburn is about 3000 BC, in ancient Mesopotamia. Of course, the world at that time didn’t have 60 million people, which is how many are estimated to struggle with heartburn and acid reflux currently, so it may not have been considered such a huge problem. But nevertheless, heartburn was enough of a nuisance to earn a word of its own.
In the first century AD, Pliny the Elder of Rome wrote about heartburn, describing methods to treat the fire burning within the chest. Pliny recommended “coral powder,” which oddly enough contained calcium carbonate—an ingredient still used in many over-the-counter medications today.
In Greece the ailment was also well-known. The famed physician Galen referred to heartburn as “kardialgia” which literally translates to “heart pain.” It is likely not a surprise to you that early cultures mistook the burning sensations of heartburn with chest pain, as the esophagus is located directly behind the breast bone.
Heartburn made its appearance early on in human culture, but back then there wasn’t much anyone could do in the way of treatment. Successful treatment for heartburn and acid reflux didn’t make an appearance until the mid-20th century, and even then medications could only reduce the symptoms of gastroesophageal reflux disease—not cure it. (Source: https://www.georgiarefluxsurgery.com/
Symptoms of GORD and Heartburn
Heartburn
Heartburn is an uncomfortable burning sensation in the chest.
It’s usually felt just below your breastbone, but can spread up to the throat in some people.
The discomfort is usually worse after eating, or when bending over or lying down.
Acid reflux
Acid reflux is where acid and other stomach contents are brought back up (regurgitated) into your throat and mouth.
It usually causes an unpleasant, sour taste at the back of your mouth.
Other symptoms
If you have GORD, you may also experience:
- a sore, inflamed oesophagus (oesophagitis)
- bad breath
- bloating and belching
- feeling or being sick
- difficulty swallowing, which may feel like a piece of food is stuck low down in your throat
- pain when swallowing
- a sore throat and hoarseness
- a persistent cough or wheezing, which may be worse at night
- tooth decay and gum disease
If you also have asthma, the symptoms may get worse as a result of stomach acid irritating your airways.
Causes of GORD and Heartburn
Gastro-oesophageal reflux disease (GORD) is usually caused by the ring of muscle at the bottom of the oesophagus (gullet) becoming weakened.
Normally, this ring of muscle opens to let food into your stomach and closes to stop stomach acid leaking back up into your oesophagus.
But for people with GORD, stomach acid is able to pass back up into the oesophagus. This causes symptoms of GORD, which can include heartburn and acid reflux.
It’s not always clear what causes this ring of muscle to become weakened, but certain things can increase the risk of it happening (see below).
Who’s most at risk of GORD?
The following factors may increase your risk of developing GORD:
- being overweight or obese – this can place increased pressure on your stomach and weaken the muscles at the bottom of the oesophagus
- eating large amounts of fatty foods – the stomach takes longer to get rid of stomach acid after digesting a fatty meal and the resulting excess acid may leak up into the oesophagus
- smoking, alcohol, coffee or chocolate – these may relax the muscles at the bottom of the oesophagus
- pregnancy – temporary changes in hormone levels and increased pressure on your stomach during pregnancy can cause GORD (read more about heartburn in pregnancy)
- – when part of your stomach pushes up through your diaphragm (thin sheet of muscle between the chest and tummy)
- gastroparesis – when the stomach takes longer to get rid of stomach acid, which means excess acid can leak up into the oesophagus
- certain medicines – some medicines can cause GORD or make the symptoms worse, including calcium-channel blockers (used to treat high blood pressure), nitrates (used to treat angina) and non-steroidal anti-inflammatory drugs (NSAIDs)
- stress
GORD can sometimes affect several members of the same family and it’s been suggested that the genes you inherit from your parents may also affect your chances of developing the condition
Diagnosing GORD and Heartburn
Your GP will often be able to diagnose gastro-oesophageal reflux disease (GORD) based on your symptoms.
They may prescribe medication to treat it without needing to carry out any tests. Read more about treating GORD.
When tests may be needed
You’ll usually only need to be referred for tests in hospital if:
- your GP is unsure whether you have GORD
- your symptoms are persistent, severe or unusual
- prescription medications aren’t controlling your symptoms
- your GP thinks you might benefit from surgery
- you have signs of a potentially more severe condition, such as difficulty swallowing or unexplained weight loss
Tests can help to confirm the diagnosis of GORD, check for other possible causes of your symptoms and determine whether you may be suitable for surgery.
Tests for GORD
Tests you may have include:
Endoscopy
An endoscopy is a procedure where the inside of your body is examined using an endoscope, which is a long, thin, flexible tube with a light and camera at one end.
The endoscope will be gently inserted into your mouth and down your throat. The procedure is usually carried out while you’re awake, but you may be given a sedative to help you relax.
The camera can show if the surface of your oesophagus (gullet) has been damaged by stomach acid, although this doesn’t happen to everyone with GORD.
Barium swallow or barium meal
A barium swallow, or barium meal, is a test to assess your swallowing ability and look for any blockages or abnormalities in your oesophagus.
You are first given some barium solution, then some X-rays are taken. Barium is a harmless substance that shows up clearly on X-rays as it passes through your digestive system.
You’ll be asked not to eat anything for a few hours before the procedure. Afterwards, you’ll be able to eat and drink normally, although you may need to drink more water to help flush the barium out of your body.
Manometry
Manometry is used to assess how well the ring of muscle at the end of your oesophagus is working, by measuring the pressure in your oesophagus.
This can rule out other possible causes of your symptoms and can help determine whether surgery would be suitable.
During the procedure, a small tube will be passed up your nose and then down into your oesophagus. The tube contains pressure sensors that can detect the pressure in the oesophagus.
24-hour pH monitoring
It may be necessary to measure the acidity level (pH) in your oesophagus to confirm a diagnosis of GORD if nothing is found during an endoscopy.
The acidity level is measured over 24 hours, using a thin tube containing a sensor that’s passed up your nose and down your oesophagus. This is usually connected to a recording device worn on your waist.
You’ll be asked to press a button on the recorder every time you become aware of your symptoms and to record your symptoms in a diary. You should eat as you normally would during the test to ensure an accurate result.
Blood tests
Sometimes a blood test may be carried out to check for anaemia, which can be a sign of internal bleeding
Treating GORD and Heartburn
Heartburn and gastro-oesophageal reflux disease (GORD) can often be treated with self-help measures and over-the-counter medicines.
If these don’t help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option.
Self-help
You may find the following measures can help reduce heartburn and other symptoms of GORD:
- Eat smaller and more frequent meals, rather than three large meals a day – don’t eat or drink alcohol within three or four hours before going to bed, and avoid having your largest meal of the day in the evening.
- Avoid anything you think triggers your symptoms – common triggers include coffee, chocolate, tomatoes, alcohol, and fatty or spicy food.
- Don’t wear tight clothing – clothes that are tight around your tummy may make your symptoms worse.
- Raise the head of your bed by up to 20cm (8 inches) – placing a piece of wood or blocks underneath one end of your bed may reduce symptoms at night; don’t just use extra pillows, as this can put a strain on your tummy.
- Try to relax – stress can make heartburn and GORD worse, so learning relaxation techniques may help if you’re often feeling stressed.
- Maintain a healthy weight – if you’re overweight, losing weight may help reduce your symptoms.
- Stop smoking – smoke can irritate your digestive system and may make your symptoms worse.
If you’re taking medication for other health conditions, check with your GP to find out whether they could be contributing to your symptoms.
Different medicines may be available, but don’t stop taking any prescribed medication without consulting your GP first.
Medication
A number of different medications can be used to treat symptoms of GORD.
Over-the-counter medicines
Over-the-counter heartburn and GORD medicines are available from pharmacies without a prescription. The main types are:
- antacids – these neutralise the effects of stomach acid
- alginates – these produce a coating that protects the stomach and oesophagus (gullet) from stomach acid
- low-dose proton-pump inhibitors and H2-receptor antagonists – see below for more information about these
These medicines aren’t suitable for everyone, so you should check the leaflet first. Ask a pharmacist for advice if you’re not sure.
Proton-pump inhibitors (PPIs)
If your symptoms don’t get better despite trying self-help measures and over-the-counter medicines, your GP may prescribe a PPI. These work by reducing the amount of acid produced by your stomach.
You’ll usually be given enough medication to last a month. Go back to your GP if they don’t help or your symptoms return after treatment finishes. Some people need to take PPIs on a long-term basis.
The possible side effects of PPIs are usually mild. They include headaches, diarrhoea or constipation, feeling sick, abdominal (tummy) pain, dizziness and a rash.
Your GP will prescribe the lowest dose that they think will control your symptoms to reduce the risk of side effects.
H2-receptor antagonists (H2RAs)
If PPIs don’t control your symptoms, a medicine known as a H2RA may be recommended for you to take alongside them on a short-term basis, or as an alternative.
Like PPIs, H2RAs reduce the amount of acid produced by your stomach.
Side effects of H2RAs are uncommon, but can include diarrhoea, headaches, dizziness, a rash and tiredness.
Surgery and procedures
Surgery may be an option if:
- the above treatments don’t help, aren’t suitable for you, or cause troublesome side effects
- you don’t want to take medication on a long-term basis
The main procedure used is called a laparoscopic Nissen fundoplication (LNF). Alternative techniques have been developed more recently, although these aren’t yet widely available.
Laparoscopic Nissen fundoplication (LNF)
LNF is a type of laparoscopic or “keyhole” surgery. This means it’s carried out using special surgical instruments inserted through small cuts (incisions) in the skin.
The procedure is used to tighten the ring of muscle at the bottom of the oesophagus, which helps to stop acid leaking up from the stomach. It’s carried out in hospital under general anaesthetic.
Most people need to stay in hospital for two or three days after the procedure. Depending on your job, you may be able to return to work within three to six weeks.
For the first six weeks after surgery, you should only eat soft food, such as mince, mashed potatoes or soup. Some people experience problems with swallowing, belching and bloating after LNF, but these should get better with time.
Newer operations and procedures
In the last few years, several new techniques for treating GORD have been developed.
The National Institute for Health and Care Excellence (NICE) says these procedures appear to be safe, but not much is known about their long-term effects.
These techniques include:
- Endoscopic injection of bulking agents – where special filler is injected into the area between the stomach and oesophagus to make it narrower.
- Endoluminal gastroplication – where folds are sown into the ring of muscles at the bottom of the oesophagus to restrict how far it can open.
- Endoscopic augmentation with hydrogel implants – where implants containing special gel are placed into the area between the stomach and oesophagus to make it narrower.
- Endoscopic radiofrequency ablation – where a tiny balloon is passed down to the bottom of the oesophagus and electrodes attached to it are used to heat it and make it narrower.
- Laparoscopic insertion of a magnetic bead band (LINX) – where a ring of magnetic beads are implanted around the lower part of the oesophagus to strengthen it and help keep it closed when not swallowing.
Speak to your surgeon about these techniques for more information.
Complications of GORD and Heartburn
The best way to prevent an allergic reaction is to avoid the allergen that causes it. This is not always easy. Allergens such as dust mites or fungal spores can be hard to spot and can breed in even the cleanest house.
It can also be hard to avoid pets, particularly if they belong to friends and family, and many food allergies are triggered because people do not realise they are eating food they are allergic to.
Below is some practical advice that should help you to avoid the most common allergens.
House dust mites
One of the biggest causes of allergies are dust mites. Dust mites are microscopic insects that breed in household dust. Below are a number of ways that you can limit the amount of mites in your house.
- Choose wood or hard vinyl floor coverings instead of a carpet.
- Fit roller blinds that can be easily wiped clean.
- Clean cushions, soft toys, curtains and upholstered furniture regularly, either by washing or vacuuming.
- Use synthetic pillows and acrylic duvets instead of woollen blankets or feather bedding.
- Use a vacuum cleaner fitted with a HEPA (high efficiency particulate air) filter, because it can remove more dust than ordinary vacuum cleaners.
- Wipe surfaces with a damp, clean cloth, as dry dusting can spread the allergens further.
Concentrate your efforts at controlling dust mites in the areas of your home where you spend the most time, such as the bedroom and living room.
Pets
It is not the pet fur that causes an allergic reaction, it is exposure to flakes of their dead skin, saliva and dried urine.
If you cannot permanently remove a pet from the house, you may find the following tips useful.
- Keep pets outside as much as possible, or limit them to one room, preferably one without carpet.
- Do not allow pets in bedrooms.
- Wash pets at least one a fortnight.
- Groom dogs regularly outside.
- Wash all bedding and soft furnishings on which a pet has lain.
If you are visiting a friend or relative with a pet, ask them not to dust or vacuum on the day you are visiting, as this will stir up the allergens into the air. Taking an antihistamine medicine one hour before entering a pet-inhabited house can help to reduce symptoms.
Mould spores
Moulds can grow on any decaying matter, both inside and outside the house. The moulds themselves are not allergens but the spores they release are. Spores are released when there is a sudden rise in temperature in a moist environment, such as when central heating is turned on in a damp house, or someone dries wet clothes next to a fireplace.
Some ways that you can prevent mould spores are outlined below.
- Keep your home dry and well ventilated.
- When showering or cooking, keep internal doors closed to prevent damp air from spreading through the house and use extractor fans.
- Do not dry clothes indoors, store clothes in damp cupboards, or pack clothes too tightly in wardrobes.
- Deal with any damp and condensation in your home.
Pollen allergies
Pollen allergies, more commonly known as hay fever, are caused when plants release pollen particles into the air (pollinate). Different plants pollinate at different times of the year, so the months that you get hay fever will depend on what sort of pollen(s) you are allergic to. Typically, people are affected during spring and summer.
To avoid exposure to pollen you can:
- Check weather reports for the pollen count and stay indoors when it is high.
- Avoid drying clothes and bedding outside when the pollen count is high.
- Wear wraparound sunglasses to protect your eyes from pollen.
- Keep doors and windows shut during mid-morning and early evening, when there is most pollen in the air.
- Shower, wash your hair and change your clothes after being outside.
- Avoid grassy areas, such as parks and fields.
- Get someone else to cut the grass for you if you have a lawn.
Severe allergies
If you have ever had a severe allergic reaction (anaphylaxis), you should carry two EpiPens or Anapens with you everywhere you go.
Wear a MedicAlert or Medi-Tag medallion or bracelet, so people are aware of your allergy in an emergency, and consider telling your teachers, work colleagues and friends so they can give you your adrenaline injection in an emergency and call an ambulance. Following this advice could save your life.