Gastro-oesophageal reflux disease (GORD) is a digestive condition where stomach acid flows back into the oesophagus. This backward flow can irritate the oesophageal lining. While occasional acid reflux is common, GORD is a more persistent and severe form.
GORD Causes and Risk Factors
GORD primarily arises when the lower oesophageal sphincter (LES), a ring of muscle at the bottom of the oesophagus, weakens or relaxes inappropriately. Normally, this muscle opens to allow food into the stomach and then closes to prevent stomach contents from returning upwards. When the LES does not close properly, stomach acid can leak back into the oesophagus, causing symptoms. Issues with how food moves through the stomach or slow stomach emptying can also contribute to GORD.
Several factors can increase the likelihood of developing GORD. Being overweight or obese puts increased pressure on the stomach, which can weaken the LES. A hiatus hernia, where a portion of the stomach pushes up through the diaphragm, can also disrupt the normal function of the LES. Pregnancy can temporarily cause GORD due to hormonal changes and increased abdominal pressure.
Lifestyle choices and certain substances also play a role. Smoking, alcohol consumption, and even coffee or chocolate can relax the LES muscle. Eating large amounts of fatty foods can slow stomach emptying, allowing excess acid to potentially leak into the oesophagus. Some medications, such as calcium channel blockers, nitrates, and non-steroidal anti-inflammatory drugs (NSAIDs), may also cause or worsen GORD symptoms.
Recognizing GORD Symptoms
The most common symptoms of GORD are heartburn and acid regurgitation. Heartburn is an uncomfortable burning sensation in the chest, often occurring after eating. Acid regurgitation involves stomach acid or food coming back up into your mouth or throat, causing an unpleasant, sour taste. Some individuals may also experience pain or difficulty when swallowing, known as dysphagia.
Beyond these typical oesophageal symptoms, GORD can manifest with extraoesophageal symptoms. These include a chronic cough, hoarseness, and even asthma-like symptoms. Dental erosion can also occur due to the repeated exposure of teeth to stomach acid. These less obvious symptoms can sometimes make GORD diagnosis more challenging.
GORD can also cause oesophagitis (a sore or inflamed oesophagus), bad breath, bloating, belching, and nausea or vomiting. Symptoms vary in severity and frequency.
How GORD is Diagnosed
Diagnosing GORD begins with a review of your medical history and symptoms. A healthcare professional can diagnose GORD based on characteristic symptoms. If symptoms are severe, frequent, or unresponsive to initial treatments, further diagnostic tests may be recommended.
One common diagnostic tool is an endoscopy, where a thin, flexible tube with a camera is inserted down the oesophagus to visualize its lining and check for inflammation or damage. pH monitoring (e.g., 24-hour oesophageal pH impedance monitoring) directly measures acid exposure and helps determine the frequency and duration of reflux episodes. Oesophageal manometry may also assess the function and strength of the oesophageal muscles, including the LES.
GORD Treatment Options
Managing GORD involves a combination of lifestyle changes and medication. Simple adjustments to daily habits can significantly reduce symptoms. Eating smaller, more frequent meals instead of three large ones can help, as can avoiding eating or drinking alcohol within three to four hours before bedtime. Elevating the head of the bed by six to eight inches can use gravity to help prevent acid reflux during sleep.
Dietary modifications are also beneficial; common triggers like coffee, chocolate, tomatoes, alcohol, and fatty or spicy foods should be avoided if they worsen symptoms. Quitting smoking and maintaining a healthy weight can reduce pressure on the stomach and strengthen the LES. Avoiding tight clothing around the abdomen can also alleviate symptoms.
Pharmacological treatments are widely used to manage GORD. Over-the-counter antacids provide quick relief by neutralizing stomach acid. H2-receptor blockers reduce acid production and offer longer-lasting relief. Proton pump inhibitors (PPIs) are more potent, significantly reducing stomach acid production and allowing the oesophagus to heal. For severe cases unresponsive to lifestyle changes or medication, surgical options like fundoplication, which reinforces the LES, may be considered.
Potential GORD Complications
If GORD is left untreated or poorly managed over an extended period, it can lead to several complications. One common issue is oesophagitis, which is inflammation of the oesophagus caused by repeated acid exposure. Chronic inflammation can then lead to the formation of oesophageal ulcers, open sores that can cause pain and bleeding.
Another potential complication is an oesophageal stricture, a narrowing of the oesophagus resulting from scar tissue formation due to long-term inflammation. This narrowing can make swallowing difficult and painful. A more serious concern is Barrett’s oesophagus, a condition where the cells lining the lower part of the oesophagus change, becoming similar to those found in the intestine. While rare, Barrett’s oesophagus increases the risk of developing oesophageal cancer.