Gastro-oesophageal reflux disease (GORD or GERD)

Gastro-oesophageal reflux disease – also known as GORD or GERD – is a serious digestive disease.

GORD is common and occurs when acid from the stomach leaks out of the stomach and up into the oesophagus (gullet) – this is known as acid reflux. The oesophagus is a long muscular tube that runs from the mouth to the stomach.

In a person suffering from GORD, the lower oesophageal sphincter muscle (LOS) – which acts as a valve keeping stomach acid in the stomach – does not work effectively. This causes acid to leak out of the stomach and up into the throat, causing a burning sensation in the chest or throat, that is, heartburn.

Acid production is, in fact, a normal bodily function, however, it becomes GORD when it leads to physical complications that detrimentally affect a person’s health and wellbeing like inflammation that may be erosive or non-erosive. Oesophageal cancer is a rare and more serious complication.

Risk factors for GORD include:

  • Obesity
  • Smoking
  • Excessive coffee consumption
  • Excessive alcohol consumption
  • Acute stress
  • Hiatus hernia
  • During pregnancy
  • Eating a diet high in fatty foods

What are its symptoms?

The most common symptoms of GORD are heartburn, acid reflux, difficulty swallowing (dysphagia) and pain swallowing (odynophagia).

Heartburn presents as a burning pain in the area just below your breastbone. This worsens when you are eating, bending over or lying down.

Acid reflux occurs when acid is regurgitated into your throat and mouth. This causes a sour taste in your throat or the back of your mouth.

Dysphagia occurs when acid scarring causes the oesophagus to narrow, making it difficult to swallow.

GORD can sometimes have a number of less common symptoms associated with the irritation and damage caused by stomach acid. This includes:

  • Feeling ill
  • Persistent cough, which is often worse at night
  • Chest pain
  • Wheezing
  • Tooth decay
  • Laryngitis (inflammation of your voice box)
  • Sore throat

If you have gastro-oesophageal reflux disease and asthma, your symptoms may be exacerbated by the acid irritating your airways.

GORD is also common in babies under two years of age as their oesophagus is short and narrow.

In younger children, GORD symptoms include:

  • Frequent crying
  • Sleeping problems
  • Vomitting up food soon after feeding
  • Irritability
  • Bad breath
  • Arching their back during or after a feed

While these symptoms are common in babies, you should contact your GP if they occur frequently.

How is it diagnosed?

If you suspect you have GORD, consult your doctor who will ask you about your symptoms and medical history, and may be able to diagnose GORD based on frequent heartburn and other symptoms.

A number of tests may also be recommended in a gastro-oesophageal reflux disease diagnosis. These include:

  • An ambulatory acid (pH) probe test uses a device to measure acid for 24 hours. It identifies when, and for how long, stomach acid regurgitates into your oesophagus. There are two monitors: A catheter that's threaded through your nose into your oesophagus, and a clip that’s placed in your oesophagus during an endoscopy.
  • X-ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, this procedure involves drinking a chalky liquid (Barium) that coats and fills the inside lining of your digestive tract. Then X-rays are taken of your upper digestive tract.
  • A flexible tube to look inside your oesophagus. Endoscopy is a way to visually examine the inside of your oesophagus and stomach.
  • An endoscopy to collect a sample of tissue (biopsy) for further testing.
  • A test to measure the movement of the oesophagus. Oesophageal motility testing (manometry) measures movement and pressure in the oesophagus. The test involves placing a catheter through your nose and into your oesophagus.

What are your treatment options?

Dietary and lifestyle changes, over-the-counter heartburn remedies, and surgery in acute cases are GORD treatment options. Treatment is aimed at decreasing the degree of reflux and reducing damage to the oesophagus lining.

Remedies include:

  • Knowing the foods to avoid such as chocolate, fatty foods, coffee, alcohol, citrus fruits, tomatoes and pepper
  • Decreasing food portion sizes
  • Eating meals at least three hours before bedtime
  • Losing weight
  • Stopping smoking
  • Elevating the head of your bed (gravity minimises reflux)

Over-the-counter heartburn remedies include antacids, which neutralise stomach acid to help relieve heartburn. While antacids can be effective for short-term heartburn relief, if symptoms persist, consult your doctor. More effective medicines such as proton-pump inhibitors (PPIs) or H2-receptor antagonists (H2RAs) can be prescribed. These reduce the amount of acid produced by the stomach.

When medication and lifestyle changes aren't enough, GORD surgery may be needed. Laparoscopic anti-reflux surgery is a minimally invasive procedure that corrects GORD by creating an improved valve mechanism at the bottom of the oesophagus.

Speak to your doctor about other new treatment techniques, including injections and implants.

Can it be prevented?

The most effective way to prevent GORD is to identify your personal triggers and eliminate them. While different people suffer from GORD for different reasons, there are numerous common triggers.

Avoid triggering an attack by following these home remedies:

  • Lose weight
  • Quit smoking
  • Don't eat close to bedtime
  • Eat smaller portions 
  • Avoid fatty foods
  • Avoid trigger foods
  • Avoid over-the-counter medications that may cause heartburn, such as aspirin.
The accuracy of this information was checked and approved by physician Dr Thomas Blake in June 2015