What is Gastroesophageal reflux disease?
Gastroesophageal reflux disease (GORD) occurs due to excessive exposure of the oesophagus (foodpipe) to gastric contents (especially acid) which reflux from the stomach into the oesophagus leading to unpleasant symptoms. These symptoms include heartburn (a burning type sensation often felt in the lower chest and moving towards the neck or throat) and regurgitation. Other symptoms can include chest tightness, excessive salivation (known as waterbrash), cough, asthma, belching and nausea. GORD is common, with approximately 15-20% of adults experiencing heartburn at least once a week.
GORD is more likely to occur in patients who are overweight or have an hiatus hernia (when the stomach slips above the diaphragm into the lower chest). It can also be aggravated by fatty food, alcohol, caffeine, chocolate and smoking.
How is GORD diagnosed?
A description of one or more of the symptoms listed above, as well as a complete or partial response to treatment with acid lowering medications is often sufficient to make a diagnosis.
An upper GI endoscopy (gastroscopy) is often used to assist in the diagnosis, though only about 1/3 of patients with GORD will actually have visible inflammation in the lower oesophagus (known as reflux oesophagitis). A normal appearing oesophagus and stomach on gastroscopy does not exclude the diagnosis.
Occasionally a test known as a 24hr pH monitor may be used to confirm the diagnosis.
Some patients with GORD develop changes in the lining of the lower oesophagus known as Barrett’s mucosa, which can slightly increase the risk of oesophageal cancer. This condition often requires ongoing gastroscopies for oesophageal dysplasia screening. Other complications of reflux include narrowing of the oesophagus due to scar tissue (a stricture) which can lead to swallowing difficulties (dysphagia).
What are the treatments for GORD?
The most commonly used and effective treatment are a group of medications known as proton pump inhibitors (PPIs) which lowers the acidity of gastric secretions. Another group of medications that also act to reduce acid are H2 receptor blockers, some of which are available over the counter. Antacids can also provide effective short term relief. Weight loss and lifestyle changes are also helpful.