Gastro-oesophageal reflux (GORD)

After you swallow food, it travels down your oesophagus (the tube between your throat and stomach) into your stomach. A ring of muscle (called the lower oesophageal sphincter) acts as a valve between your oesophagus and your stomach. This valve prevents stomach acid from going back up your oesophagus.

GORD happens when the valve doesn't work properly and it lets acid flow (reflux) into your oesophagus. This is known as acid reflux. If you have acid reflux often, it can lead to inflammation of the lining of your oesophagus. This is known as oesophagitis.

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Heartburn is the main symptom of GORD. This is a burning feeling that rises up from your upper stomach or lower chest up towards your neck.

Other common symptoms include:

• pain in your upper abdomen or chest
• feeling sick (nausea)
• an acid taste in your mouth
• indigestion (dyspepsia)
• a burning pain when you swallow hot drinks.

These symptoms tend to be worse after a meal.

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

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

One of the main risk factors for GORD is being overweight. 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 weight resting on your stomach. Other risk factors include pregnancy, smoking, abnormalities of your oesophagus and eating certain foods.

Pregnancy

Many women get heartburn during later stages of pregnancy, when your womb pushes up against your 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 frequent coughing leading to hiatus hernia. A hiatus hernia is where the upper part of your stomach is pushed up into your upper chest cavity through an opening in your diaphragm, affecting the functioning of the lower oesophageal sphincter. Read more about hiatus hernia.

Abnormalities of the oesophagus

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

Eating certain foods

Foods that can make the symptoms of GORD worse include:

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

See your doctor if you are having heartburn regularly and ongoing. To make a diagnosis of GORD, your doctor will take your medical history and conduct a physical examination. A diagnosis of GORD is highly likely if regular and ongoing heartburn is your main symptom. Further tests may be required to work out how severe your GORD is or whether there is any damage to your oesophagus.

Tests may include:

• an endoscopy – this 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 – this involves using an acid monitor (a thin tube with a sensor at one end) to measure acidity levels in your oesophagus.

It is important to begin treating GORD as soon as possible after diagnosis. Left untreated, acid reflux will continue to damage your oesophagus and create other complications. There are 3 main types of medicines used to treat GORD. The type of medicine prescribed depends on how severe your symptoms are. These medicines from mildest to strongest are antacids (with or without alginates), H2-receptor blockers and proton pump inhibitors. 

• Antacids neutralise stomach acids and provide rapid relief of symptoms especially if your condition is mild. Some antacid medicines also contain alginates, which are substances that form a raft on top of stomach contents. This stops food and acid from refluxing. Antacids don't help to heal oesophageal damage or prevent heartburn from happening again. Antacid brands include Mylanta, Eno, Quick-Eze and Gaviscon. Antacids may be prescribed or bought over the counter with advice from your pharmacist. 
• H2-receptor blockers reduce the production of stomach acid and give relief in many people, especially if you have less severe GORD. They are slower acting than antacids but provide longer term relief. For many people, this treatment allows your oesophagus to heal and relieves the symptoms entirely. Examples of available H2-receptor blockers include cimetidine and famotidine. Previously ranitidine was used but has been withdrawn from sale due to safety concerns. 
• Proton-pump inhibitors (PPIs) block stomach acid production and help to heal your oesophagus. They are recommended for severe GORD symptoms. They iinclude omeprazole and lansoprazole. Read more about proton-pump inhibitors. 

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

Medicines 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.

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

• If you are overweight, try losing weight. Excess weight puts pressure on your stomach, causing acid to back up your 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/valve.
• Cut back on how much alcohol and caffeine you drink.
• Stay upright after a meal and use gravity to help keep stomach acid 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 (to lift your head slightly higher than your stomach).
• Avoid or reduce the use of non-steroidal anti-inflammatory drugs (NSAIDs).

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