Video: Gastroesophageal Reflux (GERD)
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(Cleveland Clinic, US, 2019)
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This video may take a few moments to load.
(Cleveland Clinic, US, 2019)
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.
Image credit: Canva
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:
These symptoms tend to be worse after a meal.
Less common symptoms caused by acid irritating the nearby windpipe include:
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:
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:
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.
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:
You may find it useful to look at some Nutrition, exercise and weight management apps.
Heartburn (reflux)(external link) Gastroenterological Society of Australia
Acid reflux and oesophagitis(external link) PatientInfo, UK
Dyspepsia and heartburn/GORD(external link) Auckland Regional HealthPathways, NZ, 2020
Educational series on gastro-oesophageal reflux disease (GORD) management Research Review, NZ, 2020
Stopping proton pump inhibitors in older people(external link) BPAC, NZ, 2019
Managing gastro-oesophageal(external link) reflux (GORD) in adults – an update(external link) BPAC, NZ, 2014
Managing heartburn undifferentiated dyspepsia and functional dyspepsia in general practice(external link) BPAC, NZ, 2007
Management of dyspepsia and heartburn(external link) NZ Guidelines Group, 2004
Medicines containing ranitidine and a potential impurity, N-nitrosodimethylamine (NDMA)(external link) Medsafe, NZ, 2019
Ranitidine (recall)(external link) PHARMAC, NZ, 2021
GORD by Dr Anurag Sekra(external link) (The Goodfellow Unit, NZ, 2018)
Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.
Reviewed by: Dr Alice Miller, FRNZCGP
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