Everything you Need to Know …and More
Essential Information about Gastro-Oesophageal Reflux Disease (GORD)
What is Gastro-Oesophageal Reflux Disease?
Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet).
What are the main Symptoms of GORD?
Symptoms of GORD can include:
- Heartburn and acid refluxÂ
- Oesophagitis -a sore, inflamed oesophagus
- Dysphagia – pain when swallowing and/or difficulty swallowing
- A sore throat
- A hoarse voice
- A sour taste in your mouth
- Bad breath
- Bloating and belching
- Feeling or being sick
- A persistent cough or wheezing, which may be worse at night
- Tooth decay and gum disease
What Causes Gastro-Oesophageal Reflux Disease (GORD)
Gastro-oesophageal reflux disease (GORD) is usually caused by the ring of muscle at the bottom of the oesophagus (gullet) becoming weakened. Normally, this ring of muscle opens to let food into your stomach and closes to stop stomach acid leaking back up into your oesophagus. Howeverfor people with GORD, stomach acid is able to pass back up into the oesophagus. This causes symptoms of GORD, which can include heartburn and acid reflux.
It’s not always clear what causes this ring of muscle to become weakened, but certain things can increase the risk of it happening.
- Being overweight or obese – this can place increased pressure on your stomach and weaken the muscles at the bottom of the oesophagus
- Eating large amounts of fatty foods – the stomach takes longer to get rid of stomach acid after digesting a fatty meal and the resulting excess acid may leak up into the oesophagus
- Smoking, alcohol, coffee or chocolate – these may relax the muscles at the bottom of the oesophagus
- Pregnancy – temporary changes in hormone levels and increased pressure on your stomach during pregnancy can cause GORD
- Hiatus hernia – when part of your stomach pushes up through your diaphragm (thin sheet of muscle between the chest and tummy)
- Gastroparesis – when the stomach takes longer to get rid of stomach acid, which means excess acid can leak up into the oesophagus
- Certain medicines can cause GORD or make the symptoms worse, including calcium-channel blockers (used to treat high blood pressure), nitrates (used to treat angina) and non-steroidal anti-inflammatory drugs (NSAIDs)
- Stress
- GORD can sometimes affect several members of the same family and it’s been suggested that the genes you inherit from your parents may also affect your chances of developing the condition
Complications of Having GORD
If you have constant heartburn, indigestion or reflux for more than three weeks you should speak to your GP.
About 1 in 10 people with GORD will develop Barrett’s oesophagus. This is where repeated episodes of GORD can sometimes lead to changes in the cells in the lining of your lower oesophagus. Barrett’s oesophagus doesn’t usually cause noticeable symptoms other than those caused by GORD.
However, there’s a small risk that the changed cells could become cancerous in the future, as it’s estimated that 1 in every 10 to 20 people with Barrett’s oesophagus will develop Oesophageal cancer within 10 to 20 years.
Speak to your doctor if you experience any swallowing difficulties, or any other unusual or persistent symptoms. Surgery to remove the cancer can be carried out if it’s diagnosed at an early stage.
How is GORD Diagnosed?
Your GP may be able to diagnose gastro-oesophageal reflux disease (GORD) based on your symptoms.
You may need to be referred for tests if:
- Your GP is unsure whether you have GORD
- Your symptoms are persistent, severe or unusual
- Prescription medications aren’t controlling your symptoms
- You have signs of a potentially more severe condition, such as difficulty swallowing or unexplained weight loss
Tests can help to confirm the diagnosis of GORD, check for other possible causes of your symptoms and determine whether you may be suitable for surgery.
Tests could include:
- An endoscopy
- A barium swallow or barium meal test
- A manometry
- 24-hour pH monitoring
- Blood tests
How is GORD Treated?
The treatment you’ll be offered will may include:
- Over the counter medication – such as antacids
- Proton-pump inhibitors (PPIs) – prescribed by your GP, these work to reduce the amount of acid produced by your stomach
- Surgery – if the above treatments don’t help, aren’t suitable for you, you may be offered procedure a Laparoscopic Nissen Fundoplication (LNF)
There are also newer treatments that you may want to try:
- TiF (Transoral incisionless fundoplication)Â is an advanced endoscopy procedure used to treat GORD symptoms
- IQoro is a training device which can be used to improve muscle strength and is available on prescription from your GP in some areas
- RefluxStop is a ping pong sized silicone implant which is fixed to the upper part of the stomach to hold the lower oesophageal sphincter in place to stop acid leaking out.  In June 2024 the first patients in the UK received the RefluxStop device to stop acid reflux and heartburn. University Hospital Southampton (UHS) and Imperial College London have become the first NHS trusts in the country to install the device, with Southampton being the first to use robotic surgery for the procedure. RefluxStop is currently available at 2 NHS hospitals; St Mary’s London with surgeon Mr Ahmed Ahmed and University Hospital Southampton with Mr Fergus Noble, in addition, there is a private centre in London offering RefluxStop
Self Help for GORD
You may find the following measures can help reduce heartburn and other symptoms of GORD:
- Eat smaller and more frequent meals, rather than 3 large meals a day
- Don’t eat or drink alcohol within 3 or 4 hours before going to bed, and avoid having your largest meal of the day in the evening
- Avoid anything you think triggers your symptoms – common triggers include coffee, chocolate, tomatoes, alcohol, and fatty or spicy food
- Don’t wear tight clothing around your tummy may make your symptoms worse
- Raise the head of your bed – don’t just use extra pillows, as this can put a strain on your tummy
- Try to relax – stress can make heartburn and GORD worse, so learning relaxation techniques may help if you’re often feeling stressed
- Maintain a healthy weight – losing weight may help reduce your symptoms
- Stop smoking – smoke can irritate your digestive system and may make your symptoms worse
- If you’re taking medication for other health conditions, check with your GP to find out whether they could be contributing to your symptoms