Gastro-oesophageal reflux disease (GORD)
How heartburn and GERD occur
Gastro-oesophageal reflux disease (GORD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (oesophagus). This backwash (acid reflux) can irritate the lining of your oesophagus.
Many people experience acid reflux from time to time. GORD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week.
Most people can manage the discomfort of GORD with lifestyle changes and over-the-counter medications. But some people with GORD may need stronger medications or surgery to ease symptoms.
Symptoms
Common signs and symptoms of GORD include:
• A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in your throat
If you have night-time acid reflux, you might also experience:
• Chronic cough
• Laryngitis
• New or worsening asthma
• Disrupted sleep
When to see a doctor
Seek immediate medical care if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be signs and symptoms of a heart attack.
Make an appointment with your doctor if you:
• Experience severe or frequent GORD symptoms
• Take over-the-counter medications for heartburn more than twice a week
Causes
GORD is caused by frequent acid reflux.
When you swallow, a circular band of muscle around the bottom of your oesophagus (lower oesophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again.
If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your oesophagus. This constant backwash of acid irritates the lining of your oesophagus, often causing it to become inflamed.
Risk factors
Conditions that can increase your risk of GORD include:
• Obesity
• Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
• Pregnancy
• Connective tissue disorders, such as scleroderma
• Delayed stomach emptying
Factors that can aggravate acid reflux include:
• Smoking
• Eating large meals or eating late at night
• Eating certain foods (triggers) such as fatty or fried foods
• Drinking certain beverages, such as alcohol or coffee
• Taking certain medications, such as aspirin
Complications
Over time, chronic inflammation in your oesophagus can cause:
• Narrowing of the oesophagus (oesophageal stricture). Damage to the lower oesophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing.
• An open sore in the oesophagus (oesophageal ulcer). Stomach acid can wear away tissue in the oesophagus, causing an open sore to form. An oesophageal ulcer can bleed, cause pain and make swallowing difficult.
• Precancerous changes to the oesophagus (Barrett's oesophagus). Damage from acid can cause changes in the tissue lining the lower oesophagus. These changes are associated with an increased risk of oesophageal cancer.
Diagnosis & Treatment
Diagnosis
Endoscopy
Your doctor might be able to diagnose GORD based on a physical examination and history of your signs and symptoms.
To confirm a diagnosis of GORD, or to check for complications, your doctor might recommend:
• Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your oesophagus and stomach. Test results can often be normal when reflux is present, but an endoscopy may detect inflammation of the oesophagus (esophagitis) or other complications.
An endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for complications such as Barrett's oesophagus.
• Ambulatory acid (pH) probe test. A monitor is placed in your oesophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that you wear around your waist or with a strap over your shoulder. The monitor might be a thin, flexible tube (catheter) that's threaded through your nose into your oesophagus, or a clip that's placed in your oesophagus during an endoscopy and that gets passed into your stool after about two days.
• Oesophageal manometry. This test measures the rhythmic muscle contractions in your oesophagus when you swallow. Oesophageal manometry also measures the coordination and force exerted by the muscles of your oesophagus.
• X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your oesophagus, stomach and upper intestine.
You may also be asked to swallow a barium pill that can help diagnose a narrowing of the oesophagus that may interfere with swallowing.
Treatment
GORD Surgery
Substitute for oesophageal sphincter
Your doctor is likely to recommend that you first try lifestyle modifications and over-the-counter medications. If you don't experience relief within a few weeks, your doctor might recommend prescription medication or surgery.
Over-the-counter medications
The options include:
• Antacids that neutralize stomach acid. Antacids may provide quick relief. But antacids alone won't heal an inflamed oesophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhoea or sometimes kidney problems.
• Medications to reduce acid production. These medications — known as H-2-receptor blockers — include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid AR). H-2-receptor blockers don't act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions are available by prescription.
• Medications that block acid production and heal the esophagus. These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged oesophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC).
Prescription medications
Prescription-strength treatments for GORD include:
• Prescription-strength H-2-receptor blockers. These include prescription-strength famotidine (Pepcid) and nizatidine. These medications are generally well-tolerated but long-term use may be associated with a slight increase in risk of vitamin B-12 deficiency and bone fractures.
• Prescription-strength proton pump inhibitors. These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant). Although generally well-tolerated, these medications might cause diarrhoea, headache, nausea and vitamin B-12 deficiency. Chronic use might increase the risk of hip fracture.
• Medication to strengthen the lower oesophageal sphincter. Baclofen may ease GORD by decreasing the frequency of relaxations of the lower oesophageal sphincter. Side effects might include fatigue or nausea.
Surgery and other procedures
GORD can usually be controlled with medication. But if medications don't help or you wish to avoid long-term medication use, your doctor might recommend:
• Fundoplication. The surgeon wraps the top of your stomach around the lower oesophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of the stomach can be partial or complete.
• LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and oesophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The LINX device can be implanted using minimally invasive surgery.
• Transoral incisionless fundoplication (TIF). This new procedure involves tightening the lower oesophageal sphincter by creating a partial wrap around the lower oesophagus using polypropylene fasteners. TIF is performed through the mouth with a device called an endoscope and requires no surgical incision. Its advantages include quick recovery time and high tolerance.
If you have a large hiatal hernia, TIF alone is not an option. However, it may be possible if TIF is combined with laparoscopic hiatal hernia repair.
Care at Chartwell Hospital
At Chartwell Digestive Health we have a team of experienced gastroenterology specialists, dedicated to providing the best possible care for all of our patients.
We diagnose and treat common abdominal symptoms such as rectal bleeding, change in bowel habit and abdominal pain which can be distressing for patients. In most cases, the symptoms are due to underlying health problems. However, for more serious cases, early detection, diagnosis, and treatment is key to recovery.
Our specialist team use comprehensive examinations and testing to diagnose various conditions. In addition to testing blood and stool samples, our Consultant Gastroenterologists may use other diagnostic tools including colonoscopy, gastroscopy, flexible sigmoidoscopy, MRI, X-rays, and CT scans.
If you have GORD, or think you might be suffering from the condition, don’t hesitate to contact us at Chartwell Digestive Hospital to get the care you need.
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