Gastro-oesophageal reflux disease (GORD)

When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the oesophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GOR is common and does not necessarily mean one has GORD. Persistent reflux that occurs more than twice a week is considered GORD, and it can eventually lead to more serious health problems. People of all ages can have GORD.

What are the symptoms of GORD?

The main symptom of GORD in adults is frequent heartburn, also called acid indigestion-burning-type pain in the lower part of the mid-chest, behind the breastbone, and in the mid-abdomen. Some adults have GORD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing.

What causes GORD?

The reason some people develop GORD is still unclear. However, research shows that in people with GORD, the LOS relaxes while the rest of the oesophagus is working. Anatomical abnormalities such as a hiatus hernia may also contribute to GORD. A hiatus hernia occurs when the upper part of the stomach and the LOS move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LOS keep acid from rising up into the oesophagus. When a hiatus hernia is present, acid reflux can occur more easily. A hiatus hernia can occur in people of any age and is most often a normal finding in otherwise healthy people over age 50. Most of the time, a hiatus hernia produces no symptoms.

Other factors that may contribute to GORD include obesity, pregnancy, smoking and drinking alcohol/caffeinated drinks.

Common foods that can worsen reflux symptoms include citrus fruits, chocolate, drinks with caffeine or alcohol, fatty and fried foods, garlic and onions, mint flavorings, spicy foods, tomato-based foods, like spaghetti sauce, salsa, chillies, and carbonated drinks.

How is GORD treated?

Depending on the severity of your GORD, treatment may involve one or more of the following: lifestyle changes, medications, or surgery.

Lifestyle Changes

This includes smoking cessation, avoiding foods and beverages that worsen symptoms, losing weight if needed, eating small and frequent meals, wearing loose-fitting clothes, avoiding lying down for 3 hours after a meal, and raising the head of your bed 6 to 8 inches by securing wood blocks under the bedposts (just using extra pillows will not help).

Medications

• Antacids
  Antacids are usually the first drugs recommended to relieve heartburn and other mild GORD symptoms. Many brands on the market use different combinations of three basic salts-magnesium, calcium, and aluminum-with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhoea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects. Calcium carbonate antacids can also be a supplemental source of calcium. They can cause constipation as well.

• Foaming agents
  Foaming agents, such as gaviscon, work by covering your stomach contents with foam to prevent reflux.

• H2 blockers
  H2 blockers, such as ranitidine (Zantac), decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GORD symptoms.

• Proton pump inhibitors
  Proton pump inhibitors include omeprazole, lansoprazole, pantoprazole and esomeprazole (Nexium), which are available by prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the oesophageal lining in almost everyone who has GORD.

• Prokinetics
  Prokinetics help strengthen the LOS and make the stomach empty faster. They have frequent side effects that limit their usefulness-fatigue, sleepiness, depression, anxiety, and problems with physical movement.

Because drugs work in different ways, combinations of medications may help control symptoms.