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gastro-oesophageal reflux disease

Alternative Names
GORD, heartburn, reflux oesophagitis

In gastro-oesophageal reflux disease or GORD, stomach fluids travel, or reflux, from the stomach back into the food pipe or oesophagus (eh-sah-fah-gus). The oesophagus is a narrow, muscular tube that carries food from the mouth to the stomach. The ring of muscle that is at the bottom of the oesophagus is called the lower oesophageal sphincter. Although reflux may happen normally, it can become serious when the sphincter is not working properly.

What is going on in the body?
Once food is swallowed, it passes through the throat and into the oesophagus or food pipe. The sphincter opens to allow food to enter the stomach from the oesophagus, and then quickly closes to prevent the stomach's acids from flowing back.

The lower oesophageal sphincter should prevent the stomach contents from moving back up into the oesophagus. However, if the sphincter is relaxed, fluid can travel back up from the stomach into the oesophagus causing GORD symptoms.

What are the signs and symptoms of the disease?
The most common symptom of GORD is heartburn. Heartburn feels like a sour, burning feeling in the middle of the chest. This feeling can travel up the neck and into the mouth. It can also be felt in the back. Other symptoms of GORD include:
  • cough that does not go away
  • a need to constantly clear the throat
  • sore throat
  • hoarseness
  • loss of voice
  • chest pain
  • dental disease, such as erosion of tooth enamel
  • pneumonia
  • nausea and vomiting
  • wheezing or asthma
Symptoms do not usually last long and tend to come and go. If symptoms do last, oesophagitis, which is an inflammation of the oesophagus, or ulceration can occur and lead to constant pain.

What are the causes and risks of the disease?
GORD is one of the most common problems of the oesophagus. It can occur from eating certain foods or taking certain drugs. GORD also tends to be worse when the person lies flat after eating, especially after big meals. Being in the upright position tends to pull fluid back into the stomach.

Individuals with a hiatal hernia, which is a protruding of the stomach back up towards the mouth, or a weak lower oesophageal sphincter are more likely to develop GORD. People with a hiatal hernia have a condition in which the stomach pushes up into the diaphragm muscle. When this happens, the sphincter does not work properly. As a result, the fluid can easily leak back into the oesophagus.

Foods and drugs that can cause GORD in some people include:
  • caffeine
  • alcohol
  • peppermint
  • high-fat foods
  • chocolate
  • certain spices
  • anti-inflammatory drugs
What can be done to prevent the disease?
GORD can sometimes be prevented or decreased by avoiding foods that weaken the sphincter. These include caffeine, alcohol, peppermint, high-fat foods, and chocolate. A hiatal hernia or weak sphincter cannot be prevented.

GORD symptoms can also be made worse by:
  • being overweight
  • smoking
  • lying down too soon after eating
  • not sleeping with the torso, or upper body, elevated at least 15cm
  • eating a diet that includes a lot of fried and fatty foods, tomato, caffeine, and citrus products
  • late-night snacking
  • alcohol use
  • wearing clothing that is tight around the waist
  • medication use
How is the disease diagnosed?
GORD often goes undiagnosed. It is usually diagnosed by ruling out the other possible diseases. To confirm the diagnosis, the doctor may do an endoscopy. This procedure uses a small fibreoptic scope to look into the oesophagus. Small monitors can be dropped into the throat to monitor the acid level to confirm the diagnosis.

What are the long-term effects of the disease?
Most GORD sufferers have frequent, severe heartburn. This tears down and damages the cell wall lining of the oesophagus. Without treatment, GORD can lead to:
  • oesophagitis (ee-sah-fah-juy-tus). Oesophagitis means "inflammation of the oesophagus." Constant reflux of acid and other stomach contents causes redness and swelling of the oesophageal tissues. Very severe oesophagitis can result in ulcers and bleeding ulcers.
  • oesophageal damage causing scar tissue around the bottom of the oesophagus. This narrows the passageway to the stomach. It can make it feel as if food or liquid is stuck in the oesophagus when eating or drinking. Individuals who experience this should seek medical attention immediately.
  • Barrett's oesophagus, in which the lining of the oesophagus becomes so badly damaged that a new lining is formed. This new lining is more resistant to acid reflux. It can seem as if the symptoms have disappeared. However, these cell changes increase the risk for cancer.
What are the risks to others?
GORD is not contagious. It does not put others at risk.

What are the treatments for the disease?
GORD is usually easy to treat. With the right medical treatment and lifestyle changes, symptoms can improve or disappear. The first step is to determine the severity of the GORD. Lifestyle changes and medications are usually the next step. In extreme cases, surgery may be necessary.

Lifestyle changes may include:
  • avoiding foods or behaviours that cause reflux
  • elevating the head of the bed frame with bricks or wooden blocks to relieve symptoms
  • eating smaller meals
  • not lying down for at least 3 hours after eating
Medical treatments may include:
  • over-the-counter antacids for very mild GORD. At times, antacids can actually cause acid production.
  • prescription medication. Two types of medication are generally used to treat GORD. These medications do not prevent reflux. They neutralise the acidic fluid.
  • One type of medication is histamine (H2) blockers which help to block stomach acid production. These medications are generally taken 1 to 2 times a day. Medications available include ranitidine, famotidine, cimetidine, and nizatidine.
  • Another type of medications is proton pump inhibitors, which can further block the production of stomach acid. These medications actually block acid production within the stomach. These medications are generally taken 1 to 2 times a day. Medications available include omeprazole, lansoprazole, rabeprazol or pantoprazole.
  • medications, known as GI stimulants, may help the stomach to empty faster and are used to improve the strength of the lower oesophageal spinchter. Medications, such as metoclopramide cisapride and domperidone are used for this.
  • surgical procedures. If severe symptoms or cancer cells are diagnosed, surgery may be necessary. However, most people do not require this surgery. The medications available are generally very effective.
What are the side effects of the treatments?
The H2 blockers and proton pump inhibitors have very few side effects. Side effects from surgery may include the inability to relieve gas by belching. This may lead to gas bloat syndrome, a swollen abdomen, and increased flatulence. In time, this usually subsides.

Cisapride has been associated on occasions with electrical irregularities of the heart.

How is the disease monitored?
After diagnosis and initial treatment, individuals should let their doctor know how they are feeling. If symptoms are still present, an endoscopy may be performed. Through this procedure, the oesophagus can be examined and biopsies taken. If any type of cancer or Barrett's oesophagus is found, repeated examinations take place to detect changes.

Author: Bill Harrison, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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