Understanding Reflux and GORD: Symptoms, Causes, and Diagnosis

What are Reflux and GORD?

Reflux, commonly called acid reflux, occurs when stomach acid travels back into the oesophagus. This backward flow can cause uncomfortable symptoms, one classic being heartburn. Gastro-oesophageal reflux disease (GORD) is a more severe and chronic form of acid reflux and is reported to effect 1 in 5 people in Australia, most commonly in people over 40. If you experience reflux symptoms regularly, 2 or more times a week, or it impacts your daily life, you could be dealing with GORD.

Signs and Symptoms of GORD

GORD can present a variety of symptoms. The most common is persistent heartburn, a burning sensation in the chest or throat, particularly after eating.
Other signs and symptoms that may be present and indicative of GORD include:

• Regurgitation of food or sour taste in the mouth

• Difficulty swallowing, known as dysphagia or pain when swallowing

• Oesophagitis - painful and inflamed oesophagus

• Chronic cough or wheezing

• Hoarseness or sore throat

• Bad breath, known as halitosis

• Feeling of a lump in your throat

• Feeling the need to clear the throat

• Upper abdomen or epigastric pain and discomfort

• Pain between the shoulder blades

• Chronic neck pain and stiffness

• Tooth decay and gum disease

• Bloating and belching

• Nausea and vomiting

Risk Factors and Causes of GORD

Several factors may contribute to the development of GORD or aggravate reflux.

Some of the risk factors for GORD include:

• Being overweight or obesity

• Pregnancy

• Hiatal hernia

• Delayed stomach emptying

• Smoking
  

Some of the following may potentially aggravate reflux:

• Eating large meals or lying down right after a meal

• Eating too quickly

• Snacking close to bedtime

• Eating certain foods like citrus, tomato, chocolate, peppermint, garlic, onions, or spicy foods

• Drinking certain drinks, such as alcohol, carbonated beverages, coffee, or tea

• Exercising after a meal

• Stress

Complications of GORD

If left untreated GORD can lead to several complications. These may include:

• Oesophagitis: This involves Inflammation of the oesophageal lining

• Oesophageal Stricture: This is when narrowing of the oesophagus occurs caused by damage from stomach acid

• Barrett's Oesophagus: This is a condition where continuous exposure to stomach acid changes the lining of the oesophagus, increasing the risk of oesophageal cancer

• Respiratory problems: This can include asthma, chronic cough, or laryngitis

How is GORD Diagnosed?

To diagnose GORD your GP will take a review of your symptoms and medical history. If further investigation is needed, the following tests might be conducted:

• Oesophageal pH monitoring: This measures the amount of acid in your oesophagus

• Upper endoscopy: This involves using a flexible tube with a camera to inspect your oesophagus and stomach

• Oesophageal manometry: This measures the rhythm and muscle contractions of your oesophagus when swallowing

• Barium swallow: This involves drinking a barium solution to help outline the oesophagus and make visible in X-ray images

How is GORD treated?

Initially, your GP may suggest lifestyle changes to see if your symptoms improve. Some of these would include:

• Losing weight where indicated. Excess abdominal weight can increase intra-abdominal pressure affecting gastric emptying and the function of the lower oesophageal sphincter.

• Avoiding food and beverages that aggravate your reflux. Everyone's triggers are different so take note of what aggravates your reflux and avoid those things.

• Eat smaller meals more frequently and chew food thoroughly.

• Leave 2-3 hours between your last meal and going to bed.

• Sleeping on your left side. Due to the angle of the oesophagus and the bulk of the stomach sitting on the left, this reduces reflux episodes.

• Sleeping with the head elevated 20cm. Propping yourself up with a pillow or bolster can also help reduce nocturnal reflux episodes.

• Quit smoking. Smoking aggravates reflux and weakens the lower oesophageal sphincter.

If lifestyle factors are not improving your symptoms adequately your GP may suggest medication. Some of these could be:

• Antacids. These are medications that neutralise stomach acid. They are over-the-counter medicines and do not require a prescription.

• Proton pump inhibitors or PPIs. These medications work by inhibiting the enzymes in the stomach that produce stomach acid. PPIs are not intended for long-term use. They are usually prescribed for 4-8 weeks to reduce your symptoms.

On rarer occasions surgery may be suggested. This is usually for people who have severe symptoms, aren't improving with medication or prefer not to take medication long-term or for those with hiatal hernia.

If you believe you might have GORD, it’s essential to consult with a healthcare professional for an accurate diagnosis and appropriate treatment plan.

Sources

Health Direct. GORD (reflux) https://www.healthdirect.gov.au/gord-reflux

NSW Government. Emergency Care Institute - Patient Fact Sheet. Gastro-oesophageal Reflux Disease (GORD) https://aci.health.nsw.gov.au/networks/eci/clinical/ed-factsheets/gastro-oesophageal-reflux-disease

GI Society. Canadian Society of Intestinal Research. Heartburn keeping you up at night? https://badgut.org/information-centre/a-z-digestive-topics/heartburn-keeping-night/