Gastro-oesophageal reflux disease (GORD)
This is a general term which describes the range of situations such as acid reflux, with or without oesophagitis (inflammation of the oesophagus) and other associated symptoms.
What are the symptoms of acid reflux and oesophagitis?
- Heartburn: this is the main symptom. This is a burning feeling which rises from the upper tummy (abdomen) or lower chest up towards the neck. (It is confusing as it has nothing to do with the heart!). It generally occurs after eating.
- Other common symptoms: these include pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching, indigestion (dyspepsia), and a burning pain when you swallow hot drinks or spicy foods. Like heartburn, these symptoms tend to come and go, and tend to be worse after a meal.
- Some uncommon symptoms: these may occur and if they do, can make the diagnosis difficult, as these symptoms can mimic other conditions. For example:
- A persistent cough, particularly at night sometimes occurs. This is due to the refluxed acid irritating the windpipe (trachea). Sometimes the problem is misdiagnosed as asthma type symptoms as cough and wheeze can be a feature.
- Other mouth and throat symptoms sometimes occur such as gum problems, bad breath, sore throat, hoarseness, and a feeling of a lump in the throat.
- Severe chest pain develops in some cases (and may be mistaken for a heart attack).
- Sometime a Dentist can notice acid erosions on the teeth.
What contributes to causing gastro-oesophageal reflux?
Some people are born with a naturally low sphincter pressure and reflux from a very early age. In adult life, reflux may be worsed by fatty and spicy foods, tight clothing, smoking, alcohol and being overweight. In pregnancy, reflux nearly always occurs due to the pressure of the baby pushing the stomach up and causing reflux. A hiatus hernia may also be present. Under these circumstances, a small part of the stomach has ridden up through the diaphragm into the chest and this situation tends to lead to reflux. However, the presence of a hiatus hernia does not necessarily imply that reflux will occur.
Treatment options for reflux disease
Lifestyle changes. The most important lifestyle change to improve the symptoms of reflux is losing weight. If you are overweight, there is often a critical weight. Below this the symptoms of reflux will improve dramatically, above it, reflux will be prominent. Reducing smoking and alcohol consumption will also be helpful. Changing eating habits will also improve symptoms. It is important to have regular meals and to have the last meal several hours before going to bed. Cutting down or avoiding alcohol, caffeine and chocolate can also help as all of these nice things relax the lower oesophageal sphincter muscle.
Drug therapy. Drug therapy is usually very successful at improving the symptom of heartburn. Antacids neutralise the stomach acidity and will relieve relatively mild symptoms. If these fail then stronger prescription drugs may be necessary. These are known as proton pump inhibitors. There are several different types of proton pump inhibitors. These drugs dramatically reduce the gastric acid shutting it down to minimal levels. These drugs are usually very effective at relieving heartburn. Drugs are not for everyone, however, and some patients do develop side-effects or prefer not to take regular medication.
Surgery. Surgery is required if medical treatment fails to relieve the symptoms, or, if the medication satisfactorily relieves the symptoms but as soon as the medication is stopped, the symptoms recur. Under these circumstances a large number of patients prefer to go to surgery rather than take medication for the rest of their lives. This particularly applies to the younger patients. Surgery now days is performed using laparoscopic (keyhole) techniques with short hospitals stays.