Gastro-oesophageal reflux disease (GORD or GERD)
When acid travels up your oesophagus (food pipe or gullet) from the stomach, we call this acid reflux. It may reach your mouth and leave a bitter taste. Many people will occasionally experience acid reflux and heartburn (the burning sensation in your chest caused by reflux).
However, frequent episodes, such as once a week (mild) or multiple times a week (severe), may be due to gastro-oesophageal reflux disease (GORD or GERD). Most people can manage it with lifestyle changes and medication, though some require surgery.
If you have acid reflux and don’t believe it’s GORD, your pharmacist can advise on the best time to see your doctor. They can also recommend over-the-counter treatments, such as Gaviscon, to deal with infrequent episodes.
Your doctor can help with mild cases, prescribing medications and recommending lifestyle changes to tackle your symptoms. They may refer you to a gastroenterologist if you have a severe condition. At Digestive Health UK, our world-renowned specialists offer private diagnostic tests and treatments.
Symptoms of GORD
Treatment aims to relieve the following symptoms:
- Heartburn
- Chronic acid reflux
- Bad breath
- Belching
- Coughing
- Voice hoarseness
- Feeling or being sick
- A lump in your throat
- Feeling full quickly (early satiety)
- Oesophagitis (a sore, inflamed oesophagus)
- Difficulty swallowing or pain when swallowing
- Upper abdominal pain or chest pain and discomfort
Severe acid reflux is often mistaken for GORD. Learn more about the differences between the two conditions here.
Some people experience problems with their teeth, such as tooth decay or gum disease. If you regularly experience reflux, speak to your dentist.
Symptoms at night
Your symptoms may worsen at night or upon waking. For example, your throat may be dry or sore in the morning. You may also cough more or experience a cough at night only. To counter this, you might sleep with multiple pillows. However, this may cause back pain in the long run. Speak to your doctor about the benefit of using an acid reflux pillow to reduce symptoms at night.
Causes
You have a circular ring of muscle that tightens to close the entrance to the stomach at the end of your oesophagus. We call this the lower oesophageal sphincter (LOS or LOS valve).
Your LOS should only relax when you swallow, allowing food and liquid into your stomach. If a person has GORD, it relaxes at other times or weakens, meaning acid and bile from the stomach can flow upwards. Acid reflux can irritate your oesophageal lining. It may trigger asthma-like symptoms or existing asthma.
Risk factors
Men have a higher risk of developing this condition than women. People who are obese, pregnant, or have a hiatus hernia (where the top of the stomach bulges up into the diaphragm) have a high risk of reflux. Connective tissue disorders such as scleroderma and delayed stomach emptying also increase your risk.
Certain lifestyle choices can trigger GORD, including smoking, drinking alcohol, eating too close to bedtime, and eating an unhealthy diet.
Known trigger foods are chocolate, spicy foods, mint, tomatoes, fried foods and those high in fats. Fizzy drinks and caffeine can trigger symptoms too.
Check out our top tips to improve your gut health to learn more about changes you can make to elevate symptoms.
Why see a GORD specialist?
A GORD specialist is a gastroenterologist who specialises in diagnosing and treating this illness. If you experience symptoms regularly, it’s a good idea to see a specialist for an expert opinion.
Left untreated, it can lead to complications such as oesophageal strictures (narrowing in the oesophagus), oesophageal ulcers, and Barrett’s oesophagus.
In chronic cases, regular inflammation of the oesophagus may cause an increased risk of oesophageal cancer. If you experience this condition, speak to a specialist to determine its severity and receive treatment. Learn more here: The importance of diagnosing GORD.
Diagnosis
When you see a specialist for diagnosis and treatment, we will ask you about the symptoms you’ve been experiencing. Your doctor may have already diagnosed you based on your symptoms, but sometimes further tests are needed. These tests ensure you receive the correct diagnosis.
One of the most common tests is an endoscopy (gastroscopy). Gastroscopy involves passing a thin, flexible tube with a camera through your mouth, down your oesophagus, and to the upper part of your digestive system. This process lets us see inside your body to check what is causing your symptoms.
Our blog discusses this in more detail: How a private endoscopy can help with diagnosing GORD.
Another test you may need is a 96-hour wireless pH capsule using BRAVO or Alpha device. We place a small capsule inside your oesophagus using an endoscope. It measures the acidity of any fluid rising in your oesophagus. We use the results to assess whether you have GORD and require treatment.
To identify any issues with your LOS, we may also recommend high-resolution oesophageal manometry. This test can show us how well your oesophageal muscles and valves work. Other tests you may need include a 24-hour pH impedance test, a barium swallow, and blood tests.
Once we have identified the cause of your symptoms, we can discuss which treatments might work for you.
Our blog – ‘The importance of diagnosing GORD’ – covers more about the significance of getting tested for GORD.
Treatment
Lifestyle changes
Before considering other treatments, we will usually recommend lifestyle changes. These include:
- Dietary changes (avoiding fried or fatty foods, aspirin, caffeine and alcohol)
- Not lying down soon after a meal or eating less than 3 hours before bed
- Controlling your weight
- Reducing stress
- Not smoking
Discover more lifestyle changes in our blog: Living with GORD: What are the best treatments?
Medications
Over-the-counter medications, such as antacids, are another treatment that may help. However, if you take these several times a week, you should seek medical advice. We may prescribe stronger or alternative medications. These include proton pump inhibitors (PPIs) and H2 blockers.
PPIs work to reduce the amount of acid your stomach makes. Commonly prescribed PPIs are omeprazole and lansoprazole. We may recommend a 4-8 week course or long-term use.
H2 blockers, also known as histamine H2-receptor antagonists (H2RAs), work to reduce the stomach acid released by glands in your stomach lining. Examples include famotidine and nizatidine. You may take H2 blockers as you need them or every day.
Endoscopic procedures
Stretta and transoral incisionless fundoplication (TIF) are minimally invasive procedures. We perform both endoscopically. During stretta, we use radiofrequency energy or heat to strengthen the LOS valve. Watch our video to learn more: What is stretta therapy?
A TIF procedure involves using a TIF device and an endoscope that we insert through the mouth (transoral). We use these tools to form a partial wrap around your lower oesophagus with the tissue from the top of your stomach. This procedure prevents stomach acid from travelling up the oesophagus.
Surgery
We may consider anti-reflux keyhole surgery or other procedures to reinforce the lower oesophageal sphincter. Surgical procedures include laparoscopic insertion of a magnetic bead band (LINX) and Nissen fundoplication.
A LINX device supports the LOS valve. We place a ring of magnetic beads around the LOS to tighten it, meaning it only relaxes when it’s supposed to. It might sound scary, but the magnetic attraction is not so strong that it cannot loosen and allow food through. Another term for this is magnetic sphincter augmentation.
A Nissen fundoplication is similar to the TIF procedure, except we completely wrap the top part of your stomach around your oesophagus. Another key difference is that the Nissen procedure requires an incision (cut). We tend to do this laparoscopically (with small cuts), so it is less invasive. Read our blog to learn more about these options: What are my treatment options for GORD?
Book an appointment
At Digestive Health UK, our dedicated specialists offer face-to-face and remote consultations to learn more about your condition or receive advice regarding your symptoms. During your consultation, we discuss your symptoms in depth and cover the success or failure of any previous treatment.
We also offer private diagnostic tests if you frequently experience acid reflux without a diagnosis. We always start with the least invasive treatment option to ensure you have the best result possible with the most comfort. The quality of your care is the priority of our gastroenterologists.
Get in touch today to learn how we can help you. Live life uninterrupted by uncomfortable symptoms.