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Gastro-oesophageal Reflux Disease - GORD

What is Gastro-oesophageal Reflux Disease (GORD)?
Gastro-oesophageal reflux disease (GORD) is a common condition in which the liquid contents of the stomach reflux back up into the oesophagus (food pipe).

Why does GORD occur?
Food is carried to the stomach from the mouth via the oesophagus. The oesophagus is a muscular tube-like structure which propels food toward the stomach with movements called “peristalsis”.

The lower end of the oesophagus contains a sphincter/valve which relaxes to allow passage of food/fluid into the stomach, and then contracts to prevent reflux of stomach contents (including acid) up into the oesophagus. In some people, this ring of muscle can become weak, allowing frequent acid reflux. Certain conditions can make acid reflux more likely, including obesity and hiatus hernia. A hiatus hernia refers to a protrusion or “herniation” of the upper part of the stomach into the chest cavity through a weakness in the diaphragm (the muscle separating the chest from the abdomen).

What are the symptoms of GORD?
Short periods of reflux occur in everyone, and usually do not cause any symptoms. However, people with GORD may experience heartburn/indigestion or regurgitation. These symptoms are typically worsened with fatty or large meals, spicy foods, bending, straining, or lying flat. Other symptoms may include upper abdominal or chest discomfort, difficulty swallowing or painful swallowing. Occasionally GORD may also be the cause of a chronic cough or hoarse voice.

Do I need any tests for GORD?
The diagnosis of GORD can usually be made on the patient’s description alone, and may not require any further tests. However, a Gastroscopy is recommended if a trial of medication is not effective, or there are associated features such as difficulty or painful swallowing, weight loss, vomiting blood, or anaemia.

How is GORD treated?
General measures which may be helpful in controlling the symptoms of reflux include: avoidance of precipitating foods & large meals, reducing caffeine intake, raising the head of the bed (if night-time symptoms) and weight loss.

The mainstay of medical therapy is with acid suppressing medications. These may be required long-term for some individuals. In a small number of people with severe or resistant GORD surgical treatment may be indicated.

What are the complications of GORD?
Severe GORD may be complicated by oesophageal ulcers or strictures (scarring and narrowing of the oesophagus). GORD may also predispose to a condition called Barrett’s oesophagus, whereby the normal lining of the oesophagus is replaced by a different cell type. This new lining has a small risk of developing into oesophageal cancer, and so a surveillance gastroscopy program is recommended for Barrett’s oesophagus. Some people can also have acid reflux into the throat or lungs, causing a sore throat, hoarse voice and even pneumonia.

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