Gastro-oesophageal reflux disease (GORD)
|AGE Not significant factors||GENDER Not significant factors|
|LIFESTYLE Obesity, a high-fat diet, drinking too much coffee or alcohol, and smoking are risk factors||GENETICS Not significant factors|
Gastro-oesophageal reflux disease (GORD) is the regurgitation of acidic stomach juices into the oesophagus, causing pain in the upper abdomen and chest.
Commonly known as acid reflux, gastro-oesophageal reflux disease (GORD) is probably the most common cause of indigestion. The discomfort is due to acidic juices from the stomach flowing up into the oesophagus (the tube leading from the throat to the stomach). The lining of the oesophagus is not adequately protected against the harmful effects of stomach acid, which may cause inflammation and a burning pain known as heartburn.
Attacks of GORD are usually brief and relatively mild but if they are persistent, the lining of the oesophagus may be permanently damaged or scarred. In some cases, GORD causes bleeding from the digestive tract.
What are the causes of GORD?
The stomach contents are kept from entering the oesophagus by a doubleaction valve mechanism. One part of this mechanism is the muscular ring at the lower end of the oesophagus, known as the lower oesophageal sphincter. The other part is the effect of the diaphragm muscle on the oesophagus as the tube passes through a narrow opening in the muscle, called the hiatus. These mechanisms provide an effective one-way valve.
GORD may develop as a result of several factors acting together to make the valve leak. These include poor muscle tone in the sphincter; increased abdominal pressure due to pregnancy; obesity; or a weakness in the hiatus that allows part of the stomach to slide into the chest (a hiatus hernia). Many people develop mild attacks of GORD after eating certain foods or drinks, especially pickles, fried or fatty meals, carbonated soft drinks, alcohol, or coffee. Smoking may also worsen symptoms.
What are the symptoms of GORD?
Some of the symptoms of GORD are most noticeable immediately after eating a large meal or when a person bends over. The main symptoms include:
- Burning pain or discomfort in the chest behind the breastbone, known as heartburn.
- Acidic taste in the mouth due to regurgitation of acidic fluid into the throat or mouth.
- Persistent cough.
- Blood in the vomit or faeces.
GORD that persists for many years can cause scarring in the oesophagus, which eventually may become severe enough to cause a stricture (narrowing). A stricture can make swallowing difficult and may lead to weight loss. Long-term GORD can lead to a condition called Barrett's oesophagus, in which part of the lining of the oesophagus is replaced by the stomach lining. People with Barrett's oesophagus are at increased risk of cancer of the oesophagus.
If you have recently developed pain in the centre of your chest that seems unrelated to eating or drinking, you should seek immediate medical help because the far more serious condition angina is sometimes mistaken for the pain of severe heartburn.
What might be done?
Self-help measures can relieve many symptoms of GORD (see Managing gastro-oesophageal reflux disease). However, if your heartburn is persistent, consult your doctor.
The doctor may arrange for contrast X-rays to look for abnormalities in the oesophagus (see Barium swallow). You may also undergo endoscopy, in which a flexible viewing tube is used to examine the lining of the oesophagus. During this procedure, a small sample of tissue may be removed for examination under a microscope. Endoscopy is more sensitive than a barium swallow at detecting Barrett's oesophagus or inflammation or ulcers in the oesophagus.
If self-help measures do not relieve your symptoms, your doctor may prescribe a drug that reduces the stomach's acid production (see Ulcer-healing drugs). The rate at which the stomach is emptied may be increased by a drug such as metoclopramide (see Antispasmodic drugs and motility stimulants), making GORD less likely. Symptoms usually disappear with this treatment. If they do not, you may need an operation to return the stomach to its normal position and tighten the lower oesophageal sphincter. This may be carried out by laparoscopic surgery (see Laparoscopy), a type of endoscopic surgery.
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