Understanding GORD: Gastro-oesophageal Reflux Disease Symptoms and Treatment

Gastro-oesophageal reflux disease, commonly known as GORD (or GERD in some regions), is a chronic digestive condition where stomach acid leaks out of the stomach and into the oesophagus (the gullet). While many people experience occasional acid reflux or 'heartburn', GORD is diagnosed when these episodes happen frequently—typically twice a week or more—or cause significant discomfort or damage.

In the UK, GORD is a prevalent condition affecting a significant portion of the adult population. It occurs because the lower oesophageal sphincter (LOS)—a ring of muscle that acts as a valve between the oesophagus and the stomach—becomes weakened or relaxes inappropriately. This allow gastric juices, which are highly acidic, to travel upwards, irritating the delicate lining of the food pipe.

The symptoms of GORD can vary in intensity. For most, the most recognisable sign is heartburn: a burning sensation in the middle of the chest, often occurring after eating or while lying down. However, reflux can present in several other ways that may not seem immediately related to digestion.

• Acid Brash: A sour or bitter taste in the back of the mouth caused by regurgitated acid.
• Dysphagia: Difficulty swallowing or a sensation that food is stuck in the throat.
• Chronic Cough: Some individuals experience a persistent, dry cough, particularly at night, as acid irritates the airways.
• Hoarseness: Acid can affect the vocal cords, leading to a raspy voice.
• Bloating and Belching: Frequent burping or feeling uncomfortably full after small meals.

It is important to note that chest pain from GORD can sometimes mimic the pain of a heart attack. If you experience sudden, crushing chest pain or pain that radiates to your arm, you should seek emergency medical care immediately.

While anyone can develop GORD, certain lifestyle factors and physical conditions increase the likelihood of the lower oesophageal sphincter failing. Identifying these triggers is a crucial step in managing the condition effectively.

Key risk factors include:

• Overweight and Obesity: Excess weight puts increased pressure on the abdomen and stomach, forcing acid upwards.
• Pregnancy: Hormonal changes and the physical pressure of the growing foetus can lean to temporary GORD symptoms.
• Hiatus Hernia: This occurs when a part of the stomach pushes up through the diaphragm into the chest cavity, interfering with the LOS function.
• Dietary Triggers: Fatty or spicy foods, chocolate, caffeine, alcohol, and citrus fruits are known to relax the sphincter or increase acid production.
• Smoking: Tobacco use can decrease saliva production and weaken the muscle valve.
• Stress: While not a direct cause, stress can exacerbate the perception of symptoms and lead to unhealthy eating habits.

Management of GORD typically follows a stepped approach, beginning with lifestyle modifications before moving to pharmacological interventions. According to NICE guidelines, the goal is to achieve symptom relief and prevent complications like oesophagitis (inflammation of the oesophagus).

Lifestyle Adjustments

Small changes can make a significant difference. Patients are often advised to eat smaller, more frequent meals rather than three large ones. Avoiding food at least three hours before bedtime and elevating the head of the bed by about 10 to 20cm can prevent gravity from allowing acid to reflux during sleep.

Pharmacological Treatments

If lifestyle changes are insufficient, several medications are available:

• Antacids and Alginates: These provide short-term relief by neutralising stomach acid or forming a protective 'raft' on top of the stomach contents.
• Proton Pump Inhibitors (PPIs): Drugs such as Omeprazole or Lansoprazole reduce the amount of acid the stomach produces. These are often the first-line prescription treatment for persistent GORD.
• H2-receptor antagonists: Such as Famotidine, these are used if PPIs are not suitable or if additional symptom control is needed.

If left untreated, chronic exposure to stomach acid can lead to long-term damage to the oesophagus. This is why persistent symptoms should never be ignored. Potential complications include:

• Oesophageal Ulcers: Severe inflammation can lead to open sores, which may bleed or make swallowing painful.
• Oesophageal Stricture: Repeated damage leads to scar tissue, which narrows the oesophagus and makes swallowing difficult.
• Barrett’s Oesophagus: In a small percentage of people, the cells lining the lower oesophagus change to resemble intestinal cells. This condition requires regular monitoring as it slightly increases the risk of developing oesophageal cancer.

While many manage mild reflux with over-the-counter remedies, professional medical advice is essential if symptoms become frequent or severe. An online GP consultation is a convenient way to discuss your digestive health and receive evidence-based guidance.

You should consult a GP if:

• Lifestyle changes and supermarket medicines are not helping.
• You have symptoms of reflux most days for three weeks or more.
• Symptoms are interfering with your daily activities or sleep.
• You need advice on the long-term use of Proton Pump Inhibitors.

During a consultation, a GP can assess whether your symptoms require a prescription, lifestyle coaching, or further investigation such as an endoscopy. Early intervention is the best way to prevent the progression of GORD and improve your quality of life.