What is gastro-oesophageal reflux disease (GORD)?
GORD is a chronic digestive disease that occurs when the stomach acid, or stomach contents, flow back onto the oesophagus. This flow back is referred to as reflux and it can cause irritation of the oesophagus. Symptoms of GORD include heartburn, regurgitation, and nausea. Unfortunately, recurrent reflux of acidic stomach contents onto the oesophagus can lead to complications including, oesophagitis, oesophageal ulcers, Barrett's oesophagus, throat and laryngeal inflammation, cough, asthma and oesophageal cancer.
The reflux of acid in GORD can induce the stimulation of nerve fibres in the oesophagus which manifests as a burning pain in the middle of the chest that may even extend up into the neck or to the back. Heartburn is more common after meals when the stomach is full of food and also when a patient lies down due to the lack of gravity holding stomach contents down.
Treatment of GORD
Treatment of GORD includes lifestyle changes, drug treatment, and surgery
1. Lifestyle changes
- Elevate the head of the bed at night to raise the upper body and allow gravity to hold down stomach contents and reduce reflux
- Eat smaller meals so the stomach is less distended
- Avoid foodstuffs that reduce pressure of lower oesophageal sphincter, including alcohol, caffeinated drinks, alcohol and chocolate
- Reduce fatty food intake
- Stop smoking
- Avoid foods that aggravate the condition eg. spicy foods, or highly acidic foods
2. Drug treatment
- H2-receptor antagonists
- Proton pump inhibitors
- Pro-motility drugs e.g. metoclopramide - stimulates gastric emptying. They are most effective if taken about 30 minutes before meals
- Alginates - form a protective barrier on the stomach contents that helps block acid splashing up into the oesophagus. They are particularly effect for relief of reflux and heartburn. Alginates provide faster relief than H2-receptor antagonists and last longer than traditional antacids
Additional points to consider
- Suffers of GORD may notice some symptomatic relief by chewing gum. This stimulates the production of bicarbonate-rich saliva and also increases the rate of swallowing. By swallowing this saliva the acid is neutralised in the oesophagus thereby reducing irritation of tissues.