What is GORD?

Gastro-oesophageal reflux disease (GORD) occurs when stomach acid leaks from the stomach and moves up into the oesophagus (food pipe). This is also known as ‘reflux’.

Almost everyone has heartburn caused by acid reflux from time to time. It is considered GORD when it happens more than twice a week. It can eventually lead to more serious health problems and impact wellbeing and quality of life.

GORD can affect everyone, even children, but mostly affects adults aged 40 and over. If you are worried about a child or infant with reflux symptoms, then read The Royal Children’s Hospital Melbourne fact sheet on reflux.

What are the symptoms of GORD?

The most common symptoms of GORD include:

Heartburn

Heartburn is the main symptom of GORD. It is a burning pain or feeling of discomfort that develops just below the breastbone and can rise up. Heartburn is often worse after eating heavy meals, lying down or when bending over.

Is it heartburn or a heart attack?

Chest pain is a very common reason for people to go to the hospital emergency department. While many of these people are suffering from a heart attack, some are experiencing severe heartburn. A heart attack can feel like bad indigestion.

It’s so difficult to tell these 2 apart that sophisticated medical testing is needed to determine if they are in fact having a heart attack.

If you have any chest pain that lasts for more than a few minutes or any heart attack warning signs such as shortness of breath or pain in your jaw or arm, it’s important to seek immediate medical attention by calling triple zero (000).

If you have any doubt about whether your symptoms are heartburn or a heart attack, then also seek immediate medical attention by calling triple zero (000). Remember — it’s always OK to call triple zero (000), even if it’s a false alarm.

Regurgitation

Regurgitation refers to the reflux of stomach acid and other stomach contents up into your throat and mouth. It causes an unpleasant, sour taste in the mouth.

Difficulty swallowing

About one in 3 people with GORD have difficulty swallowing, or dysphagia, especially solids such as meat, bread and pastry. It can also feel like they have a lump in their throat.

Other symptoms of GORD

GORD can also cause other problems such as:

• feeling or being sick
• a persistent cough, which may be worse at night
• chest pain
• wheezing
• tooth decay and gum disease
• laryngitis (inflammation of the larynx) which causes throat pain and hoarseness
• bad breath
• bloating and belching

Some people may also find swallowing painful. This is caused by ulcers in the oesophagus and can happen with hot or cold solids or liquids.

If you have the acid reflux at night, you might also develop a cough or laryngitis. If you have asthma and GORD, your asthma symptoms may become worse.

What causes GORD?

Most cases of GORD are caused by a problem with the lower oesophageal sphincter (LOS). This is the muscle around at the bottom of the oesophagus (food pipe) that helps to keep the contents of the stomach from rising back up the oesophagus. The LOS can become weakened and may not close properly. This allows acid to leak up into the oesophagus, causing symptoms such as heartburn.

It’s not always clear why the LOS becomes weakened, but it’s more likely to happen in people:

• who are overweight or obese
• who consume lots of fatty foods, because the stomach takes longer to dispose of stomach acids after digesting a fatty meal
• who consume substances which may relax the LOS such as tobacco, alcohol, coffee or chocolate
• who are pregnant, due to changes in hormone levels which can relax the LOS, as well as the increased pressure on the stomach during pregnancy
• who have connective tissue disorders
• with a hiatus hernia, where part of the stomach pushes up through the diaphragm (the sheet of muscle which separates the abdomen from the chest)
• with a condition called gastroparesis (fairly common in people with diabetes) where the stomach takes longer to dispose of stomach acid
• who are feeling stressed
• who smoke
• who take certain medicines, such as aspirin

When should I see my doctor?

If you experience symptoms such as heartburn once or twice a month, then you probably don’t need to see your doctor. You should be able to manage the symptoms yourself with lifestyle changes and over-the-counter medicines.

You should see your doctor if you:

• have chest pain
• have frequent and severe symptoms and are using over-the-counter medications on a daily or weekly basis
• have symptoms not fully relieved by over the counter medications or a change in your lifestyle
• find it difficult or painful to swallow
• are losing weight
• have repeated vomiting or are vomiting blood
• are taking medicines that may be causing heartburn such as aspirin or arthritis tablets
• find exercise exacerbates your symptoms (because it could be heart disease)

How is GORD diagnosed?

In most cases, your doctor will be able to diagnose GORD by asking questions about your symptoms. If the diagnosis isn’t clear, your symptoms don’t get better or they suspect complications, your doctor may order further tests.

The most common test for GORD is an endoscopy, where a long, thin flexible tube that has a light source and video camera is inserted down the throat to examine and take images of the inside of the body.

How is GORD managed?

Making changes to your lifestyle are essential to manage and prevent GORD symptoms. They include:

• avoiding foods that trigger your symptoms, such as fatty foods, chocolate, spicy foods and coffee
• losing weight, if you are overweight or obese — even a small amount of weight loss can help your symptoms
• cutting back on alcohol
• stopping smoking, because tobacco smoke can irritate your digestive system and make your symptoms worse
• eating smaller, more frequent meals instead of 3 large meals each day
• eating your evening meal 2 to 3 hours before you go to bed
• raising the head of your bed if your symptoms are worse at night, and avoiding lying down after eating
• asking your doctor or pharmacist to review your medicines to make sure they are not making your symptoms worse

Medicines

Sometimes lifestyle changes are all you need. But if they fail to control symptoms, you may need to take medicines.

You can buy medicines without a prescription from a pharmacy (over-the-counter medicines) that control the amount of acid produced in the stomach. These are called antacids, H2-receptor antagonists or proton pump inhibitors (PPI). Talk to your pharmacist about which medicine is best for you and always follow the instructions. Let your doctor know what over-the-counter medicines you are taking.

If symptoms don’t go away see your doctor. Your doctor may prescribe a 4 to 8 week course of a PPI. These medicines work more strongly to reduce the acid in your stomach.

PPIs should not be taken long term if you don’t need them. If your symptoms are well managed, talk to your doctor about reviewing your medicine. That may involve slowly reducing your medicine or limiting it to when you have symptoms. After you have stopped taking a PPI, lifestyle changes become even more important to control your symptoms.

The Royal Australian College of General Practitioners recommends that you discuss any medication you are taking for GORD or heartburn with your doctor or specialist to assess the possibility of reducing your dose or stopping the medication if safe to do so. For further information, visit the Choosing Wisely Australia website.

Surgery

Surgery is only required for a small percentage of people with severe symptoms, or whose symptoms are not relieved adequately with medications, or who don’t want to take long-term medicines. It is performed through a ‘key-hole’ approach called laparoscopy.

Complications of GORD

For most people, GORD is a fairly straightforward condition. But for some, it can eventually lead to complications such as oesophageal ulcers, oesophageal stricture, Barrett’s oesophagus and oesophageal cancer.

Oesophageal ulcers

Excess acid rising up into the oesophagus can damage its lining causing inflammation (oesophagitis) and potentially oesophageal ulcers. These ulcers can bleed, cause pain and make swallowing difficult. Medicines used to treat GORD can also help with oesophageal ulcers.

Oesophageal stricture

If the lining of the oesophagus is continuously damaged by excess acid, scar tissue can form. If the scar tissue builds up, it can cause the oesophagus to become narrowed. This is called an oesophageal stricture. It can make swallowing difficult and sometimes painful. It is possible to have a surgical procedure to widen the oesophagus.

Barrett’s oesophagus

Repeated episodes of GORD can damage the cells lining the lower oesophagus. This condition is called Barrett’s oesophagus. It usually occurs with severe and long-standing GORD, and the symptoms tend to be the same as for GORD.

Oesophageal cancer

In some people Barrett’s oesophagus can develop into oesophageal cancer. The symptoms of oesophageal cancer are:

• difficulty swallowing
• unexplained weight loss
• persistent indigestion
• hoarseness
• a persistent cough and/or coughing blood
• vomiting

If your doctor thinks you may be at risk of developing oesophageal cancer, you may be referred for a special test (endoscopy) regularly to monitor the affected cells.

Resources and support

Find out more about GORD from:

• The Gut Foundation
• Gastroenterological Society of Australia
• Living with GORD