Gastro-oesophageal Reflux Disease (GORD)

Introduction
Gastro-oesophageal reflux disease, commonly referred to as GORD, is a chronic digestive disorder that occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (oesophagus). This backwash (acid reflux) can irritate the lining of your oesophagus. While occasional acid reflux is common and generally not a cause for alarm, persistent reflux that occurs more than twice a week is considered GORD. It is a prevalent condition affecting millions of people worldwide, significantly impacting quality of life.

The Mechanism of GORD
At the junction of the oesophagus and the stomach lies a ring of muscle known as the lower oesophageal sphincter (LOS). This valve acts as a gate, opening to allow food to pass into the stomach and closing to prevent acidic stomach contents from rising back up. In individuals with GORD, the LOS relaxes abnormally or weakens, allowing acid to escape. This results in the characteristic burning sensation known as heartburn.

Symptoms

The symptoms of GORD can vary from mild to severe. The most common signs include:

• Heartburn: A burning sensation in the chest, usually after eating, which might be worse at night or when lying down.
• Regurgitation: The sensation of sour or bitter-tasting acid backing up into your throat or mouth.
• Chest Pain: This can sometimes be severe enough to be mistaken for a heart attack.
• Dysphagia: Difficulty swallowing or the sensation of food being stuck in the throat.
• Chronic Cough: A persistent dry cough, often worse at night.
• Laryngitis: Inflammation of the voice box leading to hoarseness or a sore throat.
• Disrupted Sleep: Acid reflux often worsens when lying down, leading to poor sleep quality.

Causes and Risk Factors

Several factors can contribute to the weakening of the lower oesophageal sphincter or increase acid production. Understanding these triggers is crucial for managing the condition.

Dietary Triggers: Certain foods and drinks are notorious for triggering reflux. These include fatty or fried foods, spicy dishes, tomatoes and tomato-based products, garlic and onions, citrus fruits, chocolate, peppermint, and caffeinated or alcoholic beverages.

Lifestyle Factors: Obesity is a significant risk factor as excess weight puts pressure on the abdomen, pushing stomach contents upward. Smoking also reduces the efficiency of the LOS.

Physical Conditions: A hiatal hernia occurs when the upper part of your stomach bulges through the diaphragm into your chest cavity, making GORD more likely. Pregnancy can also increase pressure on the stomach and trigger reflux.

Complications

While most people can manage the discomfort of GORD with lifestyle changes and medication, chronic inflammation can lead to more serious complications over time.

• Oesophagitis: Continuous acid reflux can cause inflammation of the oesophageal tissue, leading to bleeding, ulcers, and open sores.
• Oesophageal Stricture: Damage to the lower oesophagus from stomach acid causes scar tissue to form. This scar tissue narrows the food pathway, making swallowing difficult.
• Barretts Oesophagus: In this condition, the tissue lining the lower oesophagus changes to resemble the lining of the intestine. While rare, these changes increase the risk of developing oesophageal adenocarcinoma, a type of cancer.

Diagnosis

A doctor can usually diagnose GORD based on symptoms and medical history. However, if symptoms are severe or do not respond to initial treatment, further diagnostic tests may be required.

Upper Endoscopy: A flexible tube with a camera and light (endoscope) is passed down the throat to examine the oesophagus and stomach. This can identify inflammation or Barretts oesophagus.

Ambulatory Acid Probe Tests: A monitor is placed in the oesophagus to identify when, and for how long, stomach acid regurgitates there. This helps confirm if symptoms are caused by GERD.

Oesophageal Manometry: This test measures the rhythmic muscle contractions of the oesophagus when swallowing and the coordination and pressure exerted by the LOS.

Treatment and Management

Treatment for GORD usually begins with lifestyle modifications and over-the-counter medications. If these are ineffective, prescription medications or surgery may be necessary.

Lifestyle Changes:

• Maintain a healthy weight to reduce abdominal pressure.
• Avoid foods and drinks that trigger heartburn.
• Eat smaller meals more frequently rather than large meals.
• Avoid lying down immediately after eating; wait at least three hours.
• Elevate the head of your bed if you experience symptoms at night.
• Quit smoking and avoid alcohol.

Medications:

• Antacids: These neutralize stomach acid and provide quick relief (e.g., Mylanta, Rolaids).
• H2 Receptor Blockers: These medications reduce the production of acid (e.g., Famotidine, Cimetidine).
• Proton Pump Inhibitors (PPIs):strong> These are stronger acid blockers than H2 blockers and allow time for damaged oesophageal tissue to heal (e.g., Omeprazole, Esomeprazole).