Introduction
Gastro-oesophageal reflux disease (GORD) or gastro-esophageal reflux disease (GERD) is one of the most common gastrointestinal conditions in the Australian population, affecting approximately 10 to 15 percent of adults. The prevalence of GORD is rising, which is thought to be due to the increasing prevalence of obesity in the community.
Reflux symptoms can include heartburn, regurgitation, swallowing difficulties, and others.
Acid reflux occurs when stomach acid travels towards the throat via the oesophagus or ‘food pipe’. When reflux is mild, symptoms can be limited with lifestyle changes or with medicines that limit the amount of acid produced in the stomach. Laparoscopic fundoplication surgery becomes a suitable treatment particularly if symptoms are severe and the patient is not responding well to medication, or if medication treatment is not preferred over the long term.
Causes
GORD is a condition where the stomach contents go the wrong way, back up into the oesophagus, causing reflux symptoms. The body usually prevents this from happening by way of a natural barrier or valve – the lower oesophageal sphincter. People experience reflux when acid, food, or fluid travel back up the oesophagus.
Heartburn and acid reflux can be made worse by lifestyle factors such as smoking, overeating, or excess alcohol. Sometimes, certain foods such as coffee, alcohol, tomatoes, or chocolate trigger heartburn and acid reflux or increase the severity of symptoms.
Acid reflux can also be exacerbated by pregnancy, overweight/obesity, stress and anxiety, smoking, increased hormones such as progesterone or oestrogen, and anti-inflammatory medicines. A main structural problem that can contribute to GORD is a hiatus hernia.
Symptoms
Heartburn causes a burning feeling in the chest. Acid reflux is an unpleasant sensation where acid travels to the throat. Symptoms can include a sour taste in the mouth and difficulty swallowing, bad breath, bloating and belching, recurring hiccups, ear pain, damage to the teeth, sinus problems and voice hoarseness. Symptoms may be more noticeable following a rich, fatty or spicy meal, a late dinner, or lying down or bending over.
Diagnosis
Dr. Moar will reach a provisional diagnosis following a detailed patient history. If heartburn and reflux are severe and persist over time despite lifestyle changes, patients may require a gastroscopy (inserting a flexible camera into the stomach under a light anaesthetic).
In some cases, further testing may be necessary such as a fluoroscopy (a contrast X-ray), 24-hour pH monitoring, or manometry (pressure testing).
Related Information
Lifestyle changes that can be used to treat acid reflux and heartburn include eating smaller, more frequent meals and avoiding large meals in the evening. You can also raise the head end of your bed by 10 to 20 centimeters, stopping stomach acid from travelling up towards your throat. Medications (Proton Pump Inhibitors “PPIs”) will often be prescribed by your treating clinicians. If you are overweight, losing weight can help.