Gastroesophageal reflux disease (GERD/ GORD)

What Is Gastroesophageal reflux disease (GERD/ GORD)?

 GORD occurs when there is an abnormal amount of stomach acid that leaks back into the oesophagus, leading to symptoms and possible damage to the lining of the oesophagus. There are different causes for GORD, but usually, there is some impairment of the functioning of the lower oesophageal sphincter (LES). This sphincter connects the oesophagus to the stomach, and contracts to prevent reflux of stomach contents into the oesophagus during and after eating.

If GORD is not treated, the damaged cells in the oesophagus can change into different cell types than normally found in the oesophagus. This condition is called Barrett’s oesophagus. If this is left untreated, it can progress to oesophageal cancer.

GORD can be diagnosed with specific tests:

If GORD is suspected, gastroscopy is usually the first investigation performed.  A flexible tube with a camera lens is “swallowed” and allows the doctor to visualise the oesophagus and stomach. Stomach ulcers can also be excluded during the same procedure. The doctor will usually take a piece of oesophageal tissue (called a biopsy) and test it to see if there are any abnormal cells (Barrett’s oesophagus) or malignant cells. The biopsy may also show some yeast like Candida Albicans or bacteria like H.Pylori present in the oesophageal tissue that will need treatment.

Monitoring of the oesophagus’ pH over twenty-four hours can also be performed to assess for abnormal spikes of acid (low pH).

Manometry measures the pressure inside the oesophagus as well as the sphincter's contraction.

Radiological procedures such as a barium swallow (swallowing of a contrast medium while taking an X-ray) can also be performed to assess sphincter functionality and exclude any narrowing or masses in the oesophagus.

White men are more at risk for oesophageal cancer than any other population group. GORD is more prevalent in patients over the age of

40 years.

What Is Gastroesophageal reflux disease (GERD/ GORD)?

 GORD occurs when there is an abnormal amount of stomach acid that leaks back into the oesophagus, leading to symptoms and possible damage to the lining of the oesophagus. There are different causes for GORD, but usually, there is some impairment of the functioning of the lower oesophageal sphincter (LES). This sphincter connects the oesophagus to the stomach, and contracts to prevent reflux of stomach contents into the oesophagus during and after eating.

If GORD is not treated, the damaged cells in the oesophagus can change into different cell types than normally found in the oesophagus. This condition is called Barrett’s oesophagus. If this is left untreated, it can progress to oesophageal cancer.

GORD can be diagnosed with specific tests:

If GORD is suspected, gastroscopy is usually the first investigation performed.  A flexible tube with a camera lens is “swallowed” and allows the doctor to visualise the oesophagus and stomach. Stomach ulcers can also be excluded during the same procedure. The doctor will usually take a piece of oesophageal tissue (called a biopsy) and test it to see if there are any abnormal cells (Barrett’s oesophagus) or malignant cells. The biopsy may also show some yeast like Candida Albicans or bacteria like H.Pylori present in the oesophageal tissue that will need treatment.

Monitoring of the oesophagus’ pH over twenty-four hours can also be performed to assess for abnormal spikes of acid (low pH).

Manometry measures the pressure inside the oesophagus as well as the sphincter's contraction.

Radiological procedures such as a barium swallow (swallowing of a contrast medium while taking an X-ray) can also be performed to assess sphincter functionality and exclude any narrowing or masses in the oesophagus.

White men are more at risk for oesophageal cancer than any other population group. GORD is more prevalent in patients over the age of

40 years.

What Are The Symptoms Of Gastroesophageal reflux disease (GERD/ GORD)?

If you suffer from GORD, you may have some of the typical symptoms. Heartburn is the commonest complaint. You may have pain after eating or during swallowing (referred to as “dysphagia”). Sometimes it may feel as though the food “gets stuck” just to the bottom of your sternum(breastbone). You make wake up with the taste of acid in the mouth (“waterbrash”), due to stomach acid reflux while lying down.

Some people may have atypical symptoms caused by GORD. Atypical symptoms may include:

  • Chronic irritating cough
  • Hoarse voice due to acid reflux affecting the vocal chords
  • Retrosternal chest pain (pain behind the breastbone) due to spasm of the LES when swallowing food.

What Are The Causes Of Gastroesophageal reflux disease (GERD/ GORD)?

GORD is most often caused by a lowered tone in the lower oesophageal sphincter (LES)

Factors/Causes that affect the functioning of the LES:

  • Hiatus hernias
  • Raised intra-abdominal pressure due to pregnancy, intra-abdominal masses, obesity or being overweight
  • Pregnancy: Progesterone lowers the tone of the oesophageal sphincter, as well as the combination of increased abdominal pressure

Factors that reduce the tone of the LES:

  • Progesterone
  • Caffeine
  • Alcohol
  • Chocolate
  • Peppermint
  • Delayed emptying of the stomach called gastroparesis will also contribute to GORD. This may occur in patients with diabetes or other abnormalities of digestion.

Medications that can contribute to the development of GORD:

  • NSAIDS (nonsteroidal anti-inflammatories)
  • Blood pressure treatments such as calcium channel blockers(CCB)

What Are The Things One Should Do To Manage Gastroesophageal reflux disease (GERD/ GORD)?

  • Avoid large meals. Eat small regular meals during the day
  • Restrict fluid intake 3 hours before bedtime
  • Raise the head of your bed or sleep on 2-3 pillows to help prevent reflux that occurs more easily when lying down
  • Lose weight if you are overweight

What Are The Things One Should Avoid To Manage Gastroesophageal reflux disease (GERD/ GORD)?

  • Don’t lie down immediately after eating.
  • Don’t consume large meals high and fat and protein that takes longer to digest and delay stomach emptying.
  • Don’t stay away from foods that lower the LES tone (see below).

What Are The Best Foods For Gastroesophageal reflux disease (GERD/ GORD)?

  • High fibre foods that assist with gastric emptying
  • Whole wheat grains, bread, pasta, brown rice
  • Vegetables high in fibre- butternut, spinach, carrots, sweet potatoes, Brussel sprouts, beans
  • Fruits high in fibre: Apple, pears, berries- strawberry, raspberry, blueberry, mango, guava

What Are The Worst Foods For Gastroesophageal reflux disease (GERD/ GORD)?

  • Caffeine
  • Alcohol
  • Cocoa
  • Peppermint
  • Carbonated drinks (CO lowers tone of LES)
  • Spicy foods

What Are The Medicines For Gastroesophageal reflux disease (GERD/ GORD)?

Medications mainly used are acid-lowering drugs that work on different pathways and lower the secretion of stomach acid:

  • PPIs (Proton Pump Inhibitors)- Pantoprazole, omeprazole, esomeprazole
  • H2 receptor antagonists – Cimetidine
  • Motility agents such as aluminium hydroxide increase the emptying of the stomach and reduce the frequency of acid reflux after meals.

Surgical management is usually only required if the patient does not respond to lifestyle modifications and medications:

Surgical management may include repair of a hiatus hernia if present.  Another surgical modality is narrowing of the oesophageal sphincter by a procedure called fundoplication. During this procedure, a part of the stomach (top part called the fundus), is wrapped around the LES, providing mechanical support during contraction.

What Are The Tips To Manage Gastroesophageal reflux disease (GERD/ GORD)?

If you have been suffering from heartburn for a long time, and been treating yourself at home, it is advisable to go to a doctor for a gastroscopy to rule out damage to your oesophagus as this can predispose you to develop cancer.

What Are The Symptoms Of Gastroesophageal reflux disease (GERD/ GORD)?

If you suffer from GORD, you may have some of the typical symptoms. Heartburn is the commonest complaint. You may have pain after eating or during swallowing (referred to as “dysphagia”). Sometimes it may feel as though the food “gets stuck” just to the bottom of your sternum(breastbone). You make wake up with the taste of acid in the mouth (“waterbrash”), due to stomach acid reflux while lying down.

Some people may have atypical symptoms caused by GORD. Atypical symptoms may include:

  • Chronic irritating cough
  • Hoarse voice due to acid reflux affecting the vocal chords
  • Retrosternal chest pain (pain behind the breastbone) due to spasm of the LES when swallowing food.

What Are The Causes Of Gastroesophageal reflux disease (GERD/ GORD)?

GORD is most often caused by a lowered tone in the lower oesophageal sphincter (LES)

Factors/Causes that affect the functioning of the LES:

  • Hiatus hernias
  • Raised intra-abdominal pressure due to pregnancy, intra-abdominal masses, obesity or being overweight
  • Pregnancy: Progesterone lowers the tone of the oesophageal sphincter, as well as the combination of increased abdominal pressure

Factors that reduce the tone of the LES:

  • Progesterone
  • Caffeine
  • Alcohol
  • Chocolate
  • Peppermint
  • Delayed emptying of the stomach called gastroparesis will also contribute to GORD. This may occur in patients with diabetes or other abnormalities of digestion.

Medications that can contribute to the development of GORD:

  • NSAIDS (nonsteroidal anti-inflammatories)
  • Blood pressure treatments such as calcium channel blockers(CCB)

What Are The Things One Should Do To Manage Gastroesophageal reflux disease (GERD/ GORD)?

  • Avoid large meals. Eat small regular meals during the day
  • Restrict fluid intake 3 hours before bedtime
  • Raise the head of your bed or sleep on 2-3 pillows to help prevent reflux that occurs more easily when lying down
  • Lose weight if you are overweight

What Are The Things One Should Avoid To Manage Gastroesophageal reflux disease (GERD/ GORD)?

  • Don’t lie down immediately after eating.
  • Don’t consume large meals high and fat and protein that takes longer to digest and delay stomach emptying.
  • Don’t stay away from foods that lower the LES tone (see below).

What Are The Best Foods For Gastroesophageal reflux disease (GERD/ GORD)?

  • High fibre foods that assist with gastric emptying
  • Whole wheat grains, bread, pasta, brown rice
  • Vegetables high in fibre- butternut, spinach, carrots, sweet potatoes, Brussel sprouts, beans
  • Fruits high in fibre: Apple, pears, berries- strawberry, raspberry, blueberry, mango, guava

What Are The Worst Foods For Gastroesophageal reflux disease (GERD/ GORD)?

  • Caffeine
  • Alcohol
  • Cocoa
  • Peppermint
  • Carbonated drinks (CO lowers tone of LES)
  • Spicy foods

What Are The Medicines For Gastroesophageal reflux disease (GERD/ GORD)?

Medications mainly used are acid-lowering drugs that work on different pathways and lower the secretion of stomach acid:

  • PPIs (Proton Pump Inhibitors)- Pantoprazole, omeprazole, esomeprazole
  • H2 receptor antagonists – Cimetidine
  • Motility agents such as aluminium hydroxide increase the emptying of the stomach and reduce the frequency of acid reflux after meals.

Surgical management is usually only required if the patient does not respond to lifestyle modifications and medications:

Surgical management may include repair of a hiatus hernia if present.  Another surgical modality is narrowing of the oesophageal sphincter by a procedure called fundoplication. During this procedure, a part of the stomach (top part called the fundus), is wrapped around the LES, providing mechanical support during contraction.

What Are The Tips To Manage Gastroesophageal reflux disease (GERD/ GORD)?

If you have been suffering from heartburn for a long time, and been treating yourself at home, it is advisable to go to a doctor for a gastroscopy to rule out damage to your oesophagus as this can predispose you to develop cancer.