What is gastro-oesophageal reflux disease (GORD)?

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GORD is a complex disease, which can present in many different ways and can result in a range of complications. It is also very common – the most prevalent gastrointestinal disorder in the western world.

GORD results from the regurgitation of acid stomach contents back into the oesophagus or gullet – the tube that conveys food from the mouth to the stomach. The lining of the oesophagus is not designed to withstand acid, and may become inflamed or ulcerated as a result.

GORD is more than heartburn

People with GORD suffer from a variety of symptoms, which may be sufficient to disrupt their normal lifestyle and contribute to an overall reduced feeling of well-being. The common symptoms are heartburn, acid regurgitation, and pain on swallowing, but approximately 25% of patients do not have heartburn, and about 50% have symptoms elsewhere in the body.

Nighttime symptoms

More than 70% of patients with GORD experience symptoms at night, which may interfere with sleep and make it difficult for the patient to function properly the next day.
 

Symptoms associated with GORD
Acid complaints Heartburn
Acid belching
Burning feelings
Bad taste in the mouth
Upper abdominal/
stomach complaints
Pressure or pain in upper abdomen
Fullness, bloating
Burping or belching
Cramps or burning
Lower abdominal/
digestive complaints
Flatulence
Bowel problems
Lower abdominal pain, pressure, or cramps
Abdominal rumbling
Nausea Vomiting, gagging, or retching
Choking sensation
Nausea
Sleep disturbance Burning, belching, or upper abdominal pain during the night
Sleep disturbance – interrupted sleep, difficulty falling asleep, nightmares
Other complaints Breathing difficulties – wheezing, cough, shortness of breath, feeling of suffocation
Headache
Sore throat, lump in throat, sore tongue, difficulty swallowing
Back pain
Loss of appetite
Excessive salivation, bad breath

How is GORD diagnosed?

Careful assessment of the symptoms and a thorough case history form the basis of the diagnosis, which may be complemented by examination of the oesophagus via an endoscope. Inflammation or ulceration in the oesophagus may be present. Nevertheless, in 50–60% of patients endoscopically visible lesions can not be found despite the presence of typical symptoms. This is referred to as endoscopy-negative GORD (enGORD or NERD).

Effective treatment is important for all patients to relieve symptoms and improve quality of life.

Causes and risk factors

GORD results from defects in the normal transit of stomach contents through the upper gastrointestinal system (ie, oesophagus and stomach). In the majority of patients, transient relaxation of the sphincter muscle at the lower end of the oesophagus allows the stomach contents to re-enter the oesophagus. The stomach contents are acidic and highly irritating to the oesophageal lining. 

Reflux is more likely to happen if other risk factors are also present, such as hiatus hernia or obesity. Disorders of stomach motility with delayed emptying also increase the opportunities for reflux, and in some individuals, the oesophagus may be more prone to injury because of external factors. Older people are more at risk.

Treatment options

Proton pump inhibitors (PPIs) are highly effective, both for controlling symptoms and healing the esophagus. These drugs are now considered the treatment of choice for patients with GORD.

Two other classes of drugs are used to treat GORD:

  • Histamine 2 receptor anatagonists (H2RAs) may result in tolerance, becoming less effective over time, and carry the potential for interactions with other drugs.
  • Antacid medications offer rapid but short-lived symptom relief. Antacids are usually not effective for healing inflammation or ulcers

 

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