Gastro-oesophageal reflux disease (GORD)

What causes GORD?

GORD usually happens because the ring of muscle at the bottom of your oesophagus (food pipe) becomes weak. Normally, this muscle opens to let food into the stomach and closes to keep stomach acid where it belongs. In people with GORD, this muscle does not close properly, so acid travels back up into the oesophagus and causes heartburn and reflux.

Doctors do not always know exactly why this muscle weakens, but certain things are known to raise the risk.

Who is more likely to get GORD?

You may be more likely to develop GORD if any of the following apply to you:

• you are overweight or obese
• you regularly have certain foods and drinks, such as coffee, alcohol, tomatoes, chocolate, or fatty and spicy food
• you smoke
• you are pregnant
• you have a hiatus hernia, where part of the stomach pushes up through the diaphragm (the thin sheet of muscle separating the chest from the abdomen)
• you have gastroparesis, a condition where the stomach empties more slowly than normal, allowing acid to build up and leak back into the oesophagus
• you take certain medicines, such as calcium channel blockers (for high blood pressure), nitrates (for angina), or non steroidal anti inflammatory drugs (NSAIDs)
• you are under a lot of stress

GORD can also run in families, so the genes passed down from your parents may play a part in whether you develop it too.

Your GP can often diagnose GORD just from your symptoms, and may give you medicine for it without running any tests.

When tests may be needed

You'll usually only be referred for hospital tests if:

• your GP isn't sure whether you have GORD
• your symptoms are persistent, severe or unusual
• prescription medicines aren't controlling your symptoms
• your GP thinks surgery might help you
• you have signs of a more serious problem, such as difficulty swallowing or unexplained weight loss

Tests for GORD

Tests for GORD may include:

• an endoscopy, where the inside of your body is examined using an endoscope, a long, thin, flexible tube with a light and camera at one end
• a barium swallow or barium meal, a test that checks your swallowing and looks for blockages or abnormalities in your oesophagus
• manometry, which checks how well the ring of muscle at the end of your oesophagus is working by measuring the pressure inside it
• 24-hour pH monitoring, which measures the acidity level in your oesophagus to confirm GORD if the endoscopy doesn't find anything
• blood tests

Heartburn and GORD often settle down with a few self-help steps and medicines you can buy without a prescription. If these don't ease things, your GP can prescribe something stronger. They may also send you to a specialist to talk about whether surgery could help in your case.

Treatment from a pharmacist

Several different medicines can help with GORD symptoms.

You can get heartburn and GORD medicines from a pharmacy without needing a prescription. The main types are:

• antacids, which neutralise stomach acid
• alginates, which form a coating that shields your stomach and food pipe from acid
• low-dose proton-pump inhibitors and H2-receptor antagonists

Not everyone can safely use these medicines, so read the leaflet before you start. If you're unsure, just ask the pharmacist.

Treatment from a doctor

If self-help steps and over-the-counter medicines aren't easing your symptoms, your GP may prescribe a proton-pump inhibitor (PPI). This works by cutting down the amount of acid your stomach makes.

You'll usually be given enough medicine for a month. Go back to your GP if it isn't helping, or if your symptoms come back once treatment ends. Some people end up needing PPIs for the long term.

If PPIs aren't keeping your symptoms in check, your doctor may suggest a medicine called an H2 receptor antagonist (H2RA). This can be taken together with a PPI for a short period, or used on its own instead. Like PPIs, H2RAs reduce the amount of acid your stomach produces.

If medication still isn't controlling your symptoms, surgery may be considered as a way to treat GORD.

Complications of GORD

If you have GORD for a long time, stomach acid can damage your oesophagus and cause further problems.

These include:

• ulcers (sores) on the oesophagus – these may bleed and make swallowing painful
• the oesophagus becoming scarred and narrowed – this can make swallowing difficult and may require an operation to correct it
• changes in the cells lining the oesophagus (Barrett’s oesophagus) – very occasionally, oesophageal cancer can develop from these cells, so you may need to be closely monitored

Don’t include personal information e.g. name, location or any personal health conditions.