Gastro-oesophageal reflux disease (GORD)

Gastro-oesophageal reflux disease (GORD) is a common condition. Acid from the stomach leaks up into the oesophagus (the gullet), and this can cause heartburn and an unpleasant taste at the back of the mouth, which is known as acid reflux.

The two main symptoms of gastro-oesophageal reflux disease (GORD) are:

• heartburn, an uncomfortable burning feeling in the chest that often comes after eating
• acid reflux, where stomach acid comes back up into your mouth and leaves an unpleasant, sour taste

GORD can also cause other symptoms:

• oesophagitis, which means a sore, inflamed oesophagus (gullet)
• bad breath
• bloating and belching
• feeling or being sick
• pain when swallowing
• difficulty swallowing
• a sore throat and hoarseness
• a persistent cough or wheezing, which may be worse at night
• tooth decay and gum disease

If you also have asthma, your symptoms may get worse because the stomach acid irritates your airways.

• you have symptoms several times a week
• over-the-counter medicines aren't helping
• your symptoms are severe
• you have difficulty swallowing
• you have possible signs of a more serious problem, like persistent vomiting, vomiting blood or unexplained weight loss

Your doctor can often diagnose gastro-oesophageal reflux disease (GORD) just from your symptoms. They may give you medicine to treat it straight away, without any tests.

Most people with gastro-oesophageal reflux disease (GORD) don't need hospital tests. Your doctor will usually refer you only if:

• your doctor is unsure whether you have GORD
• your symptoms are persistent, severe or unusual
• medicines from the doctor aren't controlling your symptoms
• your doctor thinks you might benefit from surgery
• you have signs of a more severe condition, like difficulty swallowing or unexplained weight loss

Tests for gastro-oesophageal reflux disease (GORD) may include:

• an endoscopy, where the inside of your body is looked at using an endoscope, which is a long, thin, flexible tube with a light and camera at one end
• a barium swallow or barium meal, a test to check how well you swallow and to look for any 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 in your oesophagus
• 24-hour pH monitoring, which measures the acidity level (pH) in your oesophagus and can confirm a diagnosis of GORD if nothing is found during an endoscopy
• blood tests

Heartburn and gastro-oesophageal reflux disease (GORD) can often be treated at home with self-help measures and medicines you can buy without a prescription.

If these don't help, your doctor can prescribe stronger medicine. They may also refer you to a specialist, who can talk with you about whether surgery could be an option.

Certain lifestyle changes can help reduce heartburn and other symptoms of gastro-oesophageal reflux disease (GORD).

• Eat smaller meals more often, rather than 3 large meals a day.
• Keep to a healthy weight. If you're overweight, losing weight may help reduce your symptoms.
• Try to relax. Stress can make heartburn and GORD worse, so learning relaxation techniques may help if you're often feeling stressed.

• do not eat or drink alcohol 3 to 4 hours before going to bed
• do not eat or drink anything that may trigger your symptoms
• do not wear clothes that are tight around your waist
• do not smoke, because smoke can irritate your digestive system and may make your symptoms worse
• do not stop taking any prescribed medicine without speaking to your doctor first

Raising the head of your bed by up to 20cm (8 inches) may help to relieve symptoms. When your chest and head are above your waist, stomach acid is less likely to travel up towards your throat.

You can do this by placing a piece of wood or blocks underneath one end of your bed. Don't use extra pillows to get the same effect, as this can put a strain on your tummy.

Several different medicines can be used to treat the symptoms of gastro-oesophageal reflux disease (GORD).

You can buy over-the-counter heartburn and GORD medicines from a pharmacy without a prescription. The main types are:

• antacids, which neutralise the effects of stomach acid
• alginates, which form a coating that protects the stomach and oesophagus (gullet) from stomach acid
• low-dose proton-pump inhibitors and H2-receptor antagonists

These medicines aren't suitable for everyone, so read the leaflet first. If you're not sure, ask a pharmacist for advice.

If your symptoms don't get better with self-help measures and medicines you can buy without a prescription, your doctor may prescribe a proton-pump inhibitor (PPI). It works by reducing the amount of acid your stomach produces.

You'll usually be given enough medicine to last a month. Go back to your doctor if the tablets don't help, or if your symptoms return once the course finishes. Some people need to take PPIs on a long-term basis.

If PPIs don't control your symptoms, a medicine known as an H2 receptor antagonist (H2RA) may be recommended. H2RAs may be taken alongside PPIs on a short-term basis, or instead of them. Like PPIs, H2RAs reduce the amount of acid your stomach produces.

If medicine doesn't control your symptoms, surgery may be an option to treat gastro-oesophageal reflux disease (GORD).

Gastro-oesophageal reflux disease (GORD) is usually caused by the ring of muscle at the bottom of the oesophagus (gullet) becoming weakened.

Normally, this ring of muscle opens to let food into your stomach, then closes to stop stomach acid leaking back up into your oesophagus. In people with GORD, the acid can pass back up, and that's what causes heartburn and acid reflux.

It isn't always clear why the muscle becomes weak, but certain things can raise the risk of it happening.

These things may raise your risk of developing gastro-oesophageal reflux disease (GORD):

• being overweight or obese
• having certain food and drinks, like coffee, alcohol, tomatoes, chocolate and fatty or spicy foods
• smoking
• pregnancy
• hiatus hernia, which is when part of your stomach pushes up through your diaphragm (the thin sheet of muscle between the chest and tummy)
• gastroparesis, which is when the stomach takes longer to get rid of stomach acid, so excess acid can leak up into the oesophagus
• some medicines, like calcium-channel blockers (used to treat high blood pressure), nitrates (used to treat angina) and non-steroidal anti-inflammatory drugs (NSAIDs)
• stress

GORD can sometimes run in the same family, and the genes you inherit from your parents may also affect your chances of developing it.

If you have gastro-oesophageal reflux disease (GORD) for a long time, stomach acid can damage your oesophagus and cause further problems. These include:

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