Gastro-oesophageal reflux disease (GORD)

"Gastroesophageal reflux disease | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Gastro-oesophageal reflux disease (GORD) Gastro-oesophageal reflux disease (GORD) About gastro-oesophageal reflux disease (GORD) Symptoms of GORD Causes of GORD Diagnosing GORD Treating GORD Complications of GORD About gastro-oesophageal reflux disease (GORD) Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet). It usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened. Read more about the causes of GORD . GORD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth. It may just be an occasionalnuisance for some people, but forothers it can bea severe, lifelongproblem. GORDcan often becontrolled with self-help measures and medication. Occasionally, surgery to correct the problem may be needed. Thistopic focuses on GORD in adults. Symptoms of GORD Symptoms of GORD can include: heartburn (an uncomfortable burning sensation in the chest that often occurs after eating) acid reflux (where stomach acid comes back up into your mouth and causes an unpleasant, sourtaste) oesophagitis(a sore, inflamed oesophagus) bad breath bloating and belching feeling or being sick pain when swallowing and/or difficulty swallowing Read more about the symptoms of GORD . What to do if you have GORD You canoften controlthe symptoms of GORD by making somelifestyle changes andtaking over-the-counter medication. Read treatments for GORD for more information. You dont necessarily need to see your GP if you only have symptoms occasionally. Ask your pharmacist for advice on treatments. When to see your GP Visit your GP if youre worried about your symptoms, or if: you have symptoms several times a week over-the-counter medications arent helping your symptoms are severe you have difficulty swallowing you have possible signs of a more serious problem, such as persistent vomiting,vomiting blood orunexplained weight loss Your GP will usually be able to diagnose GORD based on your symptoms, although theymay refer youfor some tests. Read more about diagnosing GORD . Treatments for GORD The main treatments for GORD are: self-help measures  this includes eating smaller but more frequent meals, avoiding any foods or drinks that trigger your symptoms, raising the head of your bed, and keeping to a healthy weight over-the-counter medicines  ask your pharmacist to recommend anantacidor analginate stronger prescription medicines  includingproton-pump inhibitors (PPIs)and H2-receptor antagonists (H2RAs) You may only need to take medication whenyou experience symptoms, although long-term treatment may be needed if the problem continues. Surgery to stop stomach acid leakinginto your oesophagus may be recommended if medication isnt helping, or you dont want to take medication on a long-term basis. Read more about the treatments for 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  thesemay 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 (Barretts oesophagus)  very occasionally, oesophageal cancer can develop from these cells, so you may need to be closely monitored Read more about the complications of GORD . Symptoms of GORD The main symptoms of gastro-oesophageal reflux disease (GORD) are heartburn and acid reflux. Heartburn Heartburn is an uncomfortableburning sensation in the chest. Its usually felt just below your breastbone, but can spread up to the throat in some people. Thediscomfort is usually worse after eating, or when bending over or lying down. Acid reflux Acid reflux is where acidand otherstomach contents arebrought back up (regurgitated)into your throat and mouth. It usually causes an unpleasant, sour taste at the back of your mouth. Othersymptoms If you have GORD, you may also experience: a sore, inflamed oesophagus (oesophagitis) bad breath bloating and belching feeling or being sick difficulty swallowing , whichmay feellike a piece of food is stuck low down in your throat pain when 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 , the symptoms may get worse as a result of stomach acid irritating your airways. Causes of 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 muscleopens to let food into your stomach and closes tostopstomach acid leaking back up into your oesophagus. But for people with GORD, stomach acid is able to pass back up into the oesophagus. This causes symptoms of GORD , which can include heartburn and acid reflux. Its not always clear what causes thisring of muscleto become weakened, but certain things can increase the risk ofit happening. Whos most at risk of GORD? The following factors mayincrease your risk of developing GORD: being overweight or obese this can place increased pressure on your stomach and weaken themuscles at the bottom of the oesophagus eating large amounts of fatty foods the stomach takes longer toget ridof stomach acid after digesting a fatty meal and the resulting excess acid may leak up into the oesophagus smoking, alcohol, coffee or chocolate  these may relax the muscles at the bottom of the oesophagus pregnancy temporary changes in hormone levelsand increased pressure on your stomach during pregnancy can cause GORD hiatus hernia when part of your stomach pushes up through your diaphragm (thin sheet of muscle between the chest and tummy) gastroparesis when the stomach takes longer toget ridof stomach acid, which meansexcess acid can leak up into the oesophagus certain medicines  some medicines can cause GORD or make the symptoms worse, includingcalcium-channel blockers (used to treat high blood pressure ),nitrates (used to treat angina ) and non-steroidal anti-inflammatory drugs (NSAIDs) stress GORD can sometimes affect several members of the same family and its been suggested that the genes you inherit from your parents may also affect your chances ofdeveloping the condition. Diagnosing GORD Your GP will often be able to diagnosegastro-oesophageal reflux disease (GORD) based on your symptoms. They may prescribe medication to treat it without needing to carry out any tests. Read more about treating GORD . When tests may be needed Youll usually only need to bereferred for tests in hospital if: your GP is unsure whether you have GORD your symptoms are persistent, severe or unusual prescription medications arent controlling your symptoms your GP thinks you might benefit from surgery you have signs of a potentially more severe condition, such as difficulty swallowing orunexplained weight loss Tests can help to confirm the diagnosis of GORD, check for other possible causes of your symptoms and determine whether you may be suitable for surgery. Tests for GORD Tests you may have include: anendoscopy abarium swallow or barium meal test manometry 24-hour pH monitoring blood tests Endoscopy Anendoscopy is a procedure where the inside of your body is examined using an endoscope, which is a long, thin, flexible tube witha light and camera at one end. The endoscope will be gently inserted into your mouth and down your throat. The procedure is usually carried out while youre awake, but you may be given a sedative to help you relax. The camera can showif the surface of your oesophagus (gullet) has been damaged by stomach acid, although this doesnt happen to everyone with GORD. Barium swallow or barium meal A barium swallow, or barium meal, is a test to assess your swallowing ability and look for any blockages or abnormalities in your oesophagus. You are first given some barium solution, then some X-rays are taken.Barium is a harmless substance that shows up clearly on X-rays as it passes through your digestive system. Youll be asked not toeat anything for a few hours before the procedure. Afterwards, youll be able to eat and drink normally, although you may need to drink more water to help flush the barium out of your body. Manometry Manometry is used to assess how well the ring of muscle at the end of your oesophagus is working, by measuring the pressure in your oesophagus. This can rule out other possible causes of your symptoms andcan help determine whether surgery would be suitable. During the procedure,a small tube will be passed up your nose and then down into your oesophagus. The tube contains pressure sensors that can detect the pressure in the oesophagus. 24-hour pH monitoring It may be necessary to measure the acidity level (pH) in your oesophagus to confirm a diagnosis of GORD if nothing is found during an endoscopy. The acidity level is measured over 24 hours, using a thin tube containing a sensor thats passed up your nose and down your oesophagus. This is usually connected to a recording device worn on your waist. Youll be asked to press a button on the recorder every time you become aware of your symptoms and to record your symptoms in a diary. You should eat as you normally would during the test to ensure an accurate result. Blood tests Sometimes a blood test may be carried out to check for anaemia , which can be a sign of internal bleeding. Treating GORD Heartburn and gastro-oesophageal reflux disease (GORD) can often be treated with self-help measures and over-the-counter medicines. If these dont help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option. Self-help You may find the following measures can help reduce heartburn and other symptoms of GORD: eat smaller and more frequent meals, rather than 3large meals a day dont eat or drink alcohol within 3or 4hours before going to bed, and avoid having your largest meal of the day in the evening avoid anything you think triggers your symptoms  common triggers includecoffee, chocolate, tomatoes, alcohol,and fatty or spicy food dont wear tight clothing  clothes that are tight around your tummy may make your symptoms worse raise the head of your bedbyup to 20cm (8 inches)  placing a piece of wood or blocks underneath one end of your bedmay reduce symptoms at night; dont just use extra pillows, as this can put a strain on your tummy tryto relax  stress can make heartburn and GORD worse, so learning relaxation techniques may help if youre often feeling stressed maintain a healthy weight  if youre overweight, losing weight mayhelpreduce your symptoms stop smoking  smoke can irritate your digestive system andmay makeyour symptoms worse If youre taking medication for other health conditions, check with your GP to find out whether they could be contributing to your symptoms. Differentmedicines may be available, but dont stop taking any prescribed medication without consulting your GP first. Medication A number of different medications can be used to treat symptoms of GORD. Over-the-counter medicines Over-the-counter heartburn and GORD medicines are available from pharmacies without a prescription. The main types are: antacids theseneutralise the effects of stomach acid alginates theseproduce a coating that protects the stomach and oesophagus (gullet) from stomach acid low-dose proton-pump inhibitors andH2-receptor antagonists see below for more information about these These medicines arent suitable for everyone, so you should check the leaflet first. Ask a pharmacist for advice if youre not sure. Proton-pump inhibitors (PPIs) If your symptoms dont get better despite trying self-help measures and over-the-counter medicines, your GP may prescribe a PPI. These work by reducing the amount of acidproduced by your stomach. Youll usually be given enough medication to last a month. Go back to your GP if they donthelp or your symptoms return after treatment finishes.Some people need to takePPIs on a long-term basis. The possible side effects of PPIs are usually mild. They include headaches, diarrhoea or constipation , feeling sick, abdominal pain , dizzinessand a rash. Your GP will prescribe the lowest dose that they think will control your symptoms to reduce the risk of side effects. H2-receptor antagonists (H2RAs) If PPIs dont control your symptoms, a medicine known as a H2RA may be recommended for you to take alongside them on a short-term basis, or as an alternative. Like PPIs, H2RAs reduce the amount of acid produced byyour stomach. Side effects of H2RAs are uncommon, but caninclude diarrhoea, headaches, dizziness, arash and tiredness. Surgery and procedures Surgery may be an option if: the above treatments dont help,arent suitable for you, orcause troublesome side effects you dont want to take medication on a long-term basis The main procedure used is calleda laparoscopic Nissen fundoplication (LNF).Alternativetechniques have been developed more recently,although these arent yet widely available. Laparoscopic Nissen fundoplication (LNF) LNF is a type of laparoscopic or keyhole surgery. This means its carried out using special surgical instruments inserted through small cuts (incisions) in the skin. The procedure is used to tighten the ring of muscle at the bottom of the oesophagus,which helps to stop acid leaking up from the stomach. Its carried out in hospital under general anaesthetic . Most people need to stay in hospital for 2or 3days after the procedure. Depending on your job, you may be able to return to work within 3to 6weeks. For the first 6weeks after surgery, you should only eat soft food, such as mince, mashed potatoes or soup. Some people experience problems with swallowing, belching and bloating after LNF,but these should get better with time. Newer operations and procedures In the last few years, several new techniques for treating GORD have been developed. The National Institute for Health and Care Excellence (NICE) says these procedures appear to be safe, butnot muchis known about their long-term effects. These techniques include: Endoscopic injection of bulking agents where special filler is injected into the area between the stomach and oesophagus to makeit narrower. Endoluminal gastroplication where folds are sown into the ring of muscles at the bottom of the oesophagus to restrict how far it can open. Endoscopic augmentation with hydrogel implants where implants containingspecialgelare placedinto the area between the stomach and oesophagus to make it narrower. Endoscopic radiofrequency ablation where a tiny balloon is passed down to the bottom ofthe oesophagus and electrodes attached to it are used to heat it and make it narrower. Laparoscopic insertion of a magnetic bead band (LINX) where a ring of magnetic beads are implanted around the lower part of the oesophagus to strengthen it and help keep it closed when not swallowing. Speak to your surgeon about these techniques for more information. Complications of GORD A number of possible complications can occur as a result of having gastro-oesophageal reflux disease (GORD) for a long time. Oesophageal ulcers Thestomach acid that leaks into the oesophagus in people with GORD can damage the lining ofthe oesophagus (oesophagitis), which can cause ulcers to form. These ulcers can bleed, causing pain and making it difficult to swallow. Medications used to treat GORD, such as proton pump inhibitors (PPIs), can help ulcers heal by reducing the amount of acid that leaks into the oesophagus. Read more about treatments for GORD . Scarred and narrow oesophagus Repeated damage to the oesophagus by stomach acid can also cause it to become scarred and narrowed. This is known as oesophageal stricture and itcan make swallowing difficult and painful. If this happens,a procedure to widen the oesophagus using a small balloon or other widening device may be recommended. Barretts oesophagus Repeated episodes of GORD can sometimes lead to changes in the cells in thelining of your lower oesophagus. This is known as Barretts oesophagus. Its estimated that about 1 in every 10 people with GORD will develop Barretts oesophagus, usuallyafter many years. Barretts oesophagus doesnt usually cause noticeable symptoms other than those caused by GORD. However, theres a small risk that the changed cells could become cancerous in the future (see below). Your doctor may suggest having an endoscopyevery few years to check for this. Oesophageal cancer Its estimated that 1 in every 10 to 20 people withBarretts oesophagus will develop oesophageal cancer within 10 to 20 years. Symptoms of oesophageal cancer include: difficulty swallowing unexplained weight loss persistent indigestion hoarseness a persistent cough and/orcoughing blood vomiting Speak to your doctorif you experience any swallowing difficulties, or any other unusual or persistent symptoms. Surgery to remove the cancer can be carried out if itsdiagnosed at an early stage. Read more about treatments for oesophageal cancer . Source: NHS 24 - Opens in new browser window Last updated: 13 December 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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