Gastro Oesophageal Reflux Disease (GORD) is a condition where acid from the stomach leaks back up into the esophagus, which can cause symptoms such as heartburn and an unpleasant taste in the mouth. It can also cause damage to the esophagus and even lead to cancer.
GORD usually happens due to a combination of factors, including a weakness in the lower oesophageal sphincter (LES), pressure on the stomach from being overweight or pregnant, and certain foods or drinks that trigger the release of acid.
Several treatments are available for GORD, including lifestyle changes, medications, and surgery. The best treatment will depend on the severity of the symptoms and the condition’s underlying cause.
Causes of Gastro Oesophageal Reflux Disease
1. A weakness in the lower oesophageal sphincter (LES)
A weakness in the lower oesophageal sphincter (LES) is a condition that can cause gastroesophageal reflux disease (GORD). The LES is a ring of muscle at the bottom of the esophagus that opens to allow food and liquid to pass into the stomach and then closes to prevent them from flowing back up.
A weakness in the LES can cause GORD by allowing acidic stomach contents to flow back into the esophagus, causing irritation and inflammation. Treatment for a weakness in the LES may include lifestyle changes, such as avoiding trigger foods and beverages, losing weight, and avoiding tight-fitting clothing. Medications, such as antacids, proton pump inhibitors, and H2 blockers, can also be used to treat the symptoms of GORD. Surgery is a last resort option for treating weakness in the LES.
2. Pressure on the stomach
Being overweight or pregnant can put extra pressure on the stomach, which can cause the LES to relax and allow acid to flow back into the esophagus.
3. Certain foods and drinks
Certain foods and drinks are known to trigger the release of acid in the stomach, which can lead to GORD. These include fatty or fried foods, citrus fruits, chocolate, coffee, and alcohol.
4. Other medical conditions
Several other medical conditions can increase the risk of GORD, including diabetes, asthma, and certain types of medications.
5. Family history
GORD is often thought of as a condition affecting people of all ages. However, it is more common in people over 50 due to multiple factors, including age and a family history of the condition.
Gastroesophageal Reflux Disease Symptoms and Diagnosis
The symptoms of GORD can vary from person to person. They may be mild or severe, and they may come and go. The most common symptom is heartburn.
Heartburn is a burning sensation in the chest that is often worse after eating. It can be accompanied by an unpleasant taste in the mouth, bloating, belching, and a feeling of tightness in the throat.
Other symptoms of GORD include:
– Regurgitation: This is when food or acid comes back into the throat or mouth.
– Dyspepsia: This is a general term for pain or discomfort in the stomach area. It can accompany symptoms such as bloating, belching, and nausea.
– A feeling of fullness: This can happen even after eating a small meal.
– Difficulty swallowing: This may be due to an underlying condition such as Barrett’s esophagus (discussed below).
– Pain in the chest: This may feel like a heart attack, but it is usually not.
– Wheezing or coughing: These symptoms may be due to aspiration pneumonia, which can happen when liquids, food, or vomit are brought into the lungs.
– Bad breath: This can happen due to the regurgitation of acid or food.
– A hoarse voice: This can happen due to stomach acid irritating the vocal cords.
If a person experiences any of these symptoms, they need to see their doctor to rule out other possible causes and determine the best course of treatment.
If a doctor suspects an individual has GORD, they will likely start with a physical examination and ask about symptoms. They may also recommend some tests to confirm the diagnosis.
Tests that diagnose GORD include:
– Gastroscopy: A tiny camera is inserted through the mouth into the stomach to check for damage to the esophagus.
– pH monitoring: This involves placing a small tube in the esophagus to measure the level of acidity over 24 hours, which can help identify periods when acid is flowing back into the esophagus.
– Barium swallow: This type of X-ray can help identify any abnormalities in the esophagus.
– Gastric emptying study: This test checks how well the stomach empties. It can help identify whether a stomach emptying delay contributes to GORD.
Complications of Gastroesophageal Reflux Disease
If left untreated, GORD can lead to several complications. These include:
– Barrett’s Esophagus: Barrett’s esophagus is a condition in which the lining of the esophagus (the food pipe) is replaced by tissue similar to the lining of the intestine. This change is thought to be due to damage from stomach acid. Barrett’s esophagus is a risk factor for developing oesophageal cancer. There are two main types of Barrett’s esophagus, columnar lined and intestinal metaplasia. Columnar-lined Barrett’s esophagus is the more common type, characterized by columnar cells in the oesophageal lining. Intestinal metaplasia in Barrett’s esophagus is less common, characterized by intestinal cells in the oesophageal lining.
– Esophagitis: Esophagitis is a condition in which the esophagus, the tube that carries food from the mouth to the stomach, becomes inflamed and irritated. Esophagitis can happen due to several things, including acid reflux, infection, or allergies. Symptoms of esophagitis include heartburn, chest pain, difficulty swallowing, and nausea. Esophagitis is treated with a combination of medications and lifestyle changes.
– Strictures: Strictures are a medical condition affecting the gastrointestinal tract. The most common symptom is abdominal pain, ranging from mild to severe. Other symptoms may include bloating, diarrhea, constipation, and nausea. Strictures happen due to various conditions, including Crohn’s disease, ulcerative colitis, and radiation therapy. Treatment typically involves surgery to remove the affected portion of the intestine. In some cases, doctors can treat strictures with medications or dietary changes.
– Aspiration Pneumonia: Aspiration pneumonia is a severe lung infection that occurs when liquids, food, or vomit are brought up from the stomach and then breathed in (inhaled), which can happen if a person has a condition that affects their ability to swallow, if they get food or liquid in their lungs (aspirate), or if they vomit and inhale the vomit. Aspiration pneumonia is a severe complication associated with many conditions, including stroke, seizure, coma, and head injury. It can also occur in people who are very sick and unable to protect their airways, such as those critically ill or on a ventilator.
– Chest Pain: This can be a symptom of a heart condition, such as angina or a heart attack. A person should see their doctor if they experience chest pain, which could signify a more severe disease.
Gastroesophageal Reflux Disease Treatment and Prevention
Gastroesophageal reflux disease treatment includes lifestyle changes, medications, and surgery. The best treatment will depend on the severity of the symptoms and the condition’s underlying cause.
1. Lifestyle changes
Making simple lifestyle changes can often help relieve GORD’s symptoms. These include:
– avoiding trigger foods and drinks
– losing weight if you are overweight or obese
– quitting smoking
– avoiding lying down immediately after eating
– elevating the head of the bed by 6 to 8 inches (15 to 20 cm)
– wearing loose-fitting clothes
Doctors can use several different medications to treat GORD. These include:
– antacids to neutralize stomach acid
– histamine H2 blockers to reduce stomach acid production
– proton pump inhibitors to block stomach acid production
In some cases, surgery may be recommended to treat GORD. Fundoplication is the most common type of surgery, which involves wrapping the stomach’s upper part around the esophagus’s lower part. This action helps strengthen the LES and prevent acid from flowing back into the esophagus.
There are several things a person can do to help prevent GORD. These include:
– Avoiding trigger foods and drinks: such as fatty or fried foods, coffee, tea, chocolate, alcohol, and citrus fruits
– Eating small meals instead of large meals
– Avoid lying down immediately after eating: wait at least 3 hours before bed.
– Elevating the head of the bed 6-8 inches (15-20 cm): this can be done by placing blocks under the legs at the head of the bed.
– Wearing loose-fitting clothes: tight clothing can pressure the stomach and abdomen, triggering reflux.
– Quitting smoking: tobacco use increases the risk of GORD.
– Maintaining a healthy weight: If a person is overweight or obese, losing weight can also help reduce GORD’s symptoms. Obesity is a significant risk factor for the condition, so even a tiny amount of weight loss can make a big difference. Even a slight weight loss of 5 to 10% can make a difference.
If a person has GORD, following their treatment plan and seeing their doctor for regular checkups is essential. Regular checkups will help keep the symptoms under control and prevent complications from developing.