Acid reflux and GORD

What acid reflux and GORD are

A ring of muscle at the bottom of the food pipe (oesophagus) normally stops stomach contents coming back up. When it is weak or relaxes at the wrong time, acid can rise and irritate the lining of the oesophagus. Occasional reflux is common. MedlinePlus describes reflux as a disease when symptoms happen two or more times a week or damage the lining. In the UK this is called GORD, and in the US, GERD.

Symptoms

• Heartburn: a burning feeling in the middle of the chest.
• An unpleasant sour taste in the mouth from stomach acid.
• A cough or hiccups that keep coming back.
• A hoarse voice.
• Bad breath.
• Bloating and feeling sick.

Symptoms are often worse after eating, when lying down and when bending over. You can have GORD without heartburn.

Causes and who is more likely to get it

Lots of people get heartburn from time to time, and there is often no obvious reason. It can be caused or made worse by:

• Food and drink such as coffee, tomatoes, alcohol, chocolate, and fatty or spicy food.
• Being overweight, and smoking.
• Pregnancy, and hormonal changes involving progesterone and oestrogen.
• Stress and anxiety.
• Some medicines, such as anti-inflammatory painkillers like ibuprofen.
• A hiatus hernia, when part of the stomach moves up into the chest.
• A stomach ulcer, or a bacterial infection in the stomach.

How it is diagnosed

A doctor will ask about your symptoms and medical history. If medicines do not help or your symptoms are severe, you may be referred for tests. These include a gastroscopy (endoscopy), where a thin tube with a camera looks at the oesophagus and stomach, a test for stomach bacteria, a pH test that measures how often acid comes up, and manometry, which checks how well the oesophagus moves food along.

How it is usually managed

Simple changes help many people:

• Eat smaller, more frequent meals.
• Avoid food and drink that trigger your symptoms.
• Do not eat in the 3 or 4 hours before bed. If your main meal is late in the evening, it is worth planning around this.
• Avoid clothes that are tight around the waist.
• Lose weight if you are overweight, stop smoking, cut down on alcohol and find ways to relax.
• Raise the head of your bed by about 10 to 20cm with blocks or books under the legs. Do not use extra pillows, which can push on your stomach and make it worse.

From a pharmacy. A pharmacist can suggest antacids or alginates. Take them with or soon after food, when heartburn is most likely, and they may work for longer. They ease symptoms in the short term but do not fix the problem, and should not be taken regularly for long periods. If you are pregnant, ask the pharmacist what is suitable.

From a doctor. A doctor may prescribe a medicine that reduces how much acid the stomach makes, usually for 4 or 8 weeks, or a different type of acid-reducing medicine if the first does not help. If stomach bacteria are found, they can be treated with antibiotics and acid-reducing medicine together. Surgery is needed only rarely. Do not stop a prescribed medicine without speaking to a doctor.

Complications to know about

Untreated, GORD can cause inflammation and scarring of the oesophagus, and changes to its lining known as Barrett’s oesophagus. It can also make asthma worse and cause a long-term cough or hoarseness. This is why heartburn that keeps coming back deserves a proper look rather than years of antacids.

When to see a doctor, and when to call 998

Call 998 for chest pain with shortness of breath, or pain in your jaw or arm, which can be signs of a heart problem rather than heartburn. Also call 998 or go to an emergency department if you are vomiting bright red blood or vomit that looks like ground coffee, your poo is black, sticky and very smelly, or you have severe tummy pain.

Get an urgent appointment if you have reflux and you have lost weight without trying, swallowing is becoming difficult, you are being sick often, there is blood in your sick, or you have pain in your upper tummy. Book a routine appointment if lifestyle changes and pharmacy medicines are not helping, or you have heartburn most days.

General practitioners and internal medicine doctors on medicAI work at independent facilities licensed by DHA or DoH. Reflux is often talked through well on a video call, and the doctor will tell you if you need tests or an examination in person.