Gastro-oesophageal Reflux Disease (GORD)

What is Heartburn or Gastric Reflux?

Heartburn occurs when stomach acid refluxes back into the oesophagus and burns its sensitive lining.

 

Gastric reflux, also called gastro-oesophageal reflux disease (GORD), is a condition where the stomach’s contents rise up from the stomach into the oesophagus.

 

Food mixed with the stomach’s digestive acids can irritate and damage the oesophagus.

 

Causes of Gastric Reflux

The exact cause of this is not known, however certain known contributory factors include;

  • Obesity
  • Hiatus Hernia 
  • Smoking
  • Pregnancy
  • Certain medications

 

Common foods such as alcohol, spicy foods, onions, chocolates, caffeine-containing drinks, mints, tomato-based foods, citrus fruits and certain medications can worsen gastric reflux.


Normally, the stomach contents are retained in the stomach with the help of the lower oesophageal sphincter (LOS), a muscle that contracts and relaxes to maintain the one-way movement of food. However, gastric reflux occurs when the LOS weakens.


Impact of Gastric Reflux

Living with gastric reflux is inconvenient as symptoms can severely interfere with your life. You may have to follow certain dietary restrictions and reflux occurring in the night can hinder a good nights sleep, thereby affecting alertness and productivity the next day.


Anatomy of Gastric Reflux

Food travels from the mouth through the oesophagus, a long, narrow tube that opens into the stomach. This food pipe is lined by muscles that expand and contract to push food down the tube, a process called peristalsis. The stomach secretes acid and other digestive enzymes for the digestion of food and stores food before it enters into the intestine.


A band of muscle called the lower oesophageal sphincter (LES) are present at the junction of the oesophagus and the stomach. This acts as a valve, preventing the reflux of acid from the stomach into the oesophagus.


Symptoms of Gastric Reflux

Heartburn is usually the main symptom of GORD, characterised by a burning-type pain in the lower part of the mid-chest, behind the breastbone.


Other symptoms include a bitter or sour taste in the mouth, trouble swallowing, nausea, dry cough or wheezing, regurgitation of food, hoarseness or change in voice and chest pain.

 

Diagnosis for Gastric Reflux

Your doctor may order some of the following tests to diagnose gastric reflux:

  • Endoscopy: allows the doctor to examine the inside of your oesophagus, stomach and portions of the intestine with an instrument called an endoscope, a thin flexible telescope
  • 24-hour pH monitoring: involves inserting a tube through your nose into the oesophagus and positioning it above the LOS. The tip of the tube contains a sensor that can measure the pH of the acid content refluxed into the oesophagus. The tube will be left in place for 24 hours.
  • BRAVO capsule: This is an alternative way to measure acid exposure in the oesophagus. A small wireless capsule is introduced into the oesophagus using a gastroscope. The pH sensor transmits signals to a computer which collects the data about the acid exposure over the next 24 hours. The capsule eventually falls off of the oesophagus lining and is safely passed in the stool.
  • Oesophageal Manometry: A tube placed into the oesophagus measures how well the muscles of the oesophagus work which is helpful in assessing the problem

 

Treatments for Gastric Reflux

Treatment is aimed at reducing reflux, relieving symptoms and preventing damage to the oesophagus. Some of the treatment options include:

  • Lifestyle changes- Weight loss, cessation of smoking and reducing alcohol consumption. Eating dinner earlier to provide a longer interval prior to sleep.
  • Antacids - over-the-counter medicines that provide temporary relief to heartburn and indigestion by neutralizing acid in the stomach
  • Other medications - PPI drugs reduce the production of acid in the stomach and are usually very effective at controlling symptoms
  • Fundoplication - A key-hole (laparoscopic) surgical procedure in which the upper part of the stomach is wrapped around the lower end of your oesophagus where it is sutured into place. This surgery strengthens the sphincter and helps prevent stomach acid and food from flowing back into the oesophagus.

 

Fundoplication Surgery for GORD

If conservative treatment options fail to resolve GORD symptoms or if patients would prefer not to continue taking anti-reflux medication long term, anti-reflux surgery can be an option. 

 

Fundoplication surgery reinforces the lower oesophageal sphincter’s ability to close and helps to prevent gastro-oesophageal reflux from occurring. This surgery can be performed laparoscopically through tiny incisions in the abdomen in most people.


It usually involves a 1-2 night stay in hospital and short period of diet modification post operatively. Patients return to a normal diet after initial recovery.

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Prognosis After Gastric Reflux Surgery

The outcome of treatment varies from person to person.

 

Surgery is beneficial in approximately 90% of patients. However, as with any surgery, Fundoplication may involve certain side effects. These can include trouble swallowing, inability to burp or vomit, bloating and passing more wind. These side effects do not occur in everyone.

 

Many patients who have suffered from years with heartburn and required medication to control the symptoms find that all symptoms are alleviated as soon as they awake from surgery, and no longer need medication.

 

Some may experience mild symptoms while for others, treatment can be very successful.

 

Most people respond well to lifestyle changes and medications. However, relapse is very common after cessation of medications, so the condition does require maintenance.

 

When medications fail to resolve symptoms or it is your preference not to take medication, surgery is recommended.

 

What if Gastric Reflux is Untreated

If left untreated, chronic GORD can cause serious complications such as inflammation of the oesophagus, oesophageal ulcers, narrowing of the oesophagus, chronic cough and reflux of liquid into the lungs (pulmonary aspiration). Some people may develop Barrett’s oesophagus, a condition characterised by changes in the oesophageal lining, which has an association with oesophageal cancer.

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