Gastro oesophageal reflux disease

Heartburn is a common symptom

Gastro oesophageal reflux disease (GORD) is a condition associated with the presence of stomach contents within the food pipe (oesophagus) over a lengthened period of time.

What are the symptoms?

The main symptom of the disease is heartburn, a burning like sensation which originates from behind the breastbone and spreads into the neck.

This symptom is often aggravated by postural changes such as bending or lying down.

Additional symptoms may include abdominal pain, flatulence and a nocturnal cough.

The latter is due to the presence of stomach contents within the lungs.

What are the associated risk factors?

There are a variety of risk factors associated with the disease.

These include being overweight, drinking alcohol, smoking and certain foods with are heavily spiced or high in fat content.

Certain drugs are also associated with the disease such as calcium channel blockers and benzodiazepines as well as having a hiatus hernia, which is where a part of the stomach passes through the diaphragm and into the chest.

What is the cause?

There are several factors associated with the disease.

The main factor being a weakness of the muscle located at the lower portion of the oesophagus which increases the backflow of stomach contents.

Other factors include a delay in oesophageal or gastric (stomach) emptying or an increase in the sensitivity of the lining of the oesophagus to gastric acid.

How is it diagnosed?

The diagnosis is essentially based on a clinical assessment.

Investigations are only sought if symptoms do not improve after commencing treatment or in individuals who present with so-called 'alarm symptoms' which include weight loss, anaemia and swallowing difficulties.

The gold standard investigation is endoscopy, which involves the passage of a camera through the mouth into the oesophagus to look for evidence of inflammation.

Additional investigations include a barium swallow, a specialized X-ray test which involves swallowing liquid containing barium.

This liquid enables the presence of ulceration within the oeosphagus to be easily detected.

How is it treated?

Management of gastro oesophageal reflux disease is two fold initially.

Simple measures such as losing weight, stopping smoking and alcohol have proven to be significant.

In addition avoiding certain foods such as chocolate, spicy or high content fatty foods have been shown to be effective.

Medical treatments exist and include the use of antacids which help neutralise stomach acid, acid suppressing drugs such as proton pump inhibitors, H2-receptor blockers which decrease the amount of acid production or prokinetic agents which enhance stomach emptying.

If however symptoms continue despite medical intervention, surgery can be an option.

Surgical treatment involves stitching a portion of the stomach around the lower end of the oesophagus to help prevent the backflow of stomach contents.

What are the complications?

The main complications of the disease are ulceration and narrowing of the oesophagus (stricture formation).

Over a prolonged time period, gastro oesophageal reflux disease can cause a change in the nature of the tissue lining the oesophagus, which is known as Barrett's oesophagus.

Barrett's oesophagus is essentially a pre cancerous condition which is associated with an increased risk of cancer formation.

What is the prognosis?

Gastro oesophageal reflux disease is a chronic condition and studies suggest that approximately 80 % of people suffer a recurrence of symptoms if medication is subsequently discontinued.

It is important therefore to continue with treatment to avoid a relapse.

Written by Dr Neel Sharma