Gastro-oesophageal reflux disease (GORD): causes, symptoms and treatments

What is gastro-oesophageal reflux disease (GORD)? 

Acid reflux: definition and causes

GORD occurs when there is a relaxation of the lower oesophageal sphincter, which normally prevents the reflux of gastric juices. The acid that flows back into the oesophagus irritates the oesophageal mucosa, leading to pain and burning sensations in the area behind the breastbone.

The difference between the occasional reflux and GORD 

Reflux can occur occasionally after a heavy or fatty meal. When this happens several times a week, disrupts daily life or does not go away without medication, it is called chronic GORD, and requires medical opinion.

GORD and hiatal hernia: is there a link? 

Hiatal hernia occurs when part of the stomach rises above the diaphragm, facilitating the acid reflux. This anatomical condition makes it easier for gastric juices to pass when the person is lying down or bending over, and accentuates the symptoms.

What are the symptoms of GORD? 

Heartburn and regurgitation 

The most characteristic symptom is retrosternal burning, also known as pyrosis. Acid regurgitation often leads to a bitter taste in the mouth. These sensations are caused by the repeated irritation of the oesophageal mucosa.

Digestive and non-digestive problems 

In addition to gastric pain, GORD can manifest itself by persistent cough, sore throat, hoarseness or even chest pain, sometimes mistaken for heart disease. These non-digestive symptoms complicate the diagnosis because they can be confused with those of other disorders.

Nocturnal reflux and sleep disturbances

Nocturnal reflux often occurs in the lying position, causing the person to wake up in the middle of the night due to the feeling of suffocation, and leads to poor sleep quality. It also increases the risk of chronic inflammation.

What causes GORD? 

Frequent causes: diet, stress, excess weight

A diet rich in fats, spices or fizzy drinks puts pressure on the stomach and encourages reflux. Stress, by increasing acid production and altering digestive motility, is also a triggering factor. Excess weight puts pressure on the abdomen, further contributing to the symptoms.

Aggravating factors: tobacco, alcohol, certain medications 

Alcohol, tobacco and certain medicines such as non-steroidal anti-inflammatory drugs (NSAIDs) weaken the oesophageal sphincter or increase gastric acidity, making reflux episodes worse.

GORD and pregnancy

During pregnancy, the pressure of the uterus on the stomach and a physiological relaxation of the oesophageal sphincter considerably increase the risk of reflux. Although temporary, this type of GORD may require dietary adjustments or special treatment.

How is GORD diagnosed? 

When should you see a doctor? 

You should see a doctor if burning sensations or regurgitations are frequent, resistant to medication or accompanied by other symptoms such as chest pain, weight loss or difficulty swallowing.

GORD diagnosis: endoscopy, pH-metry, manometry 

Oesogastroduodenal endoscopy helps visualise inflammation or scarring lesions in the oesophagus. The 24-hour pH metry measures the acidification of the oesophagus, and manometry assesses sphincter pressure and oesophageal motricity.

Which healthcare professional should you see? 

Your GP can prescribe treatment or refer you to a specialist. In the event of severe or persistent reflux, a gastroenterologist can carry out specific tests and establish a more comprehensive treatment plan.

What are the treatments for GORD? 

Drug treatments: PPI, antacids, alginates 

Proton pump inhibitors (PPIs) are considered to be the first-line treatment for chronic reflux, due to their proven efficacy. Antacids neutralise gastric acidity, while alginates create a protective barrier in the oesophagus.

Alternative medicine 

Among the alternative medicines, plants such as liquorice or camomile are a common option and can ease the symptoms. Recent studies also point to other alternatives, such as rose oil, which has been shown to be similar in efficacy to omeprazole, without including the usual side effects of PPIs.

Surgery 

When medical treatment fails or severe reflux persists, surgery becomes an option. Nissen fundoplication, which involves reshaping the oesophageal sphincter, is the most common technique and can reduce the incidence of oesophageal reflux disease.

GORD and food: what to eat, what not to eat 

What foods to avoid if you have acid reflux 

Fatty, spicy foods, citrus fruit, tomatoes, chocolate, mint, coffee and fizzy or alcoholic drinks are often responsible for acid reflux. Excessive consumption of these foods, particularly before bedtime, aggravates the symptoms.

Foods that can ease the symptoms 

Mild, low-acid foods such as cooked vegetables, wholegrain cereals, low-fat yoghurts, white meats and low-fat fish are better tolerated. They help soothe the acidity and reduce the frequency of acid reflux.

Anti-reflux diet

Here is an example of an anti-reflux diet: wholemeal bread, banana and a non-mint infusion for breakfast, rice, steamed courgettes and chicken fillet for lunch, and vegetable soup and a slice of ham for dinner. 

Everyday tips to help you tackle the reflux 

Adjusting your posture

Avoid lying down immediately after a meal, sleep on an elevated pillow, eat in a seated position and chew slowly. Sleeping on the left side also reduces the passage of acid into the oesophagus.

Managing stress and emotions 

Stress can aggravate gastric acid production. Relaxation techniques and meditation can limit the frequency and intensity of the symptoms.

Changing your lifestyle habits 

Maintaining a healthy weight, stopping smoking, limiting alcohol consumption and exercising regularly are all keys to preventing GORD and relieving its symptoms. Weight loss is strongly recommended for those suffering from acid reflux.

Conclusion 

Gastro-oesophageal reflux disease (GORD) is a common but often underestimated condition. By knowing the causes and symptoms, taking the right medication and making certain changes to your lifestyle, you can manage it better. A personalised treatment plan, established by your GP or a gastroenterologist, can limit the risks and improve your quality of life in the long term.

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