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Acid Reflux - GORD

What is Acid Reflux / GORD?

Gastro-oesophageal reflux disease (GORD), also known as “heartburn” or “acid reflux”, is the medical name given to a common condition caused by stomach acid washing (or refluxing) back into the lower part of the oesophagus (gullet).   It is one of the most prevalent chronic diseases in the world; as many as 2 in 5 (40%) of adults report symptoms of “heartburn” in any 6-12 month period.    

 

What Are The Symptoms?

  • The main acid reflux symptom is heartburn. This is an unpleasant  burning feeling which rises from the upper abdomen or lower chest towards the neck. It is sometimes confused with pain from the heart (angina), though it has nothing at all to do with heart disease

  • Other common acid reflux symptoms include: pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, excessive salivation (water brash), belching, and a burning pain when you swallow hot drinks. Like heartburn, these symptoms come and go, and tend to be worse after eating

  • Uncommon acid reflux symptoms can mimic other conditions hindering diagnosis eg

      • A persistent cough, particularly at night, may be due to the refluxed acid irritating the trachea (windpipe). In 6-10% of patients with chronic cough, GORD is the underlying cause

      • Asthma symptoms of cough and wheeze

      • Chronic hoarseness due to acid damage to the voicebox

      • Other mouth and throat symptoms such as gum inflammation, bad breath, sore throat and a constant feeling of a lump in the throat

      • Severe chest pain may also occur in some cases (and may be mistaken for a heart attack)

 

What Causes Reflux?  

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Cause of Reflux - LES fails
Fig. 1
Causes of Reflux Fig 2
Fig. 2

At the lower end of the gullet there is a ring of muscle called the lower oesophageal sphincter (LES) which normally acts as a valve to prevent acid contents of the stomach leaking (refluxing) into the lower part of the oesophagus (see Fig 1).

However, if the LES fails to function properly, stomach acid and bile juices can flow into the oesophagus, giving rise to heartburn and various other symptoms of GORD (see Fig.2).

Unlike stomach cells which secrete a special mucous to protect them from acid digestion, the lining of the oesophagus has no such protection and is therefore vulnerable to the effects of acid and bile salts. This can result in inflammation and – if prolonged – ulceration and bleeding.

It is not known why the lower oesophageal sphincter (LES) fails to work properly, but we know that GORD is more common in males, during pregnancy, smokers, heavy drinkers and in those who are obese.  Symptoms may also be more marked when bending forwards and lying down. In addition, if you have a hiatus hernia (when part of the stomach protrudes through the diaphragm), you have an increased chance of developing reflux disease.

 

 

What Are The Complications?

  • Oesophagitis/ulcer – inflammation and ulceration of the oesophagus may occur  if reflux persists

  • Anaemia may occur due to loss of blood from the inflamed oesophagus

  • Oesophageal stricture – scarring and narrowing of the oesophagus may occur, leading to  difficulty swallowing

  • Barrett's oesophagus: Patients with longstanding GORD are at increased risk of developing a condition known as  Barrett’s oesophagus which can – in turn – lead to cancer of the oesophagus.