Overview
Gastro-oesophageal reflux disease (GERD, also spelled GORD in the UK) is a chronic condition where stomach acid flows back up into the oesophagus, causing heartburn and other symptoms. It results from a weakening or inappropriate relaxation of the lower oesophageal sphincter, the muscular valve between the stomach and oesophagus.
How common is it?
GERD affects around 1 in 5 adults in Western countries. It is one of the most common reasons for GP consultations and endoscopy referrals.
Causes and risk factors
Stomach acid repeatedly reaching the oesophageal lining causes irritation and inflammation. Over time, untreated GERD can cause oesophagitis, Barrett's oesophagus (a precancerous change), and oesophageal cancer.
Common risk factors
- Obesity (particularly abdominal obesity)
- Hiatus hernia
- Pregnancy
- Smoking
- Alcohol
- Certain foods: spicy food, fatty food, chocolate, citrus, caffeine, mint
- Medications: NSAIDs, calcium channel blockers, tricyclic antidepressants
- Delayed stomach emptying (gastroparesis)
Symptoms
- Heartburn: burning sensation rising from stomach to chest
- Acid taste in mouth or regurgitation of food
- Difficulty swallowing
- Persistent cough, especially at night
- Hoarse voice, particularly in the morning
- Chest pain (must be distinguished from cardiac pain)
When to see a doctor
See a doctor for persistent heartburn not responding to over-the-counter treatment, difficulty or pain with swallowing, weight loss, or symptoms in someone over 55 (to exclude oesophageal cancer). Go to A&E for chest pain that could be cardiac.
Diagnosis
Upper GI endoscopy is the standard investigation. It assesses oesophagitis severity and excludes Barrett's oesophagus and cancer. 24-hour pH monitoring confirms acid reflux in cases with normal endoscopy.
Treatments
Proton pump inhibitors (PPIs)
Omeprazole, lansoprazole, and others are the most effective drug treatment, reducing stomach acid production. Taken 30 to 60 minutes before the first meal of the day for best effect.
Lifestyle modifications
Elevating the head of the bed by 15 to 20cm, avoiding food 2 to 3 hours before bed, losing weight if overweight, and avoiding trigger foods all reduce symptoms.
Fundoplication surgery
Laparoscopic surgery that wraps the top of the stomach around the lower oesophagus to strengthen the sphincter. An option for those who do not want long-term medication or in whom it is ineffective.
Self-care and lifestyle
- Eat smaller, more frequent meals rather than large ones
- Avoid lying down within 3 hours of eating
- Lose weight if BMI is above normal
- Elevate the head of your bed on blocks or wedge pillow
Prevention
Maintaining a healthy weight, not smoking, limiting alcohol, and avoiding known trigger foods reduce the risk and severity of GERD.