Gastro-oesophageal reflux disease (GORD)

About gastro-oesophageal reflux disease (GORD)

Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet).

It usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened. Read more about the causes of GORD.

GORD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth. It may just be an occasional nuisance for some people, but for others it can be a severe, lifelong problem.

GORD can often be controlled with self-help measures and medication. Occasionally, surgery to correct the problem may be needed.

This topic focuses on GORD in adults.

Symptoms of GORD

Symptoms of GORD can include:

• heartburn (an uncomfortable burning sensation in the chest that often occurs after eating)
• acid reflux (where stomach acid comes back up into your mouth and causes an unpleasant, sour taste)
• oesophagitis (a sore, inflamed oesophagus)
• bad breath
• bloating and belching
• feeling or being sick
• pain when swallowing and/or difficulty swallowing

Read more about the symptoms of GORD.

What to do if you have GORD

You can often control the symptoms of GORD by making some lifestyle changes and taking over-the-counter medication.

Read treatments for GORD for more information.

You don’t necessarily need to see your GP if you only have symptoms occasionally. Ask your pharmacist for advice on treatments. 

When to see your GP

Visit your GP if you’re worried about your symptoms, or if:

• you have symptoms several times a week
• over-the-counter medications aren’t helping
• your symptoms are severe
• you have difficulty swallowing
• you have possible signs of a more serious problem, such as persistent vomiting, vomiting blood or unexplained weight loss

Your GP will usually be able to diagnose GORD based on your symptoms, although they may refer you for some tests.

Read more about diagnosing GORD.

Treatments for GORD

The main treatments for GORD are:

• self-help measures – this includes eating smaller but more frequent meals, avoiding any foods or drinks that trigger your symptoms, raising the head of your bed, and keeping to a healthy weight
• over-the-counter medicines – ask your pharmacist to recommend an antacid or an alginate
• stronger prescription medicines – including proton-pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs)

You may only need to take medication when you experience symptoms, although long-term treatment may be needed if the problem continues.

Surgery to stop stomach acid leaking into your oesophagus may be recommended if medication isn’t helping, or you don’t want to take medication on a long-term basis.

Read more about the treatments for GORD.

Complications of GORD

If you have GORD for a long time, stomach acid can damage your oesophagus and cause further problems.

These include:

• ulcers (sores) on the oesophagus – these may bleed and make swallowing painful
• the oesophagus becoming scarred and narrowed – this can make swallowing difficult and may require an operation to correct it
• changes in the cells lining the oesophagus (Barrett’s oesophagus) – very occasionally, oesophageal cancer can develop from these cells, so you may need to be closely monitored

Read more about the complications of GORD.

Symptoms of GORD

The main symptoms of gastro-oesophageal reflux disease (GORD) are heartburn and acid reflux.

Heartburn

Heartburn is an uncomfortable burning sensation in the chest.

It’s usually felt just below your breastbone, but can spread up to the throat in some people.

The discomfort is usually worse after eating, or when bending over or lying down.

Acid reflux 

Acid reflux is where acid and other stomach contents are brought back up (regurgitated) into your throat and mouth.

It usually causes an unpleasant, sour taste at the back of your mouth.

Other symptoms

If you have GORD, you may also experience:

• a sore, inflamed oesophagus (oesophagitis)
• bad breath
• bloating and belching
• feeling or being sick
• difficulty swallowing, which may feel like a piece of food is stuck low down in your throat
• pain when swallowing 
• a sore throat and hoarseness
• a persistent cough or wheezing, which may be worse at night
• tooth decay and gum disease

If you also have asthma, the symptoms may get worse as a result of stomach acid irritating your airways.

Causes of GORD

Gastro-oesophageal reflux disease (GORD) is usually caused by the ring of muscle at the bottom of the oesophagus (gullet) becoming weakened.

Normally, this ring of muscle opens to let food into your stomach and closes to stop stomach acid leaking back up into your oesophagus.

But for people with GORD, stomach acid is able to pass back up into the oesophagus. This causes symptoms of GORD, which can include heartburn and acid reflux.

It’s not always clear what causes this ring of muscle to become weakened, but certain things can increase the risk of it happening.

Who’s most at risk of GORD?

The following factors may increase your risk of developing GORD:

• being overweight or obese – this can place increased pressure on your stomach and weaken the muscles at the bottom of the oesophagus
• eating large amounts of fatty foods – the stomach takes longer to get rid of stomach acid after digesting a fatty meal and the resulting excess acid may leak up into the oesophagus
• smoking, alcohol, coffee or chocolate – these may relax the muscles at the bottom of the oesophagus
• pregnancy – temporary changes in hormone levels and increased pressure on your stomach during pregnancy can cause GORD
• hiatus hernia – when part of your stomach pushes up through your diaphragm (thin sheet of muscle between the chest and tummy)
• gastroparesis – when the stomach takes longer to get rid of stomach acid, which means excess acid can leak up into the oesophagus
• certain medicines – some medicines can cause GORD or make the symptoms worse, including calcium-channel blockers (used to treat high blood pressure), nitrates (used to treat angina) and non-steroidal anti-inflammatory drugs (NSAIDs)
• stress

GORD can sometimes affect several members of the same family and it’s been suggested that the genes you inherit from your parents may also affect your chances of developing the condition.

Diagnosing GORD

Your GP will often be able to diagnose gastro-oesophageal reflux disease (GORD) based on your symptoms.

They may prescribe medication to treat it without needing to carry out any tests. Read more about treating GORD.

When tests may be needed

You’ll usually only need to be referred for tests in hospital if:

• your GP is unsure whether you have GORD
• your symptoms are persistent, severe or unusual
• prescription medications aren’t controlling your symptoms
• your GP thinks you might benefit from surgery
• you have signs of a potentially more severe condition, such as difficulty swallowing or unexplained weight loss

Tests can help to confirm the diagnosis of GORD, check for other possible causes of your symptoms and determine whether you may be suitable for surgery.

Tests for GORD

Tests you may have include:

• an endoscopy
• a barium swallow or barium meal test
• manometry
• 24-hour pH monitoring
• blood tests

Endoscopy

An endoscopy is a procedure where the inside of your body is examined using an endoscope, which is a long, thin, flexible tube with a light and camera at one end.

The endoscope will be gently inserted into your mouth and down your throat. The procedure is usually carried out while you’re awake, but you may be given a sedative to help you relax.

The camera can show if the surface of your oesophagus (gullet) has been damaged by stomach acid, although this doesn’t happen to everyone with GORD.

Barium swallow or barium meal

A barium swallow, or barium meal, is a test to assess your swallowing ability and look for any blockages or abnormalities in your oesophagus.

You are first given some barium solution, then some X-rays are taken. Barium is a harmless substance that shows up clearly on X-rays as it passes through your digestive system.

You’ll be asked not to eat anything for a few hours before the procedure. Afterwards, you’ll be able to eat and drink normally, although you may need to drink more water to help flush the barium out of your body.

Manometry

Manometry is used to assess how well the ring of muscle at the end of your oesophagus is working, by measuring the pressure in your oesophagus.

This can rule out other possible causes of your symptoms and can help determine whether surgery would be suitable.

During the procedure, a small tube will be passed up your nose and then down into your oesophagus. The tube contains pressure sensors that can detect the pressure in the oesophagus.

24-hour pH monitoring

It may be necessary to measure the acidity level (pH) in your oesophagus to confirm a diagnosis of GORD if nothing is found during an endoscopy.

The acidity level is measured over 24 hours, using a thin tube containing a sensor that’s passed up your nose and down your oesophagus. This is usually connected to a recording device worn on your waist.

You’ll be asked to press a button on the recorder every time you become aware of your symptoms and to record your symptoms in a diary. You should eat as you normally would during the test to ensure an accurate result.

Blood tests

Sometimes a blood test may be carried out to check for anaemia, which can be a sign of internal bleeding. 

Treating GORD

Heartburn and gastro-oesophageal reflux disease (GORD) can often be treated with self-help measures and over-the-counter medicines.

If these don’t help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option.

Self-help

You may find the following measures can help reduce heartburn and other symptoms of GORD:

• eat smaller and more frequent meals, rather than 3 large meals a day – don’t eat or drink alcohol within 3 or 4 hours before going to bed, and avoid having your largest meal of the day in the evening
• avoid anything you think triggers your symptoms – common triggers include coffee, chocolate, tomatoes, alcohol, and fatty or spicy food
• don’t wear tight clothing – clothes that are tight around your tummy may make your symptoms worse
• raise the head of your bed by up to 20cm (8 inches) – placing a piece of wood or blocks underneath one end of your bed may reduce symptoms at night; don’t just use extra pillows, as this can put a strain on your tummy
• try to relax – stress can make heartburn and GORD worse, so learning relaxation techniques may help if you’re often feeling stressed
• maintain a healthy weight – if you’re overweight, losing weight may help reduce your symptoms
• stop smoking – smoke can irritate your digestive system and may make your symptoms worse

If you’re taking medication for other health conditions, check with your GP to find out whether they could be contributing to your symptoms.

Different medicines may be available, but don’t stop taking any prescribed medication without consulting your GP first.

Medication

A number of different medications can be used to treat symptoms of GORD.

Over-the-counter medicines

Over-the-counter heartburn and GORD medicines are available from pharmacies without a prescription. The main types are:

• antacids – these neutralise the effects of stomach acid
• alginates – these produce a coating that protects the stomach and oesophagus (gullet) from stomach acid
• low-dose proton-pump inhibitors and H2-receptor antagonists – see below for more information about these 

These medicines aren’t suitable for everyone, so you should check the leaflet first. Ask a pharmacist for advice if you’re not sure.

Proton-pump inhibitors (PPIs)

If your symptoms don’t get better despite trying self-help measures and over-the-counter medicines, your GP may prescribe a PPI. These work by reducing the amount of acid produced by your stomach.

You’ll usually be given enough medication to last a month. Go back to your GP if they don’t help or your symptoms return after treatment finishes. Some people need to take PPIs on a long-term basis.

The possible side effects of PPIs are usually mild. They include headaches, diarrhoea or constipation, feeling sick, abdominal pain, dizziness and a rash.

Your GP will prescribe the lowest dose that they think will control your symptoms to reduce the risk of side effects.

H2-receptor antagonists (H2RAs)

If PPIs don’t control your symptoms, a medicine known as a H2RA may be recommended for you to take alongside them on a short-term basis, or as an alternative.

Like PPIs, H2RAs reduce the amount of acid produced by your stomach.

Side effects of H2RAs are uncommon, but can include diarrhoea, headaches, dizziness, a rash and tiredness.

Surgery and procedures

Surgery may be an option if:

• the above treatments don’t help, aren’t suitable for you, or cause troublesome side effects
• you don’t want to take medication on a long-term basis

The main procedure used is called a laparoscopic Nissen fundoplication (LNF). Alternative techniques have been developed more recently, although these aren’t yet widely available.

Laparoscopic Nissen fundoplication (LNF)

LNF is a type of laparoscopic or ‘keyhole’ surgery. This means it’s carried out using special surgical instruments inserted through small cuts (incisions) in the skin.

The procedure is used to tighten the ring of muscle at the bottom of the oesophagus, which helps to stop acid leaking up from the stomach. It’s carried out in hospital under general anaesthetic.

Most people need to stay in hospital for 2 or 3 days after the procedure. Depending on your job, you may be able to return to work within 3 to 6 weeks.

For the first 6 weeks after surgery, you should only eat soft food, such as mince, mashed potatoes or soup. Some people experience problems with swallowing, belching and bloating after LNF, but these should get better with time.

Newer operations and procedures

In the last few years, several new techniques for treating GORD have been developed.

The National Institute for Health and Care Excellence (NICE) says these procedures appear to be safe, but not much is known about their long-term effects.

These techniques include:

• Endoscopic injection of bulking agents – where special filler is injected into the area between the stomach and oesophagus to make it narrower.
• Endoluminal gastroplication – where folds are sown into the ring of muscles at the bottom of the oesophagus to restrict how far it can open.
• Endoscopic augmentation with hydrogel implants – where implants containing special gel are placed into the area between the stomach and oesophagus to make it narrower.
• Endoscopic radiofrequency ablation – where a tiny balloon is passed down to the bottom of the oesophagus and electrodes attached to it are used to heat it and make it narrower.
• Laparoscopic insertion of a magnetic bead band (LINX) – where a ring of magnetic beads are implanted around the lower part of the oesophagus to strengthen it and help keep it closed when not swallowing.

Speak to your surgeon about these techniques for more information.

Complications of GORD

A number of possible complications can occur as a result of having gastro-oesophageal reflux disease (GORD) for a long time.

Oesophageal ulcers

The stomach acid that leaks into the oesophagus in people with GORD can damage the lining of the oesophagus (oesophagitis), which can cause ulcers to form.

These ulcers can bleed, causing pain and making it difficult to swallow.

Medications used to treat GORD, such as proton pump inhibitors (PPIs), can help ulcers heal by reducing the amount of acid that leaks into the oesophagus. Read more about treatments for GORD.

Scarred and narrow oesophagus

Repeated damage to the oesophagus by stomach acid can also cause it to become scarred and narrowed.

This is known as oesophageal stricture and it can make swallowing difficult and painful.

If this happens, a procedure to widen the oesophagus using a small balloon or other widening device may be recommended.

Barrett’s oesophagus

Repeated episodes of GORD can sometimes lead to changes in the cells in the lining of your lower oesophagus. This is known as Barrett’s oesophagus.

It’s estimated that about 1 in every 10 people with GORD will develop Barrett’s oesophagus, usually after many years.

Barrett’s oesophagus doesn’t usually cause noticeable symptoms other than those caused by GORD.

However, there’s a small risk that the changed cells could become cancerous in the future (see below). Your doctor may suggest having an endoscopy every few years to check for this.

Oesophageal cancer

It’s estimated that 1 in every 10 to 20 people with Barrett’s oesophagus will develop oesophageal cancer within 10 to 20 years.

Symptoms of oesophageal cancer include:

• difficulty swallowing
• unexplained weight loss
• persistent indigestion
• hoarseness
• a persistent cough and/or coughing blood
• vomiting

Speak to your doctor if you experience any swallowing difficulties, or any other unusual or persistent symptoms.

Surgery to remove the cancer can be carried out if it’s diagnosed at an early stage.

Read more about treatments for oesophageal cancer.