Patient Information on Gastro-oesophageal Reflux Disease (GORD)

What is GORD?
Gastro - Oesophageal Reflux Disease is a common condition. It occurs when there is a weakening of the protective muscular valve (lower oesophageal sphincter) which normally keeps the stomach contents within the stomach. This muscle weakness allows the acidic juices from the stomach to flow (reflux) back into the gullet (oesophagus). The acid may inflame the oesophagus and give rise to heartburn. It may flow up to the mouth when it is known as regurgitation.

What causes GORD?
Normally the lower oesophageal sphincter muscle relaxes to allow food to pass into the stomach. It closes afterwards, thus allowing only a small amount of stomach acid to flow back up. Any acid which does flow into the oesophagus is quickly cleared back into the stomach, by muscular action of the oesophagus (peristalsis).

Gastro Oesophageal reflux may occur:

	When there is a weakness of the sphincter so that it does not close effectively.
	When the sphincter relaxes and opens too often.
	When the oesophagus fails to clear refluxed acid back into the stomach.
	When the stomach is slow to empty after a meal.
	When the upper part of the stomach moves into the chest through an opening in the diaphragm. This is called a hiatus hernia. A hiatus hernia can reduce the efficiency of the sphincter.

What are the symptoms of GORD?
Symptoms are many and varied Common Symptoms are:

	Heartburn - a burning pain behind the breastbone
	Regurgitation - stomach contents flowing up to the mouth
	Acid (bitter) taste in the mouth

Other Symptoms may include:
Pain in the chest, neck or jaw
Pain in the upper abdomen
Difficulty or pain with swallowing
Coughing/choking/asthma/hoarse voice
Tooth erosion, bad breath, sore throat
Sensation of a lump in the throat

How may I help myself?
Simple lifestyle adjustments can make you feel much better

	Stop smoking - nicotine relaxes the sphincter.
	Alcohol has a similar effect to smoking. Keep your intake down to recommended levels or less.
	Try to keep to your ideal weight - fat in the abdomen can put extra pressure on the sphincter.
	Avoid tight clothing which has the same effect as being overweight.
	Stay upright as much as you can. Avoid bending. Bend your knees instead.
	Elevate the head of your bed with blocks so that the whole bed slopes. Your oesophagus will then be higher than your stomach during the night. (Do not use extra pillows.)
	Eat frequent small meals which are high in fibre and low in fat. Do not eat large meals.
	After meals don't lie down or slump in a chair.
	Cut down on those foods which you know make your symptoms worse, for example spicy foods, fatty foods, chocolate, onions, tea and coffee.
	Allow very hot food to cool a little before eating.
	Be sparing with citrus fruits and juices, and tomato products.
	Try to relax. Tension and stress can make reflux worse.

What treatment may I receive?
You should follow the advice of your doctor who will recommend treatment specifically
for you.

This may include:

	Lifestyle advice as indicated above
	Medical Treatment

Which may be:
Simple antacids which neutralise the stomach acid eg Pennies, Settlers.
Alginates which form a protective foaming barrier on top of the stomach contents, eg Gaviscon, Gastrocote.
Tablets which reduce the amount of acid made in your
stomach eg cimetidine, ranitidine omeprazole,lansoprazole.

Tablets which help your gullet to clear any regurgitated
acid and help your stomach to empty more quickly.
eg metoclopramide.

Surgery

In certain patients an operation may be recommended to construct a new valve (anti-reflux surgery). This may be performed by keyhole surgery.

What are the complications of reflux disease?
Continued exposure of the oesophagus to stomach juices may inflame and damage the lining (reflux oesophagitis).
Oesophagitis may, over time, lead to scarring which may narrow the oesophagus. This may cause difficulty with swallowing. If this occurs, the narrowed area may be stretched during a gastroscopy, thus relieving the symptoms.

Long standing Gastro-oesophageal reflux can cause a change in the nature of the lining of the lower oesophageal know as Barretts macosa.

Glossary of Terms

Oesophagus	The oesophagus or gullet is a muscular tube, about 24cms long, which extends from the throat to the stomach.
Reflux	The flow of the stomach contents into the oesophagus
Lower Oesophageal Sphincter (LOS)	The muscular valve at the bottom of the oesophagus which normally retains the stomach contents within the stomach.
Diaphragm	The muscle which separates the abdomen from the chest and is used for breathing. Peristalsis Muscular action of the oesophagus, which squeezes saliva, food, drink and refluxed acid into the stomach.
Gastroscopy	An examination of the lining of the oesophagus, stomach, and duodenum with a flexible lighted tube.
Reflux Oesophagitis	Inflammation of the lining of the oesophagus caused by increased exposure to stomach juices.

This document was written by Eunice Thompson Clinical Research
Nurse and revised in collaboration with Jane Stratford, Clinical
Research Sister, and Mr TCB Dehn, Consultant Surgeon.

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