This is the first of three articles in the Topic on GORD. Gastro-oesophageal reflux disease (GORD) is also called gastric reflux disease or acid reflux. It is a condition which develops when the reflux of stomach contents causes troublesome symptoms such as heartburn or complications such as oesophageal ulcers.
The oesophagus is a tube of muscle connecting the mouth to the stomach. In normal circumstances, the lower oesophageal sphincter (LOS) (the muscular ring at the lower end of the oesophagus) opens like a valve, enabling food to pass into the stomach and then closes to prevent stomach acids seeping back into the oesophagus. However, in GORD the sphincter pressure reduces, relaxing the muscle and allows the stomach's acidic contents to reflux into the oesophagus.
The regurgitated stomach contents usually contain gastric acid and pepsin that are produced by the stomach (pepsin is an enzyme that helps digest proteins in the stomach). Whilst Pepsin and bile both irritate the lining of the oesophagus, the most damage and irritation is caused by gastric acid. What is commonly known as heartburn is in fact inflammation and a burning of the lining of the oesophagus due to repeated exposure to gastric acid.
How common is GORD?
The most common cause of indigestion in Ireland, GORD affects up to 1 in 4 people. 10% to 20% of people in the western world have at least one bout of GORD per week. This figure is only about 5% in Asia which gives an indication that our western diet which tends to have a higher fat content is a factor in GORD. GORD can affect people at any age, including infants and young children. A typical sufferer is twice as likely to be male as female. It is also a common problem for babies and infants leading to difficulty feeding in more severe cases. It can be controlled by food thickeners, alginates and removing cow’s milk from the infant’s diet if caused by lactose intolerance.
There are a number of both lifestyle and medication risk factors that could increase the possibility of developing GORD. These include:
- Being overweight or obese, particularly if this is physically around the waist. This increases pressure on the stomach from beneath thereby forcing its contents upwards.
- Fatty foods means slower stomach digestion meaning it takes longer to expel stomach acids
- Consuming an excess of alcohol, coffee, spicy foods or chocolate will increase the acidity of the stomach contents. Evidence also shows they relax the oesophageal sphincter, thereby increasing the potential for reflux
- Smoking relaxes the oesophageal sphincter, increasing risk of reflux
- Pregnancy can introduce factors which can increase the risk of GORD.
- Changes in hormone levels can weaken the LOS and increase the pressure on the stomach.
- The baby can push into the stomach which can then push stomach contents upwards (especially in later stages of pregnancy)
- Hiatus hernia is when part of a stomach pushes up through the diaphragm (the muscle used for breathing). This then creates pressure on the stomach, leading to reflux
- If you have a predisposition to GORD, sleeping flat can increase your risk.
Some drugs prescribed for non-GORD related conditions can cause the oesophageal sphincter to relax, increasing the potential for reflux. These include:
- Non steroidal anti-inflammatory drugs are anti-inflammatory pain killers and include aspirin, ibuprofen, diclofenic and naproxen.
- Antibiotics such as tetracyclines and ciprofloxacin
- Calcium-channel blockers – treats high blood pressure. Examples of calcium channel blockers include amlodipine (Istin®) and lercandipine (Zanidip®)
- Theophylline – treats respiratory conditions including asthma and chronic pulmonary obstructive disorders (COPD) such as bronchitis and emphysema
- Benzodiazepines are tranquilisers that are used on a short term basis only to treat anxiety, panic attacks and sleeping disorders. Examples include diazepam (Valium®), alprazolam (Xanax®) and temazepam (Insomniger®)
- Nitrates which treat angina by relaxing blood vessels thus reducing chest pains and discomfort associated with it. Examples include Isosorbide Mononitrate (Imdur®) and glyceryl trinitrate spray which is an under-tongue spray (eg) Glytrin Spray®, Nitrolingual Spray®.
- Biphosphonates to treat osteoporosis including Alendronic Acid (Fosamax®, fosavance®), Risedronate (Actonel®) and ibandronic acid (Bonviva®)
- Anticholinergicsused to treat a wide range of respiratory, digestive, neurological problems (eg) Atrovent® and Spiriva® inhaler used for COPD, Detrusitol® used for urinary incontinence
This is the main symptom. It presents as a burning feeling of discomfort, rising from the upper abdomen or lower chest up towards the neck. It has actually nothing to do with the heart.
Regurgitation of acid up the oesophagus often as far as the throat. This usually causes an unpleasant, sour taste.
Dysphagia means difficulty swallowing. Around 30% people with GORD have problems swallowing. It occurs when scarring through repeated exposure to stomach acid causes the oesophagus to narrow making food difficult to swallow. Many describe it as feeling like a piece of food becoming stuck somewhere near the breastbone.
Severe chest pain
This is a non-cardiac chest pain caused by GORD; this has been found in up to 50% of patients with chest pain and normal coronary angiography. Usually there is no relationship to exercise and this helps to differentiate most cases of reflux induced chest pain from true angina.
Other common symptoms include nausea, bloating and belching. These symptoms are periodic in nature and may flare up after eating, bending over or after a period of lying down.
To be continued….next week
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