Gastro-esophageal reflux disease (GORD)
GORD (also known as GERD) is a condition of the gastro-intestinal system which affects up to 1 in 5 people in the Western world. It refers to a constellation of problems which people experience such as the burning sensations just under the ribs, acid taste in mouth, chest pain, regurgitation of food in the mouth and coughing / wheezing. It can affect anyone of any age: from infants to elderly. Men and women are equally affected.
Generally, when food is digested, acid is produced in the stomach. This acid with the digested food, proceeds downstream into the bowels.
However, in people afflicted with GORD, this acid does not go downstream. Instead, refluxes back upstream through the gullet/esophagus towards the lungs and mouth thereby causing the various symptoms of GORD.
This is thought to be related to a weak, malfunctioning muscle at the top of the stomach – called the esopahgeal sphincter – which usually prevents the upstream passage of the acid.
The risk factors for GORD include obesity, asthma, autoimmune conditions, Western populations, presence of a hiatus hernia and after weight loss surgery, especially sleeve gastrectomy.
Why take GORD seriously?
Whilst most people are mildly troubled by GORD, there can be serious consequences of prolonged GORD.
Prolonged exposure of the esophagus to acid can lead to a pre-cancerous condition called Barrett’s esophagitis, which if unchecked or undetected ed, can progress to full blown cancer of the esophagus. Furthermore, long term acid exposures can lead to narrowing of the esophagus which can require repeated surgeries to correct.
How to diagnose GORD?
GORD is often diagnosed with taking a history from the patient. They will often tell you that various foods and eating positions will make it worse. To confirm the diagnosis, the doctors can perform various investigations, including endoscopy (camera down the mouth into the stomach) to look for acid related changes in the lining of the esophagus and various measurements of acid levels in the esophagus and stomach.
Treatment for GORD
GORD can be treated by various means. Firstly, lifestyle and dietary modifications are advised. Sufferers often feel better if they avoid certain foods, lose weight and stop smoking. Often if they eat earlier before they sleep, they may experience less symptoms. Medications are commonly used to treat GORD. These medications act to neutralise stomach acid or to minimise the production of stomach acid. Finally, if during various investigations, anatomical anomaly of the stomach and esopahagus is found, then surgery may be useful.
This is often the case if we find that the stomach is sitting up in the chest (hiatus hernia) , then surgery may be useful to help correct the hiatus hernia by bringing the stomach back down to its rightful position in the abdomen and GORD symptoms may be improved.