GORD: Gastro Oesophageal Reflux Disease

Gastro oesophageal reflux disease, also known as GORD (or GERD), is a chronic condition that describes stomach acids moving up the oesophagus causing a range of symptoms and potentially other health issues including dysphagia. It is usually referred to as GORD when reflux occurs regularly and more than twice per week. Typically, the oesophagus has a sphincter or natural closing mechanism at the lower end to ensure that stomach content and acid stay in the stomach and do not creep back up into the oesophagus. However, sometimes this sphincter weakens or does not work effectively and results in reflux. Reflux can also continue further up the oesophagus and surpass the upper oesophageal sphincter, making its way into the throat causing symptoms in this region too. 

RISK FACTORS

• Aged 50+

• Female

• Smoking

• Pregnancy

• Medications including NSAIDS or epilepsy medications 

• Living with: Obesity, hiatus hernia, diabetes, scoliosis, Cerebral Palsy or Down Syndrome

• Increased anxiety and/or stress

Bloating, belching and indigestion are common symptoms of GORD.

COMMON SYMPTOMS

• Heart burn and/or chest pain- an uncomfortable burning or pain in the chest that usually occurs after eating. 

• Hoarse voice- sometimes, acid content can reach the vocal folds causing irritation and inflammation, changing the character or quality of voice. This tends to resolves when reflux is managed

• Globus- this is the sensation that something is stuck in the throat when there is nothing there. Usually, this sensation is present away from or after mealtimes. This is caused when the tissue in throat becomes irritated by the acid reflux causing irritation and inflammation, feeling as though something is there. 

• Night time cough or chronic cough- this can be caused by acid reflux irritating the throat and airway, and overnight can be related to positioning e.g. lying down. Be mindful of this when resting through the day as positioning may be the key. 

• Acidic taste in mouth, bad breath - when reflux reaches the back of the mouth it can cause an acidic taste or bad breath. This can cause tooth decay and impact oral hygiene.  

• Bloating, belching, indigestion. 

• Oesophageal inflammation, scarring and narrowing, and ulcers (Barrett's oesophagus). 

• Nausea and vomiting. 

• Dysphagia or odynophagia (painful swallow) - Reflux can impact the function of the upper oesophageal sphincter by making it difficult to relax and therefore reduced it's range of opening and duration of opening during the swallow which is required to allow food and drink to pass from the throat to the oesophagus. 

TRIGGERS AND CAUSES

• Hiatus hernia- this is when part of the stomach protrudes through the diaphragm and into chest. This can alter the function of the lower oesophageal sphincter increasing the risk of reflux.

• Lying down after oral intake- When lying down, gravity is no longer helpful in keeping stomach contents down and so if food and drink has not been appropriately digested, it increases the risk of reflux. 

• Spicey, acidic and fatty foods (take aways, fried foods, chocolate)- these foods can irritate the oesophagus, slow down stomach emptying and digestion, and relax the lower oesophageal sphincter. 

• Citrus, peppermint, fizzy drinks- relaxes the lower oesophageal sphincter and increase fizzy drinks can increase the pressure in the stomach, contributing to reflux. 

• Smoking- weakens lower oesophageal sphincter, increases acid production, and reduces saliva production which generally neutralises acid. 

• Coffee- relaxes the lower oesophageal sphincter and increases acid production. 

• Alcohol- even in moderate quantities, alcohol can relax the lower oesophageal sphincter

• Pregnancy- the changes in hormones related to pregnancy and pressure on stomach due to changing anatomy can increase the risk of reflux. 

LIFESTYLE SOLUTIONS

• Diet changes- avoid the foods and drinks described above and reduce the size of your meals.

• Cease smoking and avoid second hand smoke. 

• Remain upright for at least 30-45 minutes after oral intake. Avoid exercise for approximately 2 hours after eating. 

• When sleeping, try left side lying-  the oesophagus connects to the stomach on the right side and so stomach content moves away from the oesophagus when lying on the left side.

• Elevate the head while sleeping, allow gravity to reduce reflux.

• Reduce stress and anxiety 

• Low impact exercise such as walking in order to facilitate weight loss (as required), reduce stress, and promote digestion. You may need to avoid bending over during exercise.  

Side lying at night is a common solution when living with GORD. Source: https://www.bangkokhospital.com/en/bangkok/content/sleeping-on-your-left-side-reduces-gerd

FURTHER ASSESSMENT AND TREATMENT

• Over the counter medications such as gavoscon, mylanta, quickeze, ranitidine. Each product works differently and so it is best to discuss your options with the pharmacist. 

• See a Speech Pathologist if you are experiencing difficulty or pain when swallowing. 

  • A speech pathologist will assess your swallow to see if your dysphagia symptoms are consistent with reflux. 

  • A speech pathologist may complete a videofluoroscopy (VFSS)/modified barium swallow (MBS) or flexible endoscopic evaluation of the swallow (FEES) to see how the anatomy of the throat is working when swallowing which can indicate dysfunction related to reflux or confirm globus (rather than food/drink residue). They may refer to other specialists for investigation or intervention, as required. 

• See your GP for further investigation and education.  

• Your GP may review chest pain symptoms, ensuring that it is not cardiac related. 

• Your GP may prescribe medications to manage reflux including proton pump inhibitors (such as somac and nexium) or H2-receptor antagonists (blockers)

• Specialist investigation and intervention such as gastroenterology and/or ENT. 

• Your Speech Pathologist may refer you to these specialists based on the outcome of their own assessment. Otherwise your GP can make these referrals, as appropriate.

• Endoscopy- a camera attached to the end of a flexible tube to observe the tissue and lining of the throat, oesophagus and stomach which will reveal symptoms of reflux. 

• A barium swallow- an xray video while eating a meal to observe the passage and emptying of food and drink through the oesophagus and stomach. Note: This is different to a videofluoroscopy (VFSS)  or a modified barium swallow (MBS) completed by the Speech Pathologist. 

• Surgical repair of herniations. 

• Intervention for upper oesophageal sphincter (cricopharyngeal) dysfunction. 

GORD is a common health condition that occurs amongst many people. It can cause a range of symptoms that are both notable, uncomfortable and obvious, while others are more silent. In most cases it is easily treated but sometimes it is worth investigating further with medical and healthcare professionals including Speech Pathologists. Especially when it results in dysphagia or changes to the swallow. Although dysphagia related to reflux resolves when the reflux is well managed, it may require an interim period that requires safe swallow strategies and even modified foods while a sufficient treatment plan is implemented and takes effect. There is a lot that can be done at home and independently to manage reflux through lifestyle changes but at the end of the day, always consult with your GP is you have any questions or concerns.