Gastro-oesophageal reflux disease (GORD) is a common condition where patients have symptoms caused by food and fluid in the stomach going back up into the oesophagus or gullet. On a weekly basis, up to 1 in 5 (20%) people will experience some symptoms of GORD. For many people, symptoms are minor, but in some patients they can be particularly bothersome, difficult to control and interfere with their quality of life.

Image credit: BruceBlaus (2017)

Different symptoms that patients with GORD can experience are explained below.

Heartburn or pain

A common symptom is a burning or achy sensation in the middle of the chest behind the breast bone or in the upper part of the abdomen or tummy. Sometimes this can be severe and people report feeling pain in this area.

Reflux and regurgitation

Many people report feeling fluid or an acidic sensation that comes up into the back of their throat. Often this is just a small amount of fluid that many people automatically swallow again. However, some people have larger volumes of fluid that come back up, and this can be made worse  in certain positions, such as leaning forward or lying down.

Difficulty swallowing

Another common symptom is difficulty eating and drinking. The medical term for this is dysphagia. This may vary day-to-day, so the same food or drink can be more or less of a problem on different days or weeks. Some people find food may get stuck on the way down, which can sometimes be felt in the middle of the chest behind the breast bone.

Other symptoms

A whole range of other symptoms may be described by patients with GORD. These can including belching, bloating, bad breath and a cough. These symptoms can be due to GORD, but they can also be due to many other common conditions. It can sometimes be very difficult to confidently determine whether these symptoms are due to reflux or something else.

A number of different tests may be performed to assess people with GORD, to look for other common causes of the same symptoms and make a definite diagnosis.

Upper GI endoscopy

The first test is usually an upper GI endoscopy (often referred to as an OGD). This is a common procedure involving the insertion of a thin tube with a camera on the end through the mouth into the oesophagus, stomach and first bit of the small bowel called the duodenum. This test is important to look for signs of GORD as well as to look for other problems such as a stricture or oesophageal cancer.  It is a routine procedure, but as with any test there are benefits and risks, even though the risks are very low. More information on this procedure, its benefits and risks are available here.

pH and manometry

As GORD is very common and often well controlled, not many patients with GORD need these tests. They can be useful if there is uncertainty about the cause of symptoms or to help determine if someone may benefit from surgery. They involve passing a fine tube through the nose into the oesophagus, then doing a series of swallowing tests to measure how the oesophagus works (the manometry part of the test). A tube is then left in place for 24 hours and you go home with this before having it removed the following day (pH testing). During this period, you can record symptoms that you experience which can then be looked at together with the measurements from the tube.  Together, these tests are very useful in assessing GORD.

Contrast swallow

This test may also be called a barium swallow and is often combined with a meal test to examine the stomach as well as the oesophagus. Like pH and manometry, this test is not often required for mild and well controlled GORD. However, for some patients it provides useful information to assess GORD and to look for other conditions if there is uncertainty about the cause of symptoms. It involves drinking some fluid (called barium) and having x-ray pictures taken of the fluid going down the oesophagus into the stomach. It gives useful information about how the oesophagus is working, can assess for reflux, and look for other problems like ulcers or cancer.

The options for treatment include lifestyle modification, medical treatment with drugs, and surgery.

Lifestyle modification

Well-known factors that tend to make GORD symptoms worse are being overweight, smoking, and drinking alcohol. Therefore, losing weight, stopping smoking and avoiding alcohol can significantly improve symptoms, meaning that no other treatment is required.

Some people also find specific food and drinks make their symptoms worse. For example, some people find their symptoms are worsened by hot drinks, especially those containing caffeine such as coffee and tea. Some people find chocolate is also a trigger. If your symptoms are bothersome, try avoiding these for a few weeks and see if your symptoms improve.

Other changes that can help include eating and drinking your evening meal 6 hours before going to bed, so that when you lie down your stomach is empty, reducing the tendency for stomach contents to go up into the oesophagus. Some people also find benefit by sleeping propped up, or raising the head of their bed.

Medical treatment

The most commonly used drugs to treat GORD symptoms are a group of medicines called Proton Pump Inhibitors (PPIs). These include omeprazole and lansoprazole, amongst others. For the majority of patients, these drugs are highly effective in controlling symptoms. As GORD symptoms are so common, these types of drugs are some of the most widely used in the NHS. Sometimes the dose of these medications may be varied depending upon changes in the severity of symptoms - this is something your doctor can advise you about.

Other commonly used drugs are a type of anti-histamine, such as ranitidine. If you have side effects on PPIs, your doctor may try this type of medicine instead.

Other useful medicines available over-the-counter include antacids such as Gaviscon that can have an immediate soothing effect.

Surgery

Only a small proportion of patients with GORD symptoms should consider surgery. Most people find that their symptoms vary over time, and that they are well controlled with a combination of lifestyle changes and drug treatment. However, some people have severe symptoms that are difficult to control, for example because they have significant side effects on medical treatment. If surgery is being considered, you will usually have several tests as described in the 'Tests' section to help determine whether you will benefit from surgery.

The operation involves a general anaesthetic and is usually performed with keyhole surgery. Most people who have surgery have a hiatus hernia, where the top part of the stomach has slipped upwards into the chest. This is repaired so that the stomach sit entirely in the abdomen. In addition, an anti-reflux procedure called a fundoplication is performed. There are different ways to perform this, and your surgeon will explain what will be their approach.

In appropriately selected people, surgery can provide good relief of symptoms, but there is a risk of side effects and complications.

Many patients having anti-reflux surgery can go home the same day as their operation. We have produced an information leaflet explaining what is involved, specifically designed to help people prepare for having antireflux surgery as a day case. Download this by clicking on the picture or this link here. It is also useful for patients having antireflux surgery as an in-patient, staying in hospital for at least one night.

You will need to modify how you eat and drink while you recover from the operation. Click here for our diet sheet which explains how to do this and what to expect. Immediately after your operation, you will usually be on a liquid or very soft diet to allow the swelling from the operation to settle. After a few weeks, you will usually be allowed to slowly build up the texture of food, and most people can eat normally as time goes on. However, some people always find that certain foods, particularly bread and meat, tend to get stuck unless they have small mouthfuls and chew carefully, often washing  food down with a drink. Other common side effects include bloating, being unable to vomit, and increased flatulence. Besides these side effects, there are a range of risks involved in having this type of surgery. Your surgeon will tell you more about the operation, its benefits and risks, and any specific issues relevant to your care.

You may be referred to a dietitian to help you manage your nutrition if are overweight and are trying to lose weight to improve your symptoms. You may also be referred to help modify your diet to minimise your symptoms.

Click here for our postoperative diet sheet. If you have surgery, this explains how to eat and drink while you recover over the following month.

Here are some useful links to other sources of information on gastro-oesophageal reflux disease. However, as these are external websites, we are not responsible for the accuracy of any content which may change over time.

NHS website:

https://www.nhs.uk/conditions/heartburn-and-acid-reflux/

Guts UK - digestive system charity:

https://gutscharity.org.uk/advice-and-information/symptoms/heartburn-and-reflux/