GORD: An expert answers your burning questions

GORD, or acid reflux, is becoming more and more common. With it comes increasing risk factors that can cause some serious conditions if it isn’t managed correctly.

London-based surgeon Mr Krishna Moorthy, who specialises in upper gastrointestinal surgery alongside hernia surgery, addresses the issues surrounding this frequently reported condition.

You can also read more in the upcoming part two of this article, which considers GORD diagnosis and treatment.  

What is GORD?

The oesophagus (gullet) is a muscular tube that carries food from the mouth into the stomach. There is a muscular valve (sphincter) between the stomach and the oesophagus which prevents excessive reverse flow of acid and food from the stomach back into the gullet. Acid is produced by the stomach and plays a role in digestion of food. However, the presence of acid in the oesophagus in excessive amounts results in inflammation (damage) to the oesophagus, or reflux oesophagitis. It's this excessive reflux that causes the symptoms of GORD.

What causes reflux?

• Hiatus hernia. Some people have an enlargement of the opening in the diaphragm (a muscular curtain between the chest and the abdomen) through which a portion of the stomach can slip into the chest. This causes a weakening of the valve between the stomach and the gullet, which causes acid reflux.
• A rise in the incidence of reflux in the population is mirrored by a rise in obesity. It is believed that fat causes a weakening of the valve and leads to acid reflux.
• Other risk factors are smoking and pregnancy.

What are the symptoms of GORD?

Typical symptoms

GORD is characterised by a burning sensation in the chest (just behind the breastbone). This this is known as ‘heartburn’. Patients can also experience a sour taste in the back of the throat when the acid refluxes higher up. Patients usually experience these symptoms after certain types of foods (spicy food) and with ingestion of alcohol. It is usually worse at night when the patient is lying flat as acid comes up into the gullet. Patients may even wake up in the middle of the night choking or from excessive coughing.

Prolonged damage to the gullet (oesophagus) can also result in bleeding and excessive scarring which could lead to blockage of the oesophagus, which could lead to sensation of food being stuck in the middle of the chest.

Atypical symptoms

Patients may also experience pain just below the breastbone, excessive burping and belching and bad breath. They may also show evidence of poor gum and dental health. Breathlessness and chest pain may also be described by some patients.

Why should something be done about GORD?

Reflux is not uncommon. In fact, some reflux is present in nearly everybody but the oesophagus effectively clears the acid before it causes any damage. Reflux also occurs quite commonly after excessive eating and alcohol ingestion.

Reflux in considered to be serious enough to warrant medical attention if:

• It occurs at least once every day;
• If it affects one’s life style;
• If it difficult to treat or;
• If it associated with bleeding;
• Unexplained weight loss or problems with swallowing.

In these cases, it is important to seek the help of your doctor who will start you on medications to reduce acid production.

There is also increasing evidence that long term acid damage from GORD could lead to cancer of the oesophagus. There has been a worrying increase in the incidence of a new type of cancer of the lower oesophagus called Adenocarcinoma. It is believed that long term damage to the lining of the oesophagus causes the lining to change to one called Barrett’s oesophagus and this is considered to be a precursor to cancer.

If people have suffered with reflux for more than five years and are more than 50 years old, they should have an endoscopy even if they do not have any ‘alarm’ symptoms. ‘Alarm’ symptoms are:

• Vomiting of blood
• Difficulty swallowing
• Weight loss

If you’re concerned about GORD and want to see one of London’s top gastrointestinal specialists, arrange an appointment with Mr Moorthy via his Top Doctors profile.