Gastro-oesophageal reflux disease
Also called: GERD, GORD, Acid reflux, Heartburn
Stomach acid repeatedly flows back into the oesophagus because the valve at its lower end relaxes inappropriately. It causes heartburn and regurgitation and can inflame the oesophageal lining.
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About 15–20% of adults in Western countries have weekly symptoms.
What happens in the body
Transient relaxations of the lower oesophageal sphincter, a hiatus hernia and delayed clearance let acid and pepsin injure the squamous lining (oesophagitis).
Causes
- Weak or inappropriately relaxing lower oesophageal sphincter
- Hiatus hernia
Risk factors
- Obesity
- Pregnancy
- Smoking
- Large or late meals
- Alcohol, coffee, chocolate, fatty or spicy food in some people
- Medicines: calcium-channel blockers, nitrates, NSAIDs
Symptoms
- Burning chest pain after meals or lying down (heartburn)
- Acid or food coming up into the mouth
- Sour taste
- Chronic cough, hoarseness or sore throat
- Difficulty swallowing in complicated disease
Diagnosis — tests and examinations
- Clinical diagnosis with a trial of acid suppression
- Endoscopy for alarm features (swallowing difficulty, weight loss, bleeding, anaemia, age over 55 with new symptoms)
- 24-hour pH-impedance monitoring when the diagnosis is unclear
Treatment
Medicines and medical treatment
- Proton-pump inhibitors (omeprazole, lansoprazole) — most effective
- H2 blockers (famotidine)
- Antacids and alginates (Gaviscon) for occasional symptoms
Operations and procedures
- Laparoscopic fundoplication for severe or refractory disease
- Magnetic sphincter augmentation (LINX)
Self-care, home remedies and lifestyle
- Lose excess weight
- Raise the head of the bed by 10–20 cm
- Avoid eating within 3 hours of bedtime
- Smaller meals; identify trigger foods
- Stop smoking and cut alcohol
Possible complications
- Oesophagitis and ulcers
- Stricture (narrowing)
- Barrett's oesophagus
- Oesophageal adenocarcinoma (rare)
Prevention
- Healthy weight, avoiding late heavy meals, not smoking
Outlook
Chronic and relapsing but well controlled with lifestyle measures and medication.
When to see a doctor
See a doctor for difficulty swallowing, vomiting blood, black stools, weight loss or persistent symptoms despite treatment.
Sources and further reading
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