What is GORD? Gastro-oesophageal reflux disease, or GORD, is when stomach acid flows back up into the oesophagus, the food pipe, often enough to cause troublesome symptoms or damage. Occasional reflux after a big meal is common and usually harmless. When it happens twice a week or more, or keeps coming back, doctors call it GORD. And what is GORD caused by? Most often, a weak or relaxed valve at the bottom of the oesophagus.
Key takeaways
- GORD is stomach acid flowing back into the oesophagus often enough to cause troublesome symptoms or damage.
- Heartburn and regurgitation are the main symptoms; some people have a cough or a hoarse voice.
- Lifestyle changes help many people, and medicines that lower acid work well for most others.
- Difficulty swallowing, vomiting blood, black stools or unplanned weight loss need prompt medical review.
- Never assume chest pain is harmless: call 000 if it could be your heart.
Reflux and GORD Explained
Reflux is when stomach contents, including acid, flow back up from the stomach into the oesophagus. A ring of muscle at the bottom of the oesophagus, called the lower sphincter, normally closes once food has passed through. If it relaxes at the wrong time or is weak, acid escapes upwards. What is GORD, compared with ordinary reflux? It's the kind that happens often, causes trouble or damages the oesophagus.
| Feature | Occasional reflux | GORD |
|---|---|---|
| How often | Now and then, often after large meals or rich food | Twice a week or more, or most days |
| Typical symptoms | A brief burning feeling or a sour taste | Heartburn and regurgitation, sometimes a cough, a sore throat or difficulty swallowing |
| Effect on the oesophagus | None | Can cause inflammation, narrowing or Barrett's oesophagus over time |
| What helps | Antacids from a pharmacy and simple changes | Lifestyle changes, and medicines that lower acid, reviewed by a doctor |
Common Symptoms of GORD
The main symptoms of GORD are heartburn, a burning feeling rising from the upper stomach into the chest, and regurgitation, when acid or food comes back up into your mouth with a sour or bitter taste. Symptoms are often worse after meals, when you bend over or lie down, and at night.
Other symptoms include a feeling of a lump in the throat, burping, nausea, an ongoing cough, a hoarse voice, wheezing, bad breath and worn tooth enamel. Some people have chest pain, and a few find it painful or hard to swallow, which always needs checking by a doctor.
Not everyone with reflux disease has that burning feeling, and how bad the symptoms feel doesn't always match the damage to the lining of the oesophagus. So what is GORD like day to day? For many people, symptoms come and go with what they eat, how much they eat and when they lie down.
Causes and Risk Factors for GORD
GORD is caused by the lower sphincter relaxing too often or not closing properly, letting stomach acid escape upwards. Extra weight around the stomach, pregnancy, smoking, alcohol, eating late and lying down soon after eating all make this more likely. A hiatus hernia, where part of the stomach pushes up through the diaphragm, is a common cause. Some medicines can relax the sphincter or irritate the oesophagus, including some blood pressure and pain medicines. Certain foods and drinks, such as fatty or spicy food, chocolate, coffee, citrus and fizzy drinks, cause trouble in some people but not in others.
Heartburn, Indigestion and Ongoing GORD Compared
Heartburn is a symptom, while GORD is the ongoing condition that brings it back again and again. So what is GORD, as opposed to the odd bout? The burning is felt behind the breastbone and caused by acid. Indigestion, or dyspepsia, is discomfort or fullness in the upper stomach after eating, often with bloating or nausea, and it has many other causes. GORD, short for gastro-oesophageal reflux disease, is the name doctors give it when heartburn is frequent. An occasional bout after rich foods is common and usually settles with an antacid. Burning twice a week or more, symptoms that wake you at night, or any trouble swallowing point to GORD or another problem worth checking with a doctor.
How GORD Is Treated
GORD is treated first with lifestyle changes, then with medicines that lower stomach acid if symptoms continue. Antacids neutralise acid for quick, short relief. Medicines that cut acid production, such as H2 blockers and proton pump inhibitors, let an inflamed oesophagus heal and control symptoms for most people. Low doses of some are sold by pharmacists, and others are only available on prescription in Australia. A doctor usually suggests the lowest dose that works, for the shortest time needed, and reviews it regularly.
Surgery suits a small number of people whose symptoms continue despite treatment, or who can't take medicine long term. The most common of these procedures, fundoplication, wraps the top of the stomach around the lower end of the oesophagus to strengthen the valve. People with Barrett's oesophagus, a change in the lining caused by years of acid, have regular checks with a specialist, which your GP can arrange through a referral.
Simple Ways to Prevent Reflux
The simplest ways to prevent it are changes to when and how you eat, and how you sleep. Eat smaller meals, finish eating two to three hours before bed, and stay upright after eating. Raise the head of your bed by 10 to 20 centimetres with blocks under the legs, rather than piling up pillows, and try sleeping on your left side. Losing weight if you carry extra around the stomach, stopping smoking and cutting back on alcohol all ease the pressure on the sphincter. Notice which foods and drinks bring it on and limit those, rather than cutting out whole food groups, and wear clothes that are loose at the waist. If you take medications that might make reflux worse, ask your doctor or pharmacist before you stop any.
When to See a Doctor About Reflux
See a doctor if reflux happens twice a week or more, if antacids or pharmacy medicines don't control it within about two weeks, or if you need them most days. Go promptly for difficulty or pain swallowing, food sticking, repeated vomiting, vomiting blood or what looks like coffee grounds, black or tarry stools, weight loss without trying, or new symptoms after the age of 55. These can point to an ulcer, a narrowing or, rarely, cancer, and your doctor may refer you for an endoscopy, where a specialist passes a thin flexible tube down the throat to look inside the oesophagus and stomach. A GP can also arrange tests through a pathology request, such as a breath or stool test for the stomach infection H. pylori and a blood count. Call 000 for chest pain, especially with breathlessness, sweating, or pain spreading to your arm, neck or jaw.
Summary
GORD is stomach acid flowing back up often enough to cause symptoms or damage, and this guide has covered how it feels, its causes, treatment, prevention and warning signs. What is GORD likely to need? For most people, simple changes and, if needed, a short course of medicine. If you're asking yourself what is GORD and whether you have it, a Medio GP can talk through your symptoms by phone, suggest changes, arrange tests or a referral, and discuss treatment that suits you.
Frequently asked questions
What are the symptoms of heartburn?
It's a burning feeling that starts behind the breastbone and can rise towards the neck, often after eating, bending over or lying down. It may come with a sour or bitter taste, burping or food coming back up, and it can last minutes or hours. Reflux can cause chest pain that mimics a heart attack, but don't assume it: call 000 for chest pain with breathlessness, sweating or pain spreading to your arm or jaw.
How is anti-reflux surgery performed?
It's usually done by keyhole surgery under a general anaesthetic. The surgeon makes a few small cuts in the abdomen, repairs any hiatus hernia, and wraps the top of the stomach around the lower end of the oesophagus to tighten the valve. Most people stay in hospital for a night or two and eat soft food for a few weeks while the area heals.
What are the ten worst foods to eat if you have acid reflux?
Triggers vary from person to person, but the ten most often blamed are fatty or fried food, creamy sauces, spicy food, chocolate, peppermint, citrus fruit and juice, tomatoes and tomato sauce, onion and garlic, coffee and other caffeinated drinks, and alcohol and fizzy drinks. Large serves and late-night eating matter as much as the food itself, so keep a diary and cut back on the ones that bother you.
How is reflux treated?
Treatment goes step by step. Lifestyle changes come first: smaller portions, nothing to eat in the two to three hours before bed, a raised bedhead and weight loss if needed. Antacids give quick relief, and if symptoms continue, proton pump inhibitors are effective for most people. Are PPIs safe to take long-term? They're generally safe, but long-term use has some risks, such as low magnesium or vitamin B12, so a doctor reviews whether you still need them and at what dose.
Will fundoplication surgery cure my reflux?
For people carefully chosen for it, fundoplication controls reflux well for many years, and many no longer need daily medicine. It doesn't work for everyone: some people need daily medicine again later. What are the complications of GORD surgery? Some people have food sticking for a while, bloating, or difficulty burping or vomiting, and there are the usual risks of any operation, such as infection and bleeding.
What should you know about anti reflux surgery?
Anti reflux surgery is for people whose GORD isn't controlled by medicine, who can't take medicine long term, or who have a large hiatus hernia. What is GORD, and what does the name mean? Gastro-oesophageal reflux disease means acid coming back up from the stomach, and surgery treats the faulty valve rather than the acid. Before it, a specialist usually arranges an endoscopy and tests that measure acid and how the oesophagus moves. Recovery takes a few weeks, and your GP can refer you to talk it through.
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