What Causes GORD?
The two muscles that stop the contents of your stomach from rising to your oesophagus are the diaphragm and the lower oesophageal sphincter (LOS). A common cause of GORD is when these two muscles move below the upper stomach, this condition is called a hiatus hernia. With the upper abdomen above the diaphragm and LOS, the hiatus hernia allows acid to leak into the oesophagus and cause regular reflux.
Another cause of GORD is when the two muscles are weakened over time, causing the LOS to open and allow acid to flow back into the oesophagus. There is no concrete reason as to why the LOS weakens. However, gastroenterologists have been able to identify groups of people that are more likely to develop the disease.
Risk Factors for GORD
Those who are more likely to have a weakened LOS and therefore at risk of GORD are people who:
- Are obese/overweight
- Are stressed
- Regularly take medications similar to aspirin
- Eat fatty foods which makes it harder for the stomach to dispose of acids
- Consume tobacco, alcohol, chocolate and coffee (these are substances that relax the LOS)
- Chronically cough, due to the repeated pressure of the action
- Have connective tissue disorders such as scleroderma
- Have autoimmune conditions such as eosinophilic esophagitis
- Have gastroparesis, a common condition for people with diabetes that reduces the stomach’s speed in disposing of acid
GORD in Pregnancy
Studies have indicated that the prevalence of GORD in pregnant women
is between 17% to 45%, therefore it is considered a common condition during pregnancy. The high prevalence of GORD in pregnant women is due to the increased pressure on the stomach, consequently weakening the LOS. Furthermore, a rapid change in hormone levels during pregnancy also slows the stomach's ability to dispose of acid, leading to excess acid leaking into the oesophagus.
Most women will experience symptoms of GORD late into their first trimester or early second trimester. If you are pregnant and have been diagnosed with GORD, the best way to ensure the well-being of you and your child is to consult a gastroenterologist. Following giving birth, most pregnant women will experience a rapid decline in acid reflux symptoms and, therefore, will no longer continue treatment.
You are most likely to experience symptoms of GORD shortly after eating food and when lying down or leaning forward. The most common symptom of GORD is heartburn, which is characterised by a burning sensation in your stomach and lower chest that rises towards your throat.
Other GORD symptoms include:
- Regurgitation of stomach contents and acid
- Excessive belching, bloating, hiccups or gas
- Noticeable sour taste at the back of the mouth
- Tooth decay and gum disease
- Bad breath
- Chest pain/discomfort
- Chronic coughing, hoarseness and/or throat pain
- Unexplained weight loss
- Difficulty swallowing, known as dysphagia
- Recurring indigestion, known as functional dyspepsia
- Laryngitis, which is the inflammation of the larynx (also known as the voice box)
- Disruption in sleep as a result of nocturnal symptoms
When to See a Doctor?
If you are experiencing frequent symptoms more than twice a week, you should consider consulting one of our gastroenterologists for a consultation. Ignoring these symptoms can have serious health implications, including the precancerous condition Barrett’s oesophagus and oesophageal cancer.
Dr Pran Yoganathan
is a specialist in diagnosing and treating GORD, helping you get on top of the disease before the occurrence of any serious diseases.
How is GORD Diagnosed?
An appointment with one of our gastroenterologists will involve a general physical examination and a description of the symptoms you’re currently experiencing. Typically, we will be able to diagnose GORD based on this information.
However, if our gastroenterologist suspects that another condition may be causing your symptoms, or you are exhibiting atypical symptoms, they will conduct an endoscopy. Endoscopic procedures involve a doctor feeding a small flexible tube equipped with a camera down your oesophagus and into your stomach. An endoscope is a valuable tool to examine the inside of your body and assess if you have GORD, alongside the extent of damage inflicted on the oesophagus from acid reflux.
Other diagnosis tools that we use at The Centre For GastroIntestinal Health include:
- Barium X-rays: involves you drinking a liquid containing barium that coats the walls of your oesophagus and stomach, which exposes any abnormalities during a diagnostic X-ray.
- 24 Hour acid monitoring: involves a tube inserted into your nose and fed into the oesophagus. The tube is left just above the LOS for 24 hours to monitor pH levels before being removed.
- Impedance study: this is like the acid monitoring test; however, it requires two tubes being inserted into the stomach and just above the LOS. The tubes record data that includes both the acidity and alkaline levels in your stomach.
- Acid capsule: involves inserting a pill that is inserted into the lower oesophagus via your nose or mouth. The capsule records pH data for 24 hours before detaching itself from your oesophagus, from here it will be naturally passed in your stool.
Treating GORD often involves simple changes to your diet and lifestyle. The discomfort that GORD creates is also treatable with a range of safe over the counter medications.
In more severe GORD cases that have been left undiagnosed for a significant period of time, you may require a laparoscopic surgery to avoid any further health implications.
In mild stages of GORD, simple diet and lifestyle changes can be a crucial strategy for minimising your stomach acid levels, thus allowing your oesophagus to heal.
These changes include:
- Avoiding substances that weaken the LOS, including alcohol, coffee, chocolate and tobacco
- Avoiding consumption of foods that produce excess stomach acid, such as spicy, fatty or acidic meals (for example, fried chicken or hamburgers)
- Not eating three to four hours before going to bed
- Weight loss (in cases where GORD is caused by obesity)
- Raising the head of your bed if you are experiencing night-time symptoms
Effective medicines for treating GORD are those that contain both an antacid and anti-foaming ingredient. These over the counter medications can either be taken in liquid form or via a chewable tablet. To avoid interactions, it is advised that these medications should not be used within two hours of taking any other regular medicines that you take.
If over the counter medications fail to reduce the symptoms of GORD, we may suggest proton pump inhibitor therapy. Proton pump inhibitors (PPIs) are a medication that help reduce the amount of acid produced in your stomach, which therefore minimises your symptoms and damage inflicted on your oesophagus.
Surgery is a last resort that is only utilised for severe cases of GORD. Our gastroenterologists will assess whether you qualify for surgery before referring you to a surgeon that will discuss key information for the procedure.
The anti reflux surgery is called a laparoscopic procedure. This surgical procedure is a keyhole operation, meaning that it avoids any large incisions on your abdomen. During the procedure, the surgeon will make five small incisions (5-10mm) in the abdomen and then wrap the upper stomach around the oesophagus to help tighten the LOS. As a result, your LOS will enjoy stronger support and stop your stomach leaking acid into your oesophagus.
The surgery typically takes no longer than an hour and requires you to stay in hospital for two days to ensure there are no complications.
Complications of GORD
In most cases, GORD is a treatable condition that typically won’t graduate to more severe diseases. However, chronic GORD that is left undiagnosed and untreated can have serious health implications.
Ongoing GORD can lead to complications such as:
- Oesophagitis: rising stomach acid can lead to the inflammation of the oesophagus, making it difficult and uncomfortable to swallow.
- Oesophageal ulcers: stomach acid damages the lining of the oesophagus, causing ulcers that make it painful to swallow. Sometimes these ulcers can bleed, which may result in you vomiting blood.
- Oesophageal stricture: excessive damage from stomach acid on the lining of the oesophagus causes the formation of scar tissue that narrows the oesophageal passage.
- Barrett’s oesophagus: repeated exposure of stomach acid to the oesophagus eventually damages the cells.
- Oesophageal cancer: the final stage of GORD, where the damaged cells in the oesophagus turn cancerous.
If you are worried about excessive acid reflux that may lead to GORD, there are few easy lifestyle changes that you can employ to reduce your risk of contracting the disease.
These preventative measures include:
- Maintaining a healthy weight
- Instead of eating three big portions per day, try eating small frequent meals
- Not excessively consuming alcohol
- Not smoking
- Limiting abdominal pressure inflicted when bending or lifting (always lift with your legs)
- Maintaining a healthy diet that avoids large portions and fatty foods
- Raising the head of your bed
In the instance where your reflux symptoms persist, book an appointment with our GORD specialists
at The Centre For Gastrointestinal Health for an initial consultation and examination.
Our gastroenterologists can provide an accurate diagnosis and the best personalised treatment that will help you get on top of your acid reflux before it starts inflicting any serious damage on your oesophagus.
What is the Difference Between GORD and GERD?
GERD is the same condition as GORD. The only difference between the two acronyms is that the American spelling for oesophagus is esophagus.
What is the Difference Between Acid Reflux and GORD?
GORD is a more serious form of acid reflux that occurs more frequently for prolonged periods of time. If you are experiencing persistent symptoms of acid reflux (more than two times a week), you have GORD.
Is GORD Serious?
While it is easy to treat GORD, it can lead to serious health implications such as Barrett's oesophagus and oesophageal cancer if left undiagnosed. This is why it is important to consult medical professionals for early intervention if you are experiencing frequent and severe symptoms of acid reflux.
Can you Cure GORD?
You can treat GORD with a balanced combination of medications (such as a proton pump inhibitor), as well as diet and lifestyle changes. If you are suffering from chronic gastroesophageal reflux disease, surgical treatment can be utilised to help control symptoms and limit the damage to your oesophagus.
What is the Best Treatment for GORD?
The best treatment for GORD can be through a healthy lifestyle and diet changes. This can include losing weight (if GORD is caused by obesity) and eating smaller food portions to avoid excess acid build up in the stomach.
What foods to avoid if you have GORD?
If your doctor has diagnosed you with GORD, you should avoid eating fatty or spicy foods. This will help the acid suppression, as these foods often slow down your stomach's ability to dispose of its acid.