Gastroesophageal reflux disease (GORD) is a chronic condition in which the liquid contents of the stomach regurgitate back into the oesophagus. Since these contents are highly acidic and may at times contain bile, a typical burning sensation behind the breastbone or the upper abdomen is felt.
Gravity, swallowing and saliva are important protective mechanisms for the oesophagus but they are effective only when individuals are in the upright position. During sleep, gravity has no effect, swallowing stops and the secretion of saliva is reduced. Therefore, reflux that occurs during the night is more likely to cause greater damage to the oesophageal lining.
The causes of GORD are quite complex and tend to vary in different individuals. However, several contributing factors that may increase the susceptibility of a person to develop this condition include: Abdominal obesity, multiple pregnancies, hiatus hernia, connective tissue diseases as well as lower oesophageal sphincter abnormalities or delayed gastric emptying.
The diagnosis of GORD is usually suspected by a doctor when the typical symptoms associated with this condition are present over a prolonged period of time. These may include: heartburn, acid or bile regurgitation,
increased salivation, as well as nausea and vomiting.
However, these symptoms are non-specific.
Thus, the current gold standard for the definite diagnosis of GORD is 24-hour oesophageal pH monitoring.
Endoscopy, gastric emptying and oesophageal motility studies are recommended in those individuals who do not respond well to treatment or present with more alarming symptoms such as difficulty in swallowing, anaemia, blood in the stool, wheezing, weight loss or voice changes.
The primary treatment of GORD typically revolves around simple lifestyle modifications as well as prescribed medications to neutralise the acid reflux as well as preventing the formation of excess acid in the stomach.
As a general guideline, coffee, caffeinated drinks, citrus, tomato juice, alcohol, spicy and fatty foods should be avoided.
Red meat, wholegrains and foods that are rich in fibre should be reserved for the earlier parts of the day as they are more difficult to digest and may remain in the stomach beyond bedtime if they are consumed late.
Moreover, smoking and alcohol intake should be minimised. Mindfulness and breathing techniques may also help in controlling excessive stress which may also be a contributing factor to GORD.
Several changes in eating habits, such as eating smaller portions of food and earlier evening meals are recommended. The consumption of chewing gum, milk, as well as elevation of the head and the upper body while sleeping may also improve the symptoms.
The modifications that have been described above usually are effective in treating the symptoms of GORD. Nevertheless, sometimes they are not enough. In these cases, the standard surgical treatment for severe GORD is fundoplication. In this procedure, the upper part of the stomach is wrapped around the lower oesophageal sphincter to strengthen it.
In Western populations, GORD affects approximately 10 to 20 per cent of individuals. The prevalence rate of GORD in developed nations is also tightly linked with age, with adults aged 55 to 65 being the most commonly affected.
Complications of unresolved GORD may include gastric ulcers, oesophageal strictures, Barrett’s oesophagus as well as iron deficiency and inflammation of the oesophagus. Thus, it is vital to seek medical advice if the symptoms persist.
By Dr. Georgiana Farrugia Bonnici, Specialist in Family Medicine
Disclaimer: This article is provided for general informational and educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or another qualified healthcare professional with any questions you may have regarding a medical condition.