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Gastro-Oesophageal Reflux Disease (GORD)

Gastro-Oesophageal Reflux Disease (GORD)

A common digestive condition that can affect people of all ages.

Nick is one of the leading reflux surgeons in the UK; he has many years of experience and has pioneered new surgical treatments for the condition. 

Approximately 30% of the UK’s population suffer with the symptoms of gastro-oesophageal reflux disease. While a quarter of these seek medical help, over 500,000 suffer from persistent symptoms despite treatment and over 1.5 million require long term medication, which includes powerful antacid proton pump inhibitor drugs.

What is GORD?

A common digestive condition that can affect people of all ages, including children.

It occurs where stomach acid, and sometimes contents, leak back (reflux) into the oesophagus.

When acid comes into contact with the lining of the oesophagus it causes a burning sensation in the chest or throat, which is called heartburn.

The fluid may reach the back of the mouth,  causing acid indigestion.

What are the signs and symptoms?

Amongst many symptoms the most common are:

  • Persistent heartburn and acid regurgitation into the throat and mouth
  • Chest pains
  • A hoarse voice, especially in the morning
  • Difficulty swallowing
  • The feeling of food getting stuck in the throat and a choking sensation
  • A persistent dry cough
  • Tooth decay, gum disease or an unpleasant taste in the mouth and bad breath

In more serious cases, it may cause oesophageal ulcers or bleeding.

People with asthma may suffer worsening symptoms due to the stomach acid irritating their airways.

What are the causes?

In many cases, there’s no identifiable reason for developing the condition. However, below are some potential causes. 

There’s a problem with the lower oesophageal  sphincter (LOS), which is the muscle at the bottom of the oesophagus that goes into the stomach. 

A hiatus hernia, which occurs when the upper part of the stomach pushes through the diaphragm (the muscle wall that separates the stomach from the chest).

The stomach takes longer than usual to empty also known as gastroparesis which has many causes including diabetes and paresis.

Other possible causes: 

  • Being overweight
  • Poor diet
  • Pregnancy
  • Smoking

Possible complications of GORD

Oesophageal Ulcers 

Long-term damage to the lining of the oesophagus from excessive acid production.

Oesophageal Stricture 

Repeated damage to the lining of the oesophagus, possibly leading to scar tissue and, if allowed to build up, potentially narrowing the oesophagus.

Barrett’s Oesophagus 

Repeated reflux possibly leading to changes in the cells lining the lower oesophagus. It’s estimated that 1 in 10 people with GORD will develop this condition and although it doesn’t cause any noticeable symptoms, there’s a small risk that cells affected by it may become cancerous. 

For patients diagnosed with Barrett’s oesophagus, we may recommend regular endoscopies (every 2–3 years) to check that the cells haven’t changed.

Oesophageal Cancer 

It’s estimated that in England, each year, 1 in 200 people with Barrett’s will develop oesophageal cancer.

Respiratory Disease

Reflux is related to asthma, pneumonia and chronic lung conditions and probably chronic inflammatory conditions including idiopathic pulmonary fibrosis, laryngopharyngeal cancer. Some studies suggest that long-term reflux is associated with an increased risk of developing throat cancer.

Dental Disease

Long-term exposure of teeth to reflux particularly acid can cause enamel damage as well as dental caries requiring fillings and other dental interventions.

Treatment Options

The treatment of reflux symptoms usually involves escalation from the least to increasingly interventional options.

Conservative treatment 

Lifestyle modifications.

  • Avoid trigger foods especially those high in fats, acidic foods such as citrus
  • Avoid eating late if nighttime symptoms predominate
  • Prop the head of the bed up at night
  • Lose weight, if overweight


There are several different classes of medications which may be helpful.

  • Simple antacids
  • Alginates such as Gaviscon
  • H 2 blockers such as Famotidine or Nizatidine
  • Proton pump inhibitors these are powerful antacids and the most commonly prescribed
  • such as Omeprazole, Lansoprazole and Pantoprazole
  • Prokinetics these promote gastric emptying and include Metoclopramide and Domperidone
  • Neuromoduretics which may reduce appreciation of symptoms and include Tricyclic and
  • SSRI’s

Many patient will find that alterations of their drug regime including timings of dosage can significantly improve symptoms.

Surgical treatment

This is an option when medication and lifestyle changes have not improved symptoms. It is also considered when patients choose to avoid medications because of their consequences.

Modern surgery is minimally invasive and undertaken using laparoscopic techniques. Most patients return home on the same day and recover rapidly.

The operations: 

In approximately 90% of patients, surgery  successfully prevents reflux and alleviates the majority, if not all, of the symptoms. Furthermore, most people find that they no longer need their antacid medication. 

Possible complications of surgery

Gas-bloat syndrome can happen because the surgery tightens the sphincter between the oesophagus and the stomach. This may stop air from travelling back up, preventing the patient from burping thus making them feel bloated. We advise avoiding foods that are known to cause gas, such as beans and cabbage. 

As with all keyhole surgery, there’s a possibility that we may need to convert to open surgery.

Other possible complications: 

  • Perforation of the oesophagus or stomach
  • Hernia
  • Bleeding
  • Visceral injury