GORD is the acronym for gastro-oesophageal reflux disease, which is what most people would refer to as heartburn.

Dietary change

A wide variety of foods have been reported to make GORD symptoms worse. Commonly cited foods include coffee, fizzy drinks, alcohol, citrus fruits and juices, high fat dairy products and fried food.

40% of people with GORD have delayed gastric emptying and we know fatty foods slow gastric emptying further. Coffee and chocolate decrease lower oesophageal sphincter pressure and so increase reflux. Citrus is acidic and irritates nerves in the oesophagus that are already much more sensitive because of the ongoing reflux. It is worth experimenting and leaving out these foods from your diet. Many people, however, will not get adequate benefit from this alone.

Lifestyle changes may help

You are more likely to be able to reduce GORD symptoms by making some adjustments to your lifestyle and everyday habits:

  • Avoid bending or exercising just after eating.
  • Avoid garments or belts that fit tightly around the waist.
  • Do not lie down with a full stomach. For example, avoid eating within 2 to 3 hours of bedtime.
  • Eat smaller meals. Full stomachs are more likely to ‘overflow’.
  • Lose weight if you are overweight.
  • Sleep on a slight incline. Increasing the head of your bed by about 8-10 inches. Pillows aren’t very effective because they just alter the angle of the head; bricks under the top legs of the bed are a common solution.
  • Don’t smoke; this is bad for your health generally but makes GORD symptoms worse.

How is GORD treated?

Anti-GORD medications are among the most widely prescribed in the Western world:

  • Antacids before meals or in response to heartburn can reduce gastric acidity. They neutralise acids rather than prevent their production.
  • Alginates put a protective coat over the mucosa as well as reducing acidity and decreasing reflux. This is one of the most effective non-prescription treatments.
  • Proton pump inhibitors are the most effective prescription drugs for reducing gastric acid secretion. These stop acid secretion at the source by inhibiting the proton pump in the cells of the stomach wall.
  • H2 receptor blockers reduce gastric secretion of acid by blocking the secretion of histamine. They are not nearly as effective as proton pump inhibitors and relieve symptoms in less than 50 % of people with GORD.

A variety of other drugs can be prescribed:

  • Prokinetics strengthen muscular contractions of the intestinal wall, thus speed up gastric emptying.
  • Sucralfate (Carafate®) can help to heal and prevent further oesophageal damage caused by GORD.
  • Baclofen is a skeletal muscle relaxant that has also been shown to decrease lower oesophageal sphincter relaxations. This reduces episodes of reflux.

Anti-reflux surgery can be performed to re-build the sphincter. A hiatus hernia can be repaired at the same time. The standard surgical treatment for GORD is the Nissen fundoplication, in which the upper part of the stomach is wrapped around the lower oesophageal sphincter to strengthen the sphincter and prevent acid reflux.

Novel endoscopic techniques are being developed for minimally invasive endoscopic therapy for GORD.

Treating pre-cancerous changes in Barrett’s oesophagus

Around 2 in every 100 patients develop pre-cancerous changes in their oesophagus after long-term damage caused by GORD. Half of them are then likely to go on to develop oesophageal cancer over the following 5 years.

The National Institute of Clinical Excellence (NICE) has approved the use of HALO radiofrequency ablation, a technique that destroys the abnormal mucosa but leaves the deeper tissue unharmed to prevent cancer progression in people with Barrett’s oesophagus.