Gastro-oesophageal reflux disease (GORD)

Gastro-oesophageal reflux disease, or GORD, is a digestive disorder that affects the lower oesophageal sphincter (LOS) - the muscle connecting the oesophagus with the stomach. Many people, including pregnant women, have heartburn or acid indigestion caused by GORD. Doctors believe that some people have GORD due to a condition called hiatus hernia. In most cases heartburn can be relieved through diet and lifestyle changes; however some people may require medication or surgery. This fact sheet provides information on GORD -its causes, symptoms, treatment and long-term complications.

What is gastro-oesophageal reflux?

Gastro-oesophageal refers to the stomach and oesophagus. Reflux means to flow back or return. Therefore gastro-oesophageal reflux is the return of the stomach's contents back up into the oesophagus.

In normal digestion the LOS opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices flowing back into the oesophagus. Gastro-oesophageal reflux occurs when the LOS is weak or relaxes inappropriately allowing the stomach's contents to flow up into the oesophagus.

The severity of GORD depends on LOS dysfunction as well as the type and amount of fluid brought up from the stomach and the neutralising effect of saliva.

What is the role of hiatus hernia in GORD?

Some doctors believe a hiatus hernia may weaken the LOS and cause gastro-oesophageal reflux. Hiatus hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the stomach from the chest. Studies show that the opening in the diaphragm acts as an additional sphincter around the lower end of the oesophagus. Studies also show that hiatus hernia results in retention of acid and other contents above this opening. These substances can reflux easily into the oesophagus.

Coughing, vomiting, straining or sudden physical exertion can cause increased pressure in the abdomen resulting in hiatus hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people 50 years old and over have a small hiatus hernia. Although considered a condition of middle age, hiatus hernias affect people of all ages.

Hiatus hernias usually do not require treatment. However treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off its blood supply, called a para-oesophageal hernia) or is complicated by severe GORD or oesophagitis (inflammation of the oesophagus). The doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.

What other factors contribute to GORD?

Dietary and lifestyle choices may contribute to GORD. Certain foods and beverages, including chocolate, peppermint, fried or fatty foods, coffee or alcoholic beverages may weaken the LOS causing reflux and heartburn. Studies show that cigarette smoking relaxes the LOS. Obesity and pregnancy can also cause GORD.