Introduction

Everyone gets heartburn now and again. But if you get it often, you could have what doctors call GORD. This stands for gastro-oesophageal reflux disease.

We have brought together the best research about heartburn and GORD and weighed up the evidence about how to treat it. You can use our information to talk to your GP and decide which treatments are best for you.

Everyone gets heartburn now and again. It's an uncomfortable burning feeling that usually starts just below your breastbone and rises into your throat.

You may get a sour or bitter taste in your throat. Most people get it only once in a while, usually after drinking alcohol or eating rich or spicy food.

But if you have heartburn often, you could have what doctors call GORD. This stands for gastro-oesophageal reflux disease.

Key points for people with GORD

• The most common symptom of GORD is heartburn. If you have heartburn at least twice a week, you probably have GORD.^[1]

• If you get heartburn several times a week, you will probably need treatment to get better.

• Drugs called proton pump inhibitors are the best treatment for GORD.

• Drugs called H2 blockers also work but not as well as proton pump inhibitors.

• Surgery can help if you have had GORD for a long time and drug treatment hasn't worked.

How things normally work

To understand GORD and the best way to treat it, it helps to know something about your digestive system (the parts of your body that help break down food for cells to use).

The tube that carries food from your mouth to your stomach is called the oesophagus. It's about 25 centimetres (10 inches) long.^[2] It's made of muscle and stronger supporting tissue (called connective tissue). (Some people call the oesophagus the gullet.)

Your oesophagus starts at the back of your throat and runs down to your stomach. It sits next to your windpipe (the tube that goes to your lungs).

When you swallow, your windpipe closes off and food or liquid is pushed from your throat into your oesophagus. Muscles in your oesophagus start to tighten and relax, making a squeezing movement that carries the food down to your stomach.

The lining of your oesophagus is made of overlapping folds of tissue that allow it to stretch open so that larger pieces of food can pass through. The lining is pink and moist and looks a bit like the inside of your mouth.^[3]

Underneath the surface of the lining are glands that make a thick fluid called mucus. Mucus helps food slip down more easily. And it also protects the oesophagus from damage.^[4]

There is a ring of muscle at the lower end of your oesophagus, where it joins your stomach. This ring of muscle separates your oesophagus from your stomach. This muscle acts like a valve.

Usually, the ring of muscle is closed. But when food reaches it, nerves trigger the muscle to open so food can pass into your stomach. Once food has passed into your stomach, the muscle tightens up again and closes. This stops the contents of your stomach coming back into your oesophagus.

When food reaches your stomach, stomach juices and acid help break down the food so that it can move on to the next part of your digestive system.

As you breathe, your chest presses down. This also helps keep acid out of your oesophagus.