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Gastro-oesophageal reflux disease (GORD)

Gastro-oesophageal reflux disease (GORD) happens when stomach acid affects the oesophagus (gullet), the tube between the mouth and the stomach.

GORD symptoms include heartburn, an acid taste in the mouth and swallowing problems, called dysphagia.

Heartburn is common, affecting around 1 in 5 people at least once a week.

What causes gastro-oesophageal reflux disease?

In a person with GORD, usually the lower oesophageal sphincter muscle (LOS) doesn't work properly. This is supposed to act as a valve keeping stomach acid in the stomach. However, if the LOS doesn't fully close, acid may leak out of the stomach and rise up towards the throat.

Risk factors for GORD include:

 

What are the symptoms of heartburn?

Heartburn is the most common symptom of GORD and usually feels like a burning chest pain beginning behind the breastbone and moving upwards to the neck and throat. 

The burning, pressure or pain of heartburn can last as long as two hours and is often worse after eating. Lying down or bending over can also result in heartburn. Many people obtain relief by standing upright or by taking an antacid.

Heartburn pain can be mistaken for the pain associated with heart disease or a heart attack, but there are differences. Exercise may aggravate pain resulting from heart disease, and rest may relieve the pain. Heartburn pain is less likely to be associated with physical activity.

What is the treatment for GORD?

Doctors recommend lifestyle and dietary changes for most people needing treatment for GORD. Treatment aims at decreasing the amount of acid and reducing damage to the lining of the oesophagus from refluxed materials.

Avoiding foods and beverages that are identified as triggering symptoms is recommended. These may include chocolate, peppermint, fatty foods, coffee, and alcoholic beverages. Foods and beverages that can irritate a damaged oesophageal lining - such as citrus fruits and juices, tomato products, and pepper - may also need to be avoided.

Decreasing the size of portions at mealtime may also help control symptoms. Eating meals at least three hours before bedtime may lessen reflux by allowing the acid in the stomach to decrease and the stomach to empty partially. In addition, being overweight often worsens symptoms. Many overweight people find relief when they lose weight.

Cigarette smoking weakens the LOS, so stopping smoking is important to reduce GORD symptoms.

Elevating the head of the bed on 15cm (6in) blocks or sleeping on a specially designed wedge reduces heartburn by allowing gravity to minimise reflux of stomach contents into the oesophagus. Do not use pillows to prop yourself up, which only increases pressure on the stomach.

Antacids taken regularly can neutralise acid in the oesophagus and stomach and stop heartburn. Many people find that non-prescription antacids provide temporary or partial relief. An antacid combined with a foaming agent such as alginic acid helps some people. These compounds are believed to form a foam barrier on top of the stomach that prevents acid reflux occurring.

However, long-term use of antacids can result in side effects, including diarrhoea, altered calcium metabolism (a change in the way the body breaks down and uses calcium) and build-up of magnesium in the body. Too much magnesium can be serious for patients with kidney disease. If you need antacids for more than two weeks, or need to use them twice a week or more, seek medical advice.

For chronic reflux and heartburn the GP may prescribe medication to reduce acid in the stomach. These medicines include H2 blockers, which inhibit acid secretion in the stomach.

Another type of drug, the proton pump (or acid pump) inhibitor (PPI) inhibits an enzyme (a protein in the acid-producing cells of the stomach) necessary for acid secretion therefore blocking acid secretion.

Other approaches to therapy include increasing the strength of the LOS, and hastening the emptying of stomach contents with motility drugs that act on the upper gastrointestinal (GI) tract.

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