Gastro-oesophageal reflux disease (GORD) occurs when stomach acid frequently flows back into the oesophagus due to reduced strength or competence of the Lower Oesophageal Sphincter (LOS). This causes irritation and inflammation, leading to symptoms like heartburn and regurgitation.
GORD mainly occurs when the LOS becomes weak or damaged. Several factors can reduce its function:
Obesity
Smoking and alcohol
Eating large meals or eating late
Hiatus (sliding) hernia
Reduced saliva (post-radiotherapy)
Conditions causing increased stomach pressure (e.g., diabetic gastroparesis)
When acid moves into the oesophagus repeatedly, it causes oesophagitis (inflammation), ulcers, and long-term complications if untreated.
Alcohol excess, severe stress, corrosive ingestion
With hiatus hernia or after surgeries like oesophagojejunostomy
Acid reflux → inflammation
Inflammation → oesophageal muscle spasm
Muscle spasm → stomach/oesophagus position changes
Position change → more reflux
This forms a vicious cycle unless treated.
The most common complaint is heartburn, a burning sensation behind the breastbone. Symptoms usually worsen when lying down and improve when sitting up.
.Heartburn (Pyrosis)
.Burning pain, can mimic angina
.Regurgitation
.Sour fluid/food coming back into the throat
.Chest Pain
.Non-cardiac, burning in nature
.Dysphagia
.Difficulty swallowing (late sign → stricture)
.Belching & Bloating
.Common, especially after meals
.Globus Sensation
If chest pain is severe or radiating, always rule out heart disease.
.Oesophageal ulcers and bleeding
.Peptic strictures (narrowing → food difficulty)
.Barrett’s Oesophagus (cell changes that may progress to cancer)
.Adenocarcinoma of oesophagus (rare but serious)
Inflammation, ulcers, mucosa appearance are seen
Motility/pressure of oesophagus
Gold Standard – measures acid exposure
Treatment depends on severity, but most cases improve with a combination of lifestyle changes + medications.
Reduce weight if overweight
Stop smoking & minimise alcohol
Avoid chocolate, coffee, aerated drinks (Coke), spicy/oily foods
Eat small, frequent meals instead of large portions
Do not lie down for 2–3 hours after meals
Sleep with the head end raised
Antacids + Alginate
Neutralises acid & forms a protective layer
Proton Pump Inhibitors (PPIs)
Pantoprazole 40 mg, Esomeprazole 20 mg
.Reduces acid production
Radiofrequency therapy to strengthen LES
Injection therapy near the gastro-oesophageal junction
Endoscopic suturing/plication to tighten the LES
If lifestyle changes, medicines, and endoscopic therapy fail, surgery like Fundoplication may be recommended.
Severe inflammation/stricture
Recurrent strictures
Large hiatus hernia
Barrett’s oesophagus with complications
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