What is GORD, and how can it be treated?
Written by:Gastro-oesophageal reflux disease (GORD) is the most common digestive disorder affecting patients. On average, 10% of the population experience symptoms every day. Highly revered consultant general, upper gastrointestinal, and trauma surgeon Professor Mansoon Khan shares his expertise on the condition. The surgeon, who treats patients in Haywards Heath and Hove, explains how GORD can be best managed, reducing the severity of the attacks.
What is GORD?
Stomach acid contains very strong acids, including enzymes, which are important for digestion. Whilst the lining of the stomach has adapted to deal which this highly acidic substance, in some people this acid can enter the oesophagus resulting in symptoms like indigestion or heartburn. There are a number of underlying causes that result in GORD, such as problems with the stomach, the oesophagus, or the muscle that separated them. Lifestyle factors that can put you at risk of developing GORD are being overweight, smoking, consuming excessive caffeine or alcohol, and eating certain foods, for example, spicy or fatty foods.
What are the symptoms of GORD?
Symptoms associated with GORD include difficulty when swallowing, resulting in a feeling the food is getting stuck as well as feeling a lump in your throat and needing to clear it. Others are:
- a hoarse voice.
- a bad taste in your mouth.
- a dry, irritated, and sore throat
- a chronic cough, often occurring after lying down
- excessively burping.
If GORD is left untreated, gastric juices can cause long-term damage to the oesophagus. As a result, it can become inflamed or narrow, and ulcers or changes in the inner lining (Barrett’s oesophagus) can occur.
How can I improve my GORD?
By eating smaller meals more frequently, you can help the symptoms of GORD. You shouldn’t eat at least two hours before bed and don’t rush meals or exercise immediately after them. Avoid the consumption of fatty, fried, or spicy food, and refrain from drinking fizzy or caffeinated beverages.
Quit smoking and maintain a healthy weight to improve symptoms. Additionally, raise the head end of your bed by ten to twenty-five centimetres by placing blocks underneath it. This helps prevent acid from entering the oesophagus which can happen when lying flat.
Certain medications will increase your risk of getting acid reflux, such as steroids, iron supplements, some anti-depressants, ant-inflammatory medicines, and medicine that prevents blood clots. Whilst taking these, a short-term solution is to take ‘raft-forming’ antacid, like Gaviscon Advance®. This forms a barrier in your stomach to help prevent reflux. Another possibility is the take medication to reduce the acidity of your stomach secretions. If symptoms persist, speak to your GP.
If symptoms of GORD fail to be managed with medical intervention or if a patient experiences side-effect from the medication, anti-reflux surgery may need to be considered. Similarly, some people opt for surgery as it is more appealing than being on acid suppression medication for the rest of their lives.
How is anti-reflux surgery performed?
Prior to surgery, various tests have to be performed to determine if the patient is a good candidate for anti-reflux surgery. These include an upper GI endoscopy (OGD), a 24-hour pH test, oesophageal manometry study, and occasionally an impedance test. They diagnose the cause of acid reflux and whether there is a co-existing disease that worsens symptoms.
Anti-reflux surgery can either be a fundoplication or a LINX procedure. Fundoplication is carried out to reinforce the lower oesophageal sphincter (LOS), the muscle between the stomach and oesophagus that prevents acid from leaking out. To strengthen the barrier between the stomach and oesophagus, a portion of the stomach is wrapped around the lower end of the oesophagus. The LINX procedure is the creation of a ‘valve’ between the oesophagus and stomach by placing a magnetic ring around the junction where they meet.
Both procedures are predominately performed laparoscopically. Surgeons will use minimally invasive techniques to enter a small incision in the abdominal wall, with long and thin operating instruments under the guidance of a narrow, tube-like camera. This technique results in less pain, less scaring, requires a shorter stay in the hospital, and a lower risk of infection. Some patients may be better suited to more traditional, open surgery, which is still a safe and effective procedure.
What are the complications of GORD surgery?
Some patients have difficulties belching after undergoing a fundoplication, while others report abdominal bloating. These often resolve within the first six months and are rarely serious. You may also experience the inability to vomit, increased flatulence, and diarrhoea.
Dysphagia (difficulties swallowing) is quite a common side-effect due to swelling in the area. Similarly, this will resolve itself and a soft, liquid diet won’t aggravate it. If dysphagia persists, speak to your doctor.
General complications that can arise include a reaction to the general anaesthesia or bleeding, infection, or injury to a nearby organ. When performed by an experienced surgeon, the procedure is safe and complications are unusual.
Professor Mansoor Khan is a highly experienced surgeon. If you are interested in finding out more about surgical treatment for GORD and would like to book a consultation with him, you can do so by visiting his Top Doctors profile.
