Gastro-oesophageal Reflux Disease (GORD/ GERD) Treatment in Sydney
What is GERD?
Gastro-oesophageal reflux disease (GERD) is when stomach acid regularly pushes back up into the oesophagus. Acid reflux can irritate the lining of the oesophagus and cause heartburn or other symptoms.
Most people experience heartburn occasionally, but it is only called GERD if reflux occurs frequently (with mild symptoms at least twice a week, or more severe symptoms at least once a week).
GERD can usually be managed with lifestyle changes and medication. Occasionally, surgery is required.
What are the symptoms of GERD?
Heartburn is a common symptom of GERD. For many people, heartburn is worst when they lie down at night, and it may interfere with their sleep.
Other symptoms of GERD include:
- Regurgitation (This is when stomach contents come back up into your mouth.)
- Feeling of a lump in your throat
- Chronic (ongoing) cough
- Difficulty swallowing
- Vomiting
- Sore throat
- Hoarseness
- Excessive burping
- Chest pain (It is important that you seek immediate medical care if you experience chest pain, as it could be a sign of a serious emergency, rather than GERD.)
What causes GERD?
Your stomach and oesophagus are separated by a ring of muscle called the lower oesophageal sphincter (LES). The LES acts as a valve between your oesophagus and stomach, and prevents the backflow of stomach contents into the oesophagus.
If the LES becomes too relaxed, or is weakened, acid reflux can occur. Acid reflux is also common if you have a hiatal hernia, where part of the stomach bulges into the chest cavity.
Factors that increase pressure in your abdomen, such as pregnancy or obesity, increase the risk of GERD. Nicotine and caffeine tend to relax the LES and worsen GERD, while alcohol and certain medications (such as anti-inflammatories) can cause further irritation of the oesophagus.
Eating large meals, especially late at night, may worsen acid reflux. Fatty, spicy or fried foods can trigger reflux, while stress could also worsen reflux symptoms.
Is GERD harmful to my health?
Stomach acid irritates the lining of the oesophagus. This is called oesophagitis. Ongoing oesophagitis can lead to other complications:
- Oesophageal ulcer – This is an open sore in the oesophagus. Oesophageal ulcers may cause bleeding, pain and difficulty swallowing.
- Oesophageal stricture – Scarring from chronic oesophagitis may lead to a narrowing of the oesophagus, which causes problems with swallowing.
- Barrett’s oesophagus – Damage from ongoing oesophagitis can lead to changes in the cells that form the lining of the lower oesophagus. This is important because it increases your risk of developing oesophagus cancer. Barrett’s oesophagus can occur in up to 10% of people with chronic GERD.
How is GERD diagnosed?
GERD can usually be diagnosed by discussing your symptoms with your doctor.
Other tests may be required:
- Gastroscopy
- Gastrografin swallow test – During a gastrografin swallow test, you are asked to drink a liquid that contains a contrast medium. X-rays are then taken, with the contrast showing the outline of the oesophagus and stomach.
- High resolution manometry and 24-hour pH monitoring – Occasionally, it is necessary to measure acid levels in the oesophagus. This test also checks oesophageal pressure and motility (movement).
How is GERD treated?
GERD can usually be managed with lifestyle modifications, as well as medication. H2-Receptor blockers or Proton Pump Inhibitors (PPI’s) are the medications most often used.
Occasionally, surgery may be required. Surgery for a chronic GERD is called a laparoscopic fundoplication. During this keyhole surgery, the top part of the stomach (called the fundus) is wrapped around the lower part of the oesophagus. This creates a valve that prevents acid from leaking up into the oesophagus.
