Gastro-oesophageal reflux disease (GORD) part1

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Gastro-oesophageal reflux disease (GORD) is a condition which develops from reflux of stomach contents upwards.GORD is a condition that tends to be more common at Christmas due to over-eating or rich and heavy food.

Causes

The oesophagus is a tube of muscle connecting the mouth to the stomach. In normal circumstances, the lower oesophageal sphincter (LOS) (the muscular ring at the lower end of the oesophagus) opens like a valve, enabling food to pass into the stomach and then closes to prevent stomach acids seeping back into the oesophagus. However, in GORD the sphincter pressure reduces, relaxing the muscle and allows the stomach's acidic contents to reflux into the oesophagus.

How common is GORD?

The most common cause of indigestion in Ireland, GORD affects up to 1 in 4 people. 10% to 20% of people in the western world have at least one bout of GORD per week. It is twice as common in males as females.

Predisposing factors

Here are lifestyle and medication risk factors that increase the possibility of developing GORD:

-Being overweight or obese, particularly if this is physically around the waist. This increases pressure on the stomach from beneath forcing contents upwards.

-Fatty foods slows stomach digestion so it takes longer to expel stomach acids

-Consuming excess alcohol, coffee, spicy foods or chocolate increases the acidity of the stomach contents and relaxes the oesophageal sphincter thus increasing reflux potential

-Smoking relaxes the oesophageal sphincter increasing reflux risk

-Pregnancy increases risk of GORD because.

Changes in hormone levels can weaken the LOS

The baby pushes into the stomach which pushes stomach contents upwards (especially in later stages of pregnancy)

-Hiatus hernia is when part of a stomach pushes up through the diaphragm (the muscle used for breathing). This creates pressure on the stomach, leading to reflux

-Stress

-If you have a predisposition to GORD, sleeping flat can increase risk.

Medication

Some drugs prescribed for non-GORD related conditions can cause the oesophageal sphincter to relax increasing the potential for reflux including:

-Non steroidal anti-inflammatory drugsare anti-inflammatory pain killers and include aspirin, ibuprofen, diclofenic and naproxen.

-Antibiotics such as tetracyclines and ciprofloxacin

-Calcium-channel blockers – treats high blood pressure (eg) amlodipine (Istin^®) and lercandipine (Zanidip^®)

-Theophylline – treats respiratory conditions including asthma and chronic pulmonary obstructive disorders (COPD) such as bronchitis and emphysema

-Benzodiazepines are tranquilisers used on a short term basis only to treat anxiety, panic attacks and sleeping disorders (eg) diazepam (Valium^®), alprazolam (Xanax^®) and temazepam (Insomniger^®)

-Nitrateswhich treat angina by relaxing blood vessels thus reducing chest pains and discomfort. Examples include Isosorbide Mononitrate (Imdur^®) and glyceryl trinitrate spray which is an under-tongue spray (eg) Glytrin Spray^®, Nitrolingual Spray^®.

-Biphosphonates to treat osteoporosis including Alendronic Acid (Fosamax^®), Risedronate (Actonel^®) and ibandronic acid (Bonviva^®)

-Anticholinergics used to treat respiratory, digestive, neurological problems (eg) Atrovent^® and Spiriva^® inhaler used for COPD, Detrusitol^® used for urinary incontinence

Symptoms

-Heartburn

This is the main symptom. It presents as a burning feeling of discomfort, rising from the upper abdomen or lower chest up towards the neck. It has actually nothing to do with the heart.

-Regurgitation

Regurgitation of acid up the oesophagus often as far as the throat. This usually causes an unpleasant, sour taste.

-Dysphagia

Dysphagia means difficulty swallowing. Around 30% people with GORD have problems swallowing. It occurs when scarring through repeated exposure to stomach acid causes the oesophagus to narrow making food difficult to swallow. Many describe it as feeling like a piece of food becoming stuck somewhere near the breastbone.

-Severe chest pain

This is a non-cardiac chest pain caused by GORD; this has been found in up to 50% of patients with chest pain and normal coronary angiography. Usually there is no relationship to exercise and this helps to differentiate most cases of reflux induced chest pain from true angina.

Other common symptoms include nausea, bloating and belching. These symptoms are periodic in nature and may flare up after eating, bending over or after a period of lying down.