London Reflux Clinic

If you’re concerned you may have GORD, then look out for:

• Difficulty swallowing
• Heartburn
• Frequent acid reflux (where acid from the digestive tract comes up through the upper abdomen and into the mouth)
• Bad breath
• Belching
• Feeling sick or vomiting
• Pain when swallowing
• Sore throat and a hoarse voice
• A chronic cough which may get worse at night
• Tooth decay and gum disease

The reason why GORD happens isn’t always obvious, but certain factors can increase the risk of this condition developing. Risk factors include:

• Hiatus hernia: This is when part of your stomach pushes up through your diaphragm (the layer of muscle between your chest and stomach). This is commonly associated with GORD.
• Being overweight: this places increased pressure on your stomach, and over time can weaken the muscles at the base of your gullet.
• Smoking and drinking too much alcohol or coffee.
• Gastroparesis: this is when food sits in the stomach longer than it should and regurgitates up into the oesophagus.
• Certain medicines: some medicines can cause GORD or make symptoms worse.
• Stress can worsen symptoms.

GORD is a difficult illness to live with. Some people, especially those that have been experiencing symptoms for a long time, can face complications, such as:

• Oesophageal ulcers: this is when stomach acid constantly leaks into the oesophagus and ends up damaging the lining. For long-term sufferers, this can mean ulcers form, which can cause difficulty in swallowing and chest pain, and lead to longer term damage.
• Scarred oesophagus: GORD causes damage to the ring of muscles that separates the gullet from the stomach, as well as to the gullet itself. Over time, this can cause the tissues to become scarred and the tube to become narrower causing difficulty in swallowing.
• Weakening of the oesphageal muscle so the oesophagus becomes less efficient at propelling food downwards.
• Barrett’s oesophagus: this means that the cells in your gullet have started to change. Over a long period of time, if left untreated this can develop into cancer in a small number of people.
• Oesophageal cancer: this is when the cells in your gullet grow in an uncontrolled way. If you notice your GORD symptoms are getting worse, find it difficult to swallow or have unexplained weight loss, see a doctor and seek an assessment.

Some of the tests to diagnose GORD that your consultant might recommend include:

• Endoscopy – this provides direct visualisation of your oesophagus and stomach, allows biopsies to be taken and also provides a good overall assessment of your oesophageal health.
• Barium tests – those are used to help visualise parts of the gastrointestinal tract (gut) such as the oesophagus (gullet), stomach and small intestines. The gut doesn’t show up well on ordinary x-rays. However, if you drink a white ‘chalky’ liquid that contains a chemical called barium sulphate, the outlines of the gut show up clearly on x-rays. This is because x-rays don’t pass through barium. These tests can help assess your swallowing ability and help identify any problems in your gullet.
• Manometry – this helps doctors see how well the muscle of your oesophagus is working. Manometry can help rule out other potential causes of your symptoms and is useful in the lead up to surgery.This test involves passing a thin tube up your nose and down into your oesophagus. The tube contains sensors that can detect the pressure in your oesophagus.
• pH monitoring – this test involves a doctor passing a thin tube through your nose. This thin catheter will measure your oesophageal acid level (known as pH) for the next 24 – 96 hours.
• Blood tests

If the tests show that you have GORD, your consultant might recommend lifestyle changes and prescription medications. The medication your doctor recommends will be based on the severity of your case. Over-the-counter medications will usually only help if you have a mild transient case of acid reflux.

However, if your symptoms don’t improve, don’t ignore them as you may find the problem only gets worse. Take over-the-counter medicines to start with, preferably alongside dietary and lifestyle changes, and if you don’t notice any improvement, you might be a candidate for surgery.

If surgery looks like the best option to stop your symptoms, the team here at St John & St Elizabeth Hospital has been offering advanced surgery for GORD for over 20 years, and will support you every step of the way.