Gastro-oesophageal Reflux Disease (GORD)—often referred to as ‘acid reflux’—is a very common condition in the UK. It occurs when the acidic contents of the stomach leak backwards into the oesophagus (the food pipe). While many people experience occasional heartburn, GORD is diagnosed when this reflux becomes chronic, causing persistent symptoms or physical damage.
At the bottom of your oesophagus, there is a ring of muscle called the Lower Oesophageal Sphincter (LOS). It acts like a one-way valve, opening to let food into the stomach and closing to keep acid down. In GORD, this muscle becomes weak or relaxes at the wrong time, allowing stomach acid to wash upwards.
The classic sign of GORD is heartburn—a painful, burning sensation in the middle of the chest, usually felt after eating or when lying down. However, some people experience ‘silent reflux’, where they don’t feel burning at all but instead have a chronic cough, a hoarse voice, or the feeling of a lump in their throat.
Many people with chronic GORD also have a hiatus hernia. This occurs when the top part of the stomach slides up through the diaphragm (the large muscle separating the chest from the abdomen) into the chest cavity. This displacement makes it much harder for the LOS valve to stay closed, leading to constant reflux.
Some sufferers experience a sudden rush of slightly salty or sour saliva in the mouth. This is known as water brash. It is an involuntary reflex where the salivary glands overproduce saliva to try and neutralise the acid that the body senses is rising up into the oesophagus.
Being overweight or obese increases the pressure on the stomach (intra-abdominal pressure). This physical pressure can force the stomach contents past the LOS valve and into the oesophagus. For many, losing even a small amount of weight can significantly reduce the frequency of reflux episodes.
While triggers vary, several common culprits relax the LOS valve or increase acid production:
Caffeine and Chocolate: Both contain compounds that relax the sphincter muscle.
Peppermint: Known to relax smooth muscle, including the ‘valve’.
Fatty or Spicy foods: These delay stomach emptying, keeping acid in the stomach longer.
Smoking and Alcohol: Both can irritate the gut lining and weaken the valve.
The most common medical treatment for GORD involves Proton Pump Inhibitors (PPIs), such as Omeprazole or Lansoprazole. These medications don’t stop the reflux from happening, but they reduce the amount of acid your stomach produces. This means that if ‘reflux’ does occur, it is less likely to cause pain or damage.
If the oesophagus is constantly bathed in acid for years, the body may try to protect itself by changing the type of cells lining the food pipe to be more like the cells in the intestine. This is a condition called Barrett’s Oesophagus. While not cancerous itself, it requires regular monitoring as it slightly increases the risk of oesophageal cancer.
Because GORD is a physical problem, physical solutions often help. Using a ‘wedge pillow’ or raising the head of your bed by about 10–20cm using blocks can use gravity to keep acid in the stomach while you sleep. Simply using extra pillows often doesn’t work, as it can bend the body at the waist, actually increasing stomach pressure.
When medications don’t work or a patient doesn’t want to take them for life, a surgical procedure called a Laparoscopic Nissen Fundoplication may be considered. A surgeon wraps the top part of the stomach around the lower oesophagus to physically strengthen the valve and prevent acid from escaping.
MyHSN Top Tip: Avoid eating your evening meal within three hours of going to bed. Lying down with a full stomach is the easiest way for acid to escape into the oesophagus. Giving your stomach time to empty before you sleep can often reduce the need for medication.
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