Heartburn & Indigestion

Gastro-oesophageal reflux disease (GORD) is a common condition where acid from the stomach leaks out of the stomach and up...

Gastro-oesophageal reflux disease (GORD) is a common condition where acid from the stomach leaks out of the stomach and up into the oesophagus (gullet).

The oesophagus is a long tube of muscle that runs from the mouth to the stomach.

Common symptoms of GORD include:

  • Heartburn – burning chest pain or discomfort that occurs after eating
  • Acid reflux – you may have an unpleasant taste in the mouth, caused by stomach acid coming back up into your mouth
  • Pain when swallowing (odynophagia)
  • Difficulty swallowing (dysphagia)

GORD occurs only occasionally for some people, but if the symptoms persist it's usually regarded as a condition that needs treatment.

What causes GORD?
It's thought that GORD is caused by a combination of factors, but the most common is the failure of the lower oesophageal sphincter (LOS) – a ring of muscle towards the bottom of the oesophagus.

This acts like a valve, opening to let food fall into the stomach, then closing to prevent acid leaking out of the stomach.

In GORD, this sphincter doesn't close properly, allowing acid to leak up out of the stomach.

Known risk factors for GORD include:

  • Being overweight or obese
  • Being pregnant
  • Eating a high-fat diet

Diagnosing GORD
Your GP should be able to diagnose and treat GORD by asking you about your symptoms.

Further testing is usually only required if you have pain or difficulty swallowing, or if your symptoms don't improve despite taking medication.

Testing usually involves using an instrument called an endoscope, which is a long, thin, flexible tube with a light and camera at one end. It will be gently lowered down your throat so that any acid damage to the oesophagus can be seen.

Endoscopy is usually used if the diagnosis of GORD is in doubt, to check for any other possible causes of your symptoms, such as functional dyspepsia (an irritable stomach or gullet) or irritable bowel syndrome (IBS).

Treating GORD
A step-by-step approach is usually used for treating GORD. This means that simple treatments, such as changing your diet, will be tried first.

If this proves ineffective in controlling your symptoms, medication such as antacids, proton-pump inhibitors (PPIs) or H2-receptor antagonists (H2RAs) may be recommended.

Antacids neutralise the effects of stomach acid, and PPIs and H2RAs reduce the amount of acid that the stomach produces.

Surgery may be required in cases where medication fails to control the symptoms of GORD.

Complications
A common complication of GORD is that the stomach acid can irritate and inflame the lining of the oesophagus. This is known as oesophagitis. In severe cases of oesophagitis, ulcers (open sores) can form, which can cause pain and make swallowing difficult, particularly if the gullet becomes narrowed (stricture).

Cancer of the oesophagus, known as oesophageal cancer, is a rarer and more serious complication of GORD

Outlook
Most people initially respond well to treatment with medication, but symptoms can often return quite quickly (within days or weeks).

People with recurring GORD may need to take medication on a long-term basis.

How common is GORD?
GORD is a common digestive condition. About 1 in 5 people are thought to experience at least 1 episode of GORD a week, with 1 in 10 people experiencing symptoms of GORD on a daily basis.

GORD can affect people of all ages, including children. However, adults aged 40 years or over are mainly affected. The condition affects both sexes equally, although males are more likely to develop complications.

Visit your local CarePlus Pharmacy for more advice.

Indigestion
Indigestion can be pain or discomfort in your upper abdomen (dyspepsia) or burning pain behind the breastbone (heartburn).

Dyspepsia and heartburn may occur together or on their own. Symptoms usually appear soon after eating or drinking.

Common associated symptoms include:

  • Feeling full or bloated
  • Feeling sick (nausea)
  • Belching
  • Bringing up (regurgitating) fluid or food into the gullet (oesophagus)

Indigestion is a common problem that affects many people, but in most cases it's mild and only occurs occasionally.

Why it happens
Indigestion may be caused by stomach acid coming into contact with the sensitive, protective lining of the digestive system (mucosa). The stomach acid breaks down the lining, leading to irritation and inflammation, which can be painful.

The majority of people with indigestion don't have inflammation in their digestive system. Therefore, their symptoms are thought to be caused by increased sensitivity of the mucosa (to acidity or stretching).

In most cases indigestion is related to eating, although it can be triggered by other factors such as smoking, drinking, alcohol, pregnancy, stress or taking certain medications.

Treating indigestion at home
Most people are able to treat indigestion with simple changes to their diet and lifestyle, or with a number of different medications, such as antacids.

Very rarely, a serious underlying health condition is the cause of indigestion. If this is suspected, then further investigation such as an endoscopy will be required (see below).

When to see your doctor
Most people will not need to seek medical advice for their indigestion. However, it is important to see your GP if you have recurring indigestion and any of the following apply:

  • You are 55 years old or over
  • You have lost a lot of weight without meaning to
  • You have increasing difficulty swallowing (dysphagia)
  • You have persistent vomiting
  • You have iron deficiency anaemia
  • You have a lump in your stomach
  • You have blood in your vomit or blood in your stools

This is because these symptoms may be a sign of an underlying health condition, such as a stomach ulcer or stomach cancer. You may need to be referred for an endoscopy to rule out any serious cause.

An endoscopy is a procedure where the inside of the body is examined using an endoscope (a thin, flexible tube that has a light and camera on one end).

Severe indigestion can cause long-term problems with parts of your digestive tract, such as scarring of the oesophagus or the passage from your stomach.

Ask your CarePlus Pharmacist for advice. Indigestion can be easily treated with over the counter medicines and lifestyles changes can prevent re-occurrence.



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