Gastro-oesophageal reflux disease (GORD)

The main symptoms of acid reflux are:

• A burning sensation in the middle of your chest
• An acid taste in the mouth
• Pain in the upper abdomen and chest

You may also notice:

• A persistent cough especially at night due to refluxes acid irritating the windpipe(trachea).
• A sore throat and hoarseness
• Bad breath
• Bloating and feeling sick
• Severe chest pain develops in some cases (and may be mistaken for a heart attack)

Your symptoms will probably be worse after eating, when lying down and when bending over.

If you have any of the following alert symptoms, then it is important to seek urgent advice from your GP or by phoning 111:

• Persistent/worsening symptoms (especially if you have had Barrett’s oesophagus, known dysplasia, atrophic gastritis or intestinal metaplasia or you had peptic ulcer surgery more than 20 years ago)
• Severe pain
• Are 55 years old or older
• Unintentional weight loss
• Difficulty swallowing
• Vomiting recurrently
• Feel like you have a lump in your stomach
• Bloody poo or vomit (partially digested blood is dark brown or black creating tarry black stools known as “melaena” or so-called “coffee ground” vomit)

These symptoms could be a sign of something more serious.

Most people have heartburn at some time, especially after a large meal. Things that can make it worse include:

• Being overweight
• Smoking
• Drinking alcohol in excess
• Stooping or bending forwards
• Eating a large meal, especially near bedtime
• Stress and anxiety
• Having a hiatus hernia (a condition where part of the stomach protrudes into the chest through the diaphragm)
• Some medications such as ibuprofen and other anti-inflammatory painkillers
• Certain foods – including coffee, tomatoes, chocolate, fatty and spicy foods
• Pregnancy

You can avoid triggers that may make reflux worse:

• Stop smoking if you are a smoker
• Reduce or stop drinking alcohol
• Reduce or stop drinking coffee
• Reduce or stop eating chocolate, fatty foods and other foods that make your symptoms worse
• Eat smaller meals and avoid eating within 3-4 hours of bedtime
• Lose weight if you are overweight or obese
• Raise the head of your bed so stomach acid is less likely to travel up towards your throat
• Do not wear clothes that are tight around your waist

You can obtain advice from a pharmacist about medications you can buy without prescription. Your pharmacist will want to ask you about your health problems and other medication you are taking to be sure the treatments recommended are suitable for you. Find a pharmacy here.

These medications include antacids and antacids with alginates. The antacid helps to neutralise acid in your stomach and the alginate forms a layer on top of the liquid in your stomach, so helping to reduce your symptoms. These medications usually work better in liquid than tablet form, although of course tablets are much easier to carry around.

You can also buy small numbers of medications that are like those that your doctor can prescribe. These help by reducing the amount of acid that is made by your stomach.

Your pharmacist can also discuss whether any medications you are buying for other conditions might be making your reflux worse. An example is non-steroidal anti-inflammatory drugs such as ibuprofen. It is possible that the pharmacist could recommend an alternative which would not cause the symptoms.

If you have alert symptoms mentioned above, then you should arrange to get urgent medical advice.

Otherwise, if lifestyle changes and over the counter pharmacy medications are not helping, you should seek medical advice by contacting your GP. Your GP will probably go through the lifestyle measures you have already taken. They will also review your prescription medications to see if any of those might be contributing to the problem and to consider alternatives.

Your GP can prescribe further medications to help reduce the amount of acid your stomach is producing. They may carry out some tests to help rule out other problems.

If your symptoms are severe or if medications do not help, then your GP may refer you for tests by a specialist. This could include a gastroscopy, where a thin tube with a camera is passed down your throat to find out what’s causing your symptoms.

Although a gastroscopy is usually a simple test, like all investigations it can occasionally result in complications. For this reason, it is important to be sure that all the other less invasive options are considered first as most people will improve and not require a gastroscopy.

In Devon, in order to help ensure that gastroscopy is only carried out on appropriate patients, your GP must include in the referral letter details of the steps that you have taken and the tests that have already been carried out. Unless there are alert symptoms, the referral will only be accepted if you have already tried to resolve the problem by taking the recommended lifestyle measures and trying medication.