Gastro-oesophageal Reflux Disease (GERD)

Gastro-oesophageal reflux disease (GERD) occurs when stomach acid regularly flows back up into the oesophagus (the tube connecting the throat to the stomach), causing irritation and characteristic symptoms.

• Heartburn — a burning sensation in the chest, often after eating or when lying down
• Regurgitation of sour or bitter-tasting fluid into the mouth or throat
• Difficulty or discomfort swallowing in some cases
• Chronic cough, hoarseness, or a sensation of a lump in the throat can occur with longstanding reflux
• Alarm features requiring urgent referral: difficulty swallowing, unintentional weight loss, or vomiting blood

• Occurs when the muscle that normally prevents stomach contents from moving back into the oesophagus becomes weak or relaxes inappropriately.
• Risk is increased by obesity, pregnancy, smoking, alcohol use, certain foods (such as fatty or spicy foods, caffeine, and carbonated drinks), and lying down soon after eating.

• Usually a clinical diagnosis based on the characteristic pattern of heartburn and regurgitation.
• A trial of acid-suppressing treatment is often used both to relieve symptoms and to support the diagnosis.
• Upper endoscopy is reserved for patients with alarm features, those who do not respond to initial treatment, or longstanding symptoms, to look for complications or exclude other diagnoses.

Lifestyle measures — avoiding large or late meals, reducing intake of trigger foods, weight loss where relevant, elevating the head of the bed, and stopping smoking — are recommended as first steps for everyone.

A proton pump inhibitor, such as omeprazole, is the first-line medicine, taken once daily before a meal for 4–8 weeks, and can be continued longer-term or used intermittently for recurring symptoms.

An antacid can be used for quick relief of occasional mild symptoms.

Patients with alarm features — such as difficulty swallowing, unexplained weight loss, or evidence of bleeding — or those whose symptoms do not improve with treatment are referred for further assessment, including possible endoscopy.

• Avoid large meals, especially close to bedtime.
• Reduce intake of foods and drinks known to trigger symptoms, such as fatty or spicy foods, caffeine, and carbonated drinks.
• Maintain a healthy body weight.
• Avoid smoking and limit alcohol intake.
• Elevate the head of the bed if nighttime symptoms are troublesome.