Gastro-oesophageal reflux disease (GORD) sometimes termed GERD due to the American spelling of “esophagus” is believed to be a condition where stomach acid leaks from the stomach back up the oesophagus causing heartburn. However this may not always be the case. Dr Gerry Mullin, a US gastroenterologist explains that in his experience GORD may not be due to excess stomach acid at all, but more on this later.
GORD is a fairly common digestive condition with one in five people experiencing symptoms once a week, and 1 in 10 experiencing symptoms daily. Most cases of GORD affect adults aged 40 or over. A complication of GORD is irritation and inflammation of the oesophagus, known as oesophagitis, the development of ulcers and in rare cases the development of oesophageal cancer.
It is thought that GORD is caused by a malfunction of the lower oesophageal sphincter (LOS), a type of smooth muscle between the oesophagus and stomach that should normally close tight and not allow the contents of the stomach to backwash into the oesophagus. The pH of the stomach should normally be 1.5-2, which is extremely acidic. Dr Rakowski suggests that the more acidic the stomach is the tighter the LOS contracts preventing backwash of stomach acid into the oesophagus. But he suggests that if the pH of the stomach increases (becoming slightly less acidic) the LOS loosens and allows acid in to the oesophagus causing GORD. It is important to remember that pH 4 is still acidic enough to burn the oesophagus. There are a variety of reasons why this might happen such as being overweight or obese, being pregnant or eating a high-fat or high grain based diet.
However, there are other proposed causes of GORD such as hiatal hernia, delayed gastric emptying, duodenal and bile reflux into the stomach, low stomach pH (see here how to test stomach acid with the HCL test) and impaired oesophageal mucosal defence systems and salivary function.
Management of GORD
The first step in the management of GORD should be changing your diet and lifestyle. London nutritionist Steve Hines can help design a nutrition plan to help manage you GORD. Dietary changes include avoiding chocolate, citrus, tomatoes, peppermint, onions, garlic, eating small meals (as over eating is a causative factor), stopping smoking and reducing alcohol intake. However many people take antacids or other stomach acid lowering medication. Although this may reduce the symptoms of GORD it can lead to further problems such as poor digestion and malabsorption of nutrients.
Other therapies include acupuncture, improving sleep and reducing stress and visceral manipulation from an osteopath.