Gastro-oesophageal reflux is the presence of stomach contents within the oesophagus (gullet). A degree of gastro-oesophageal reflux is a normal phenomenon but the protective mechanisms of the oesophagus generally ensure episodes are short lived. However, the lining of the oesophagus is more easily damaged than that of the stomach and in addition is very sensitive therefore frequent and excessive exposure to gastric secretion may lead to inflammation and symptoms of heartburn.
There is a spectrum of severity of gastro-oesophageal reflux, at one end of the spectrum most people have experienced a degree of heart burn after over eating. It is estimated that one third of the adult population will experience gastro-oesophageal reflux symptoms every few days. In approximately 10% of adults symptoms will be severe enough to require medications and in a significant proportion symptoms will be severe or frequent enough to affect quality of life. In only a very small minority of patients will complications arise which may lead to serious medical problems i.e. stricture formation or ulceration. Treatment is, therefore, targeted according to a patient’s symptoms.
There are a range of therapeutic options available for the treatment of gastro-oesophageal reflux disease (GORD) and it is important to match these to the severity of symptoms and a patient’s individual life style. Treatment would usually begin with the least invasive interventions consistent with control of symptoms such as avoiding food that triggers reflux, losing weight, modification of medications likely to precipitate symptoms and escalate to the more invasive options.
If these measures are unsuccessful
Treatment with drugs that reduce acid secretion in stomach and acid reflux
If symptoms are not controlled
In addition diagnostic endoscopy a 24 hour pH measurement and oesophageal manometry will be required to determine optimal treatment for patients with GORD.