Dr Chris Hofmeyr


What is GORD?

Gastroesophageal reflux, often referred to as GORD, occurs when acid from the stomach backs up into the oesophagus. Normally, food travels from the mouth, down through the oesophagus and into the stomach. A ring of muscle at the bottom of the oesophagus, the lower oesophageal sphincter (LOS), contracts to keep the acidic contents of the stomach from "refluxing" or coming back up into the oesophagus. In those who have GORD, the LOS does not close properly, allowing acid to move up the oesophagus. When stomach acid touches the sensitive tissue lining the oesophagus and throat, it causes a reaction similar to squirting lemon juice in your eye. This is why GORD is often characterized by the burning sensation known as heartburn. In some cases, reflux can be SILENT, with no symptoms until a problem arises. Almost all individuals have experienced reflux (GOR), but the disease (GORD) occurs when reflux happens on a frequent basis often over a long period of time.

What is LPR?

During gastroesophageal reflux, the acidic stomach contents may reflux all the way up the oesophagus, beyond the upper oesophageal sphincter (a ring of muscle at the top of the oesophagus), and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR), which can affect anyone. Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning, or something "stuck." Some may have difficulty breathing if the voice box is affected.

In infants and children, LPR may cause breathing problems such as: cough, hoarseness, stridor (noisy breathing), croup, asthma, sleep disordered breathing, feeding difficulty (spitting up), turning blue (cyanosis), aspiration, pauses in breathing (apnoea), apparent life threatening event (ALTE), and even a severe deficiency in growth. Proper treatment of LPR, especially in children, is critical.

What are the symptoms of GORD and LPR?

The symptoms of GORD may include persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing. Some people have GORD without heartburn. Instead, they experience pain in the chest that can be severe enough to mimic the pain of a heart attack. GORD can also cause a dry cough and bad breath. Some people with LPR may feel as if they have food stuck in their throat, a bitter taste in the mouth on waking, or difficulty breathing, although uncommon.

If you experience any of the following symptoms on a regular basis (twice a week or more) then you may have GORD or LPR. For proper diagnosis and treatment, you should be evaluated by your primary care doctor for GORD or an otolaryngologist-head and neck surgeon (ENT doctor).

Who gets GORD or LPR?

Women, men, infants, and children can all have GORD. This disorder may result from physical causes or lifestyle factors. Physical causes can include a malfunctioning or abnormal lower oesophageal sphincter muscle (LOS), hiatal hernia, abnormal oesophageal contractions, and slow emptying of the stomach. Lifestyle factors include diet (chocolate, citrus, fatty foods, spices), destructive habits (overeating, alcohol and tobacco abuse) and even pregnancy. Young children experience GORD and LPR due to the developmental immaturity of both the upper and lower oesophageal sphincters.

Unfortunately, GORD and LPR are often overlooked in infants and children leading to repeated vomiting, coughing in GOR and airway and respiratory problems in LPR such as sore throat and ear infections. Most infants grow out of GORD or LPR by the end of their first year; however, the problems that resulted from the GORD or LPR may persist.

What role does an ear, nose, and throat specialist have in treating GORD and LPR?

A gastroenterologist, a specialist in treating gastrointestinal orders, will often provide initial treatment for GORD. But there are ear, nose, and throat problems that are either caused by or associated with GORD, such as hoarseness, laryngeal (singers) nodules, croup, airway stenosis (narrowing), swallowing difficulties, throat pain, and sinus infections. These problems require an otolaryngologist-head and neck surgeon, or a specialist who has extensive experience with the tools that diagnose GORD and LPR. They treat many of the complications of GORD, including: sinus and ear infections, throat and laryngeal inflammation and lesions, as well as a change in the oesophageal lining called Barrett's oesophagus, which is a serious complication that can lead to cancer. Your primary care physician or paediatrician will often refer a case of LPR to an otolaryngologist-head and neck surgeon for evaluation, diagnosis, and treatment.

Diagnosing and Treating GORD and LPR

In adults, GORD can be diagnosed or evaluated by a physical examination and the patient's response to a trial of treatment with medication. Other tests that may be needed include an endoscopic examination (a long tube with a camera inserted into the nose, throat, windpipe, or oesophagus), biopsy, x-ray, examination of the throat and larynx, 24 hour pH probe, acid reflux testing, oesophageal motility testing (manometry), emptying studies of the stomach, and oesophageal acid perfusion (Bernstein test). Endoscopic examination, biopsy, and x-ray may be performed as an outpatient or in a hospital setting. Endoscopic examinations can often be performed in your ENT's office, or may require some form of sedation and occasionally anaesthesia.

Symptoms of GORD or LPR in children should be discussed with your paediatrician for a possible referral to a specialist.

Most people with GORD respond favourably to a combination of lifestyle changes and medication. On occasion, surgery is recommended. Medications that could be prescribed include antacids, histamine antagonists, proton pump inhibitors, pro-motility drugs, and foam barrier medications. Some of these products are now available over-the-counter and do not require a prescription. Children and adults who fail medical treatment or have anatomical abnormalities may require surgical intervention. Such treatment includes fundoplication, a procedure where a part of the stomach is wrapped around the lower oesophagus to tighten the LES, and endoscopy, where hand stitches or a laser is used to make the LOS tighter.

Adult lifestyle changes to prevent GORD and LPR

  • Avoid eating and drinking within two to three hours prior to bedtime
  • Do not drink excessive alcohol
  • Eat small meals and slowly
  • Lose weight
  • Quit smoking
  • Wear loose clothing
  • Limit problem foods
    • Caffeine
    • Carbonated drinks
    • Chocolate
    • Peppermint
    • Tomato and citrus foods
    • Fatty and fried foods
    • White bread