Gastro-oesophageal Reflux

• Gastro-oesophageal reflux disease (GORD) is very common, occurring in about 15-30% of the Western population. The classic symptoms of ​​GORD are heartburn and regurgitation, however patients can present with a variety of symptoms. Heartburn is usually a burning sensation behind the chest whilst regurgitation is the sensation of gastric contents spilling into the back of the throat or mouth. Some patients may complain of difficult swallowing, pain on swallowing or the sensation of food getting stuck in the throat. Long-standing GORD can lead to pre-cancerous changes in the lining of the oesophagus (called Barrett's Disease).

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• The diagnosis of GORD is often made based on clinical symptoms. However, an accurate diagnosis usually requires further evaluation with a gastroscopy (allowing direct visualisation of the lining of the oesophagus) or with a measurement of the degree of acid reflux (pH-metry) as compared to a patient's reported symptoms. A hiatus hernia (stomach hernia through the diaphragm) may contribute to the development of reflux symptoms. If there is a concern for a hiatus hernia, this can be assessed with a gastroscopy and a barium swallow.

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• The treatment of GORD utilises a variety a strategies, including dietary modification, weight loss, ceasing smoking, medical therapy and sometimes, surgery. Medical therapy may include a variety of antacid medications. Surgery may be indicated for patients who do not respond to medical therapy. Surgery can involve repair of a hiatus hernia if present and an anti-reflux procedure (called a fundoplication). These procedures are typically performed laparoscopically ("keyhole").