Gastroesophageal Reflux Disease (GERD/GORD) & Hiatus Hernia
Gastric Reflux
Causes of Reflux
The oesophagus is a narrow tube that passes food from the mouth to the stomach. At the junction of the stomach, the oesophagus is surrounded by ring shaped muscles called the lower oesophageal sphincter (LES), which acts as a valve, ensuring the one-way movement of food.
Gastric reflux, also called gastro-oesophageal reflux disease (GORD), is a condition where the stomach's contents (food or liquid) rise up from the stomach into the oesophagus. Food mixed with the stomach’s digestive acids can irritate and damage the oesophagus.
Normally, the stomach's contents are retained in the stomach with the help of the LES, a muscle that contracts and relaxes to maintain the one-way movement of food. However, gastric reflux occurs when the LES weakens. The exact cause of this is not known, however, certain factors including obesity, smoking, pregnancy and possibly alcohol, may contribute to GORD. Common foods such as spicy foods, onions, chocolates, caffeine- containing drinks, mint flavourings, tomato-based foods, citrus fruits and certain medications can worsen gastric reflux.
Heartburn is usually the main symptom of GORD, characterised by a burning-type pain in the lower part of the mid-chest, behind the breast bone. Other symptoms include a bitter or sour taste in the mouth, trouble swallowing, nausea, dry cough or wheezing, regurgitation of food (bringing food back up into the mouth), hoarseness or change in voice and chest pain.
Diagnosis for Gastric Reflux
- Endoscopy: allows the doctor to examine the inside of your oesophagus, stomach and portions of the intestine with an instrument called an endoscope, a thin flexible lighted tube
- Barium X-rays: involves swallowing a barium preparation, which can be detected through X-rays
- 24-hour pH monitoring: involves inserting a tube through your nose into the oesophagus, and positioning it above the LES. The tip of the tube contains a sensor which can measure the pH of the acid content refluxed into the oesophagus. The tube will be left in place for 24 hours.
- pH capsule: allows measuring acid exposure in the oesophagus. A small wireless capsule is introduced into the oesophagus by a tube through the nose or mouth. The tube is removed after the capsule is attached to the lining of the oesophagus. The pH sensor transmits signals to a computer which collects the data about the acid exposure over the next 24 hours. The capsule eventually falls off the oesophagus lining and is safely passed in the stool.
- Impedance study: requires two probes; one is placed in the stomach and the other just above the stomach. The dual sensor helps to detect both acidic and alkaline reflux.
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