Acid Reflux (Gastro-Oesophageal Reflux Disease; GORD)

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What is Acid Reflux?

Acid reflux, also known as gastro-oesophageal reflux disease (GORD), is a disease of the lower oesophagus (foodpipe) and stomach. Acid reflux involves inflammation and irritation of the lower oesophagus due to the reflux of food and gastric acid. This reflux of gastric contents is spontaneous and involuntary. Below is an endoscopic image showing ulceration of the lower end of the oesophagus caused by the refluxed gastric acid.

Who gets Acid Reflux?

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GERD

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Acid reflux is extremely common: as many as one in five people experience Acid reflux symptoms at least once a week, and one in ten people have acid reflux symptoms every day.

Children

Acid reflux may also occur in infants and children. However, in this age group it is important to distinguish between the relatively rare occurrence of acid reflux, and the common and normal condition of 'physiological reflux'. Physiological reflux usually develops during the first year of life with symptoms of vomiting or irritability, but soon resolves without the need for treatment and with no long-term consequences. Reflux of stomach contents, with or without associated disease of the oesophagus, is common in infants due to immaturity of the stomach and oesophagus and their high fluid intake.

Predisposing Factors

Patients with the following predisposing factors are at higher risk of developing reflux:

Obesity
Cigarette smoking
High levels of caffeine consumption (e.g. coffee, tea or chocolate)
Excessive alcohol ingestion
Eating large meals (especially late at night) or meals high in fat
Pregnancy
Hiatus hernia
Family history: There is some genetic predisposition to reflux
Some drugs (particularly those used to treat high blood pressure and angina)

Children

The oesophagus is connected to the top of the stomach. The lower end of the oesophagus has thick muscle layers (called a sphincter) that keep the oesophagus closed and normally prevent food going backwards up the tube. In infants and children a large amount of reflux is caused by intra-abdominal pressures exceeding the pressures across the lower oesophageal sphincter. Thus abdominal straining and delayed gastric emptying can increase the likelihood of reflux. Some conditions associated with neurological impairments may also predispose your child to the development of acid reflux.

Progression

Without acid reflux treatment, the long-term damage to the oesophagus in acid reflux disease can lead to a number of complications. These include development of strictures (tight bands) across the oesophagus, which may make swallowing difficult, and ulceration of the stomach, which may lead to bleeding into the gut.

One in ten patients with acid reflux, and in particular those with long-standing or severe acid reflux, will develop Barrett's oesophagus. This is a condition where the normal lining of the oesophagus is replaced by a different type of tissue, normally found in the intestines, in response to long exposure to damaging acid or bile. Patients with Barrett's oesophagus are more likely to develop strictures or ulceration, but most importantly they have a much higher chance (30-40 fold higher relative risk) of developing adenocarcinoma of the oesophagus.

Children

In infants and children, mild acid reflux symptoms usually resolve within the first 12 months of life. As the child gets older, the gastrointestinal system matures and a more solid diet and upright posture also help to prevent reflux. For these children, reflux is more of a nuisance and doesn't cause any real problems. However, a small percentage of children will go on to develop true acid reflux (gastro-oesophageal reflux disease). These children may require more investigations and treatment to prevent complications (see below).

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