The Symptoms of Gord

Typical Symptoms

Gastro-Oesophageal Reflux Disease is characterised by one or more of the following symptoms:

Heartburn
Heartburn is a burning sensation which extends from the upper abdomen into the thorax. The burning sensation may extend to the throat, or even to the ears.

Difficulty in Swallowing
Solid food or liquids can stick in the oesophagus. Repeated swallowing efforts must then be undertaken, or fluids must be swallowed to enable the obstructed food to descend into the stomach. Pain during swallowing can occur, particularly with acid foods, e.g. orange juice.

Reflux and Regurgitation
Reflux and regurgitation occur whenever acid or food from the stomach regurtitate into the mouth. This may occur in the upright position, during bending or in the lying down position. Some individuals feel as if they are re-chewing their food after their meal. The symptoms may arise e/g when bending over to clean one's teeth, or fastening one's shoe laces. During the night regurgitation may take place to such a degree that a feeling of obstruction occurs.

Atypical Symptoms

Chest Pain
Chest pain may vary from sporadic pain to severe almost constant pain. On occasion the patient may consult a heart specialist for examination of the chest pain.

Lung symptoms

Asthma, chronic bronchitis, chronic cough and hoarseness can occur as the result of GORD. In 80% of adults with asthma, the asthma is exacerbated by GORD.

The swallowing mechanism

After food has been chewed, it is swallowed via the oesophagus to reach the stomach. The oesophagus represents a long tube which connects the pharynx with the stomach. The inner surface of the oesophagus is lined with mucous membrane. The outer lining of the oesophagus consists of two layers of muscle, viz the circular fibres and a longitudinal layer. The muscles of the oesophagus are responsible for the contraction of the oesophagus in order to propel the food into the stomach. These contractions constitute the wave like activity of the oesophagus stoamch and intestine which is known as peristalsis.
   

Anatomy

The oesophagus extends from the throat or pharynx to the stomach. The oesophagus passes through an opening in the diaphragm. This opening is known as the diaphragmatic hiatus. Below the hiatus, the oesophagus becomes continuous with the stomach. The hiatus consists of muscle fibres which arise from the diaphragm and are arranged around the lower end of the oesophagus.

At the lower end of the oesophagus at the junction with the stomach there is a circular muscle present. The oesophagus joins the stomach at an angle . This circular muscle and the angle of the stomach , as well as the muscles around the opening in the diaphragm, are all involved in creating a valve between the oesophagus and the stomach. This valve works as a uni-directional one allowing the food to pass into the stomach. Thevlave closes after swallowing to prevent the acidic stomach contents from regurgitating into the oesophagus. In the event that the valve is not functioning properly, excessive acidic stomach contents from the stomach may regurgitate into the oesophagus. The result of such regurgitation are the symptoms of GORD with eventual damage to the distal oesophagus.   

Factors which contribute to GORD

Some people are born with a poorly functioning valve between the oesophagus and the stomach. A hiatus hernia is often present in cases of GORD. GORD can also occur in the absence of an hiatus hernia.

Specific foods can produce GORD
These include fatty foods, strongly spiced foods, certain medications, tight clothes, smoking, alcohol, and coffee. Exercise or body position e.g bending or lying down may also lead to GORD. Stress also plays a role. All the above mentioned causes can cause laxness of the valve. As a result acid leaks back into the mouth and causes the symptoms.