Acid Reflux and GORD - An Overview
What is GORD?
Gastroesophageal reflux disease (GORD) is a persistent digestive disorder that occurs when stomach contents such as acid, pepsin or bile flows into the oesophagus due to a dysfunction of the lower oesophageal sphincter pressure. Acid reflux can occasionally be triggered by certain foods such as caffeine or spicy foods or overeating which cause the lower oesophageal sphincter to weaken and open allowing stomach contents to flow into the oesophagus.
GORD is predicted to impact 14% of the adult population worldwide. In the UK, GERD affects up to 20% of the population.
How is GERD diagnosed?
GORD is diagnosed through a physical exam, medical history, symptoms and sometimes diagnostic tests.
What is lower oesophageal sphincter?
The lower oesophageal sphincter (LOS) is made up of muscle at the bottom of the oesophagus and surrounded by the diaphragm (also a muscle), that keep the sphincter tightly closed and separating the oesophagus from the stomach, these two muscle layers prevent stomach contents from flowing upward (refluxing) into the oesophagus.
What is the pathophysiology of GORD?
A weak or damaged lower oesophageal sphincter is the main cause of GORD. If a person’s LOS is weak or damaged, the muscle can lose its ability to close. When the LOS fails to close, it allows stomach acid to flow up from the stomach into the oesophagus, causing severe acid reflux and heartburn.
What causes the LOS pressure to weaken?
The open and closing of the LOS is controlled by the gastrointestinal smooth muscle and through the nervous system specifically the vagus nerve. A normal functioning LOS will remain closed and relaxes to open and allow food to enter the stomach. Several mechanisms and factors can cause the LOS to weaken and most of the causes are preventable.
1. Hiatus Hernia
A hiatus hernia occurs when part of the stomach pushes up through the diaphragm into the chest. The diaphragm is the muscle that separates the chest and abdomen. This increases abdominal pressure and weakens LOS pressure resulting in acid reflux. Hiatal hernia can be caused by being overweight, pregnancy, abdominal injury and Barretts oesophagus.
2. Overeating or Being Overweight
When a person regularly overeats or is overweight, this causes stomach distention and puts a lot of extra pressure on the LOS. Over time, the LOS loses its shape and its strength, allowing acid to flow upward into the oesophagus.
3. Pregnancy
Acid reflux is common during pregnancy caused by hormonal changes and the growing baby putting pressure on the stomach and LOS.
4. Smoking
Smoking exposes the oesophagus to a lot of toxins and chemicals that damage the protective membranes in the LOS, causing it to weaken.
5. Drinking Alcohol
Alcohol relaxes the muscles in the LOS and allows stomach acid to flow upward, which over time also causes considerable damage to the LOS.
6. Certain Medications
Blood pressure medication, hormone replacement therapy, sleeping pills and sedatives, antibiotics, antidepressants, iron and potassium supplements, and proton pump inhibitors can weaken the LOS.
7. Certain Foods
Trigger foods high in saturated fats, caffeine, chocolate, chilli, fizzy drinks and acidic foods are something people with GERD always have to avoid as it tends to cause the LOS to relax.
8. Emotional Stress and Anxiety
The vagus nerve controls our digestive system such as stomach acid production, maintenance of LOS pressure and gut motility. When under extreme emotional stress or anxiety, these important functions are impaired leading acid reflux and GORD related symptoms.
9. Type 2 Diabetes Mellitis
Diabetes can cause damage to the vagus nerve which regulates digestion and normal function of the LOS.
What are the symptoms of GORD?
The most common symptom of GORD is heartburn, a burning sensation in the chest area, caused by stomach acid refluxing into the oesophagus and radiating toward the mouth. The burning sensation in the chest area may radiate to the neck or the back. Heartburn may worsen when lying down or bending over.
Other common symptoms include:
Indigestion
Sore and inflamed throat
Regurgitation
Globus sensation
Difficulty swallowing
Recurrent cough
Throat clearing
Hoarseness
Bronchospasm
What are the complications of GORD?
Left untreated, GORD can result in several serious complications, including;
Oeosophagitis (erosion and ulcerations of the oesophagus)
Barrett’s esophagus
Difficulty swallowing
What are the treatments?
Western medicines approach is to prescribe Proton Pump Inhibitors (PPIs) and H2 Blockers to suppress the production of stomach acid, to eliminate trigger foods and implement lifestyle changes.
Antacids are used to neutralise the acid in your stomach to relieve indigestion and heartburn. However, long term use of PPI or antacids leads to nutrient deficiencies and small intestinal bacterial overgrowth. Rebound symptoms of increased stomach acid production often occurs when PPI medication is stopped without proper weaning off.
The naturopathic nutritional therapy approach is to address the underlying cause and risk factors to increase the integrity of the LOS through nutrition and lifestyle changes. At the same time, we naturally calm the symptoms of reflux to support the healing process.
References:
Clarrett DM, Hachem C. Gastresophageal Reflux Disease (GERD). Mo Med. 2018 May-Jun;115(3):214-218.
Lee, S. D., Keum, B., Chun, H. J., & Bak, Y. T. (2011). Gastroesophageal Reflux Disease in Type II Diabetes Mellitus With or Without Peripheral Neuropathy. Journal of neurogastroenterology and motility, 17(3), 274–278. https://doi.org/10.5056/jnm.2011.17.3.274
Rosen, R. D., & Winters, R. (2023). Physiology, Lower Esophageal Sphincter. In StatPearls. StatPearls Publishing.
Song, E. M., Jung, H. K., & Jung, J. M. (2013). The association between reflux esophagitis and psychosocial stress. Digestive diseases and sciences, 58(2), 471–477. https://doi.org/10.1007/s10620-012-2377-z