Gastro-oesophageal reflux (GOR)
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What is GOR and how common is it?
Gastro-oesophageal reflux (GOR) is stomach acid coming up into the throat or food passage between the throat and stomach and causes “heartburn”. As location of the discomfort is often poor, may give the sensation of a “lump in the throat”. The stomach acid may also reach the back of the voice box (larynx) and cause hoarseness and cough, particularly in the early morning. There may be a sore throat or a bad taste in the mouth.
Complications such as scarring which narrows the oesophagus (food passage to the stomach) is unusual but make swallowing difficult. It is a common condition which can come and go without treatment, and about 5% of the Western population experience symptoms of GOR several times a month.
One of the mainstays of treatment is modification of lifestyle as follows:
- Weight must be kept down to that expected for the patient’s height.
- Smoking aggravates the symptoms and should be stopped.
- Diet – hot spicy foods should be avoided, as should tomato and citrus fruits and drinks such as a fruit juices, coffee, tea, fizzy drinks, alcohol, chocolate and peppermint as they tend to provoke reflux of acid into the oesophagus. Avoid eating large meals – better to have smaller more frequent meals. Do not eat within 2 hours of going to bed to allow the stomach to empty.
- Posture – Avoid slumping, bending, or stooping or tight belts etc that press on the stomach. Patients should sleep propped up the best way is to put 6” blocks under the head end of the bed. Sleeping on the right side or on the stomach will help empty the stomach.
- Drugs – such as progesterone, anticholinergics, beta blockers, aspirin and non-steroidal anti-inflammatory drugs, and nicotine increase acid production and promote reflux.
Antacids (Gelusil, Rennes) are available without prescription. You should not take them if you are taking tetracycline.
Simple alginates (derived from seaweed) taken 45 minutes after meals and at bedtime float on top of the acid stomach contents and prevent reflux (Gaviscon). They often have to be given for a while with a drug to reduce acid production. (H2- receptor antagonists – e.g. Cimetidine) – and Proton pump inhibitors e.g. Zoton, these drugs are often given on their own for about a month.
Less than half patients treated will get recurrence of their symptoms within six months of stopping treatment. It may be necessary to keep on maintenance treatment e.g. Losec 10 or 20 mgs daily, will be over 80% effective.
For queries please contact Ambulatory Care on (01908) 995 470