Persistent acid reflux.

What is GORD?

Gastro-oesophageal reflux disease (GORD) is the medical name for persistent acid reflux. Acid from the stomach moves up into the oesophagus (food pipe), causing symptoms and, over time, sometimes causing damage. The valve between the oesophagus and stomach (lower oesophageal sphincter) doesn’t close fully or relaxes inappropriately, allowing stomach contents through.

Occasional reflux is normal and harmless. GORD is diagnosed when reflux is frequent, troublesome, or causing damage to the oesophagus.

Symptoms

Classic GORD symptoms:

• Heartburn — burning sensation behind the breastbone, often rising up the chest
• Acid regurgitation — sour or bitter taste in the back of the throat or mouth
• Difficulty swallowing or food sticking
• Pain on swallowing
• Worsening when lying down or bending over
• Often worse at night or after meals

Less classic ("atypical") symptoms also seen:

• Chronic cough (especially at night)
• Hoarseness or sore throat that won’t settle
• Asthma-like wheeze worsening with reflux
• Bad breath
• Dental erosion
• Chest pain that mimics heart pain (worth proper assessment to rule out heart disease)
• Excessive throat-clearing or globus (lump in the throat sensation)

Causes and triggers

GORD usually results from multiple contributing factors:

Anatomical

• Hiatus hernia (part of the stomach pushed up through the diaphragm) — very common
• Weak lower oesophageal sphincter (the muscle that should close after swallowing)
• Delayed stomach emptying

Lifestyle and dietary triggers

• Obesity (especially abdominal weight)
• Pregnancy
• Smoking
• Alcohol
• Coffee, fizzy drinks
• Spicy, fatty, or acidic foods (varies by person)
• Large meals close to bedtime
• Lying down soon after eating
• Tight clothing around the waist

Medications

• Certain blood pressure medications (calcium channel blockers, beta blockers)
• NSAIDs (ibuprofen, etc.)
• Some asthma inhalers
• Some osteoporosis medications

Other

• Stress — both directly and through behaviour changes (eating, alcohol, sleep)
• H. pylori infection (testing recommended for persistent symptoms)
• Other gastric conditions (gastritis, ulcers)

When reflux needs urgent attention

NICE NG12 (recognising suspected cancer) requires urgent endoscopy referral for any of these features.

How we assess at MHW

1. Detailed history

Pattern of symptoms, duration, what worsens/improves them, dietary patterns, weight, medication history, smoking, alcohol, family history of GI cancers. We also ask about red flag symptoms specifically.

2. Examination

Physical examination including abdomen, weight check, blood pressure. ENT examination if atypical symptoms (chronic cough, hoarseness).

3. Investigations

For uncomplicated GORD without red flags, a trial of treatment is often appropriate before testing. For persistent symptoms, atypical features, or red flags, we arrange:

• H. pylori testing — breath test or stool antigen
• Endoscopy (OGD/gastroscopy) — the gold standard test, looking directly at the oesophagus and stomach. Privately we can usually arrange within a week.
• Blood tests — FBC (anaemia), inflammatory markers, coeliac screen, liver function
• 24-hour pH monitoring — occasionally needed for atypical or refractory cases
• Abdominal ultrasound — if gallstones suspected (similar symptoms)

4. Plan

A clear written plan based on findings — lifestyle changes, medication, and timing for review or further investigation.

Treatment options

Lifestyle and dietary modification

First-line for many patients and effective for some. See the dedicated section below.

Acid-reducing medications

Several classes of medication reduce stomach acid and effectively treat reflux symptoms. The class, dose, and duration depend on severity and findings. We discuss the options with you in consultation. UK law prevents naming specific prescription medications on this website.

Treatment of underlying cause

If H. pylori is positive, eradication treatment (typically a short course of combined antibiotics and acid-reducing medication) often resolves symptoms. If a hiatus hernia is large or symptoms don’t respond to medication, surgical options exist.

Stepping down treatment

NICE recommends stepping down acid-reducing medication once symptoms are controlled — trying the lowest effective dose, or taking on demand rather than daily. Many patients on long-term acid suppression have never had this conversation.

Lifestyle approaches

These work, particularly for milder symptoms:

• Weight management — even modest weight loss often significantly improves reflux
• Stop smoking — smoking weakens the lower oesophageal sphincter
• Reduce alcohol
• Identify your triggers — keep a food diary for 2 weeks; common culprits include coffee, chocolate, citrus, tomato, spicy/fatty foods, mint, fizzy drinks
• Smaller meals, eaten earlier — allow 3 hours before lying down
• Raise the head of the bed — 15–20 cm with blocks (not just extra pillows)
• Avoid tight clothing around the waist
• Stress reduction

Long-term considerations

Long-standing untreated GORD can lead to complications:

• Oesophagitis — inflammation of the oesophagus
• Oesophageal strictures — narrowing causing swallowing problems
• Barrett’s oesophagus — pre-cancerous change in the oesophageal lining, requiring surveillance
• Oesophageal cancer — rare but increased risk with long-standing untreated reflux

This is why we don’t just keep increasing acid-reducing medication doses indefinitely without periodically reassessing — including endoscopy where indicated.

When to see us

Consider booking if:

• You’ve had heartburn or reflux symptoms for more than a few weeks
• You’re taking acid-reducing medication daily and want to review whether it’s still needed
• You’ve never had a proper endoscopy and have had reflux for years
• You’re over 55 with new reflux symptoms
• You have any red flag symptoms (see above)
• Symptoms are affecting your sleep or daily life
• You’ve been told you "just need to stay on PPIs forever"

Frequently asked questions

Do I need an endoscopy?

Not everyone. NICE guidance is clear on when endoscopy is indicated: red flag symptoms, age over 55 with new or persistent symptoms, or symptoms not responding to treatment. We’ll discuss whether endoscopy is appropriate for you.

Can I get a private endoscopy?

Yes. We refer to private endoscopy services typically within a week. Procedure is usually a comfortable outpatient appointment under light sedation.

How much do PPIs cost long-term?

If you require long-term acid suppression, the cost varies. After private initiation we can usually arrange for NHS GP repeat prescriptions through shared-care arrangements.

Are there side effects to long-term acid-reducing medication?

This is a reasonable concern. The medications are generally safe but emerging data suggests modest risks with very long-term use (years to decades). This is exactly why periodic review — including whether you still need treatment at the same dose — matters.

Could it be my heart?

Yes, and we take that seriously. Chest discomfort can be cardiac and we routinely consider this, particularly in older patients or with cardiac risk factors. Sometimes the best test is an ECG and basic cardiac assessment.

What if my GP has prescribed me PPIs for years?

Worth a review. Many patients on long-term PPIs have never had endoscopy, never had H. pylori testing, and have never tried stepping down the dose. A proper review may reduce or stop your medication.

Is reflux serious?

Usually not. The vast majority of people with GORD have a treatable condition with no long-term consequences. The minority who develop complications usually have warning signs that proper assessment picks up.