Clinical Focus: GORD (Gastroesophageal reflux disease)

Clinical Focus: GORD (Gastroesophageal reflux disease)

GORD occurs when stomach acid leaks from the stomach and moves up into the oesophagus (food pipe) causing a range of symptoms on a regular basis.

Most common symptoms include;

  • Reflux (heartburn); a burning sensation in the centre of your chest 
  • Regurgitation of acid into the throat or mouth, 
  • Bitter taste in the mouth, 
  • Upset stomach, 
  • Belching, 
  • Nausea after eating, 
  • Feeling full, 
  • Bloating in the stomach and upper abdomen, 
  • Dry cough,  🚩
  • Wheezing, 
  • Hoarseness, 
  • Feeling of tightness in the throat 🚩
  • Vomiting
  • Difficulty in swallowing 🚩 

What is the cause?

GORD involves impairment of the muscles at the top of the stomach, leading to a ‘backflow’ of gastric contents into the oesophagus.  What causes this to happen is multifactoral, but contributing factors are:

  • Obesity
  • Stress
  • High fat diets
  • Eating overly large meals
  • Poor digestion – lack of digestive enzymes
  • Bad breath
  • Constipation
  • Tight clothing
  • Horizontal body position
  • Late night meals
  • Caffeinated drinks
  • Common trigger foods like Spices, Mint, Chocolate, refined carbohydrates
  • Food Intolerances
  • Smoking
  • Hiatus Hernia
  • Medications like Calcium channel blockers,  NSAID’s SSRI’s corticosteroids and nitrates.
  • SIBO (small intestinal bacterial overgrowth) 
  • Too little stomach acid – YES you read that right, 30% of GORD patients actually have normal stomach acidity!!!!

Standard medical treatment is to inhibit the production of stomach acid.

Options are generally limited to 

  • Over the counter medications include antacids like Gaviscon which neutralise the stomach acid
  • PPI’s – Proton pump inhibitors like Omeprazole and Lansoprazole anything ending in a ‘prazole’.  These cause a prolonged reduction of stomach acid production.
  • H2 antagonists like Ranitidine and anything ending in a ‘tidine’.  These also cause a reduction in stomach acid production.

These medications are only meant to be used in the short term but over 60% of users never even attempt to discontinue singing them, and this is probably because being one of the most prescribed drugs in the UK there will be plenty of people describing what happens when you try to stop using them.  This is known as ‘rebound hypersecretion’ where the stomachs acid production goes into overdrive, producing (yes you have guessed it) symptoms of reflux.  And this can last for at least 2 months!!!!!!

And that is not the worst of it, long term use of these medications can increase the risk of: 

  • H.pylori infection, resulting in gastric ulceration
  • SIBO – Small Intestinal bacterial overgrowth    could link lead to SIBO blog???
  • IBS – Irritable Bowel Syndrome 
  • Clostridium difficile associated diarrhoea
  • Reduced nutrient absorption, primarily iron, B12 and Vitamin C, which altogether may drive systemic issues like cardiovascular disease, dementia and osteoporosis.

But there is another way ………………

A Nutritionists approach

  1. 🚩 Refer all red flag symptoms to GP, to rule out anything more sinister.
  2. Take a detailed case history to understand patient as a whole, focussing on any underlying nutrient deficiencies and the functioning of the gut.  Based on these observations recommendations are made and progress is monitored using a symptom tracker, like journaling.
  3. Eliminate possible trigger foods, most common are spicy, fatty, gluten, dairy and refined carbohydrates.  This is not however a longterm solution as Nutritionalists do not like excluding foods unless absolutely necessary, our goal is to have your digestion working optimally so all foods can be enjoyed, even the bad ones …….. in moderation. 😊
  4. Improve digestion and absorption using natural remedies and lifestyle changes, including; reducing stress, chewing properly, adding bitter foods to stimulate digestion, using digestive enzymes and sometimes increasing stomach acid. 😱
  5. Recommend natural remedies to soothe the symptoms of heartburn including Slipper Elm, Aloe Vera and Licorice, while we fixed the root cause.
  6. Recommend a Stool test.  Rarely is GORD the only thing going on.  So a comprehensive stool test can be a great way to really see how the gut is functioning.  This helps us to get to the root cause.  Stool tests focus of 5 key areas, maldigestion, Inflammation, infection, dysbiosis and metabolic imbalances which shows a need for probiotics.  The results lead to a targeted approach to tackle the underlying cause.

My quick fix top tips for GORD

  1. Keep a food/symptom diary and eliminated obvious trigger foods.
  2. Do not eat when stressed
  3. Eat smaller regular meals
  4. Do not eat too late and never go to bed on a full stomach
  5. Book in to see a Nutritionist before symptoms become more serious.

⚠️ Untreated GORD can lead to changes in the cells of the oesophagus which can increase your risk of cancer, especially in those with a family history, so get it sorted ⚠️

Remember symptoms are you bodies way of telling you something is not right, are you listening?

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