GERD (GORD): symptoms, treatment and what to eat

Nearly everyone gets heartburn now and then. The NHS describes it as a burning feeling in the chest caused by stomach acid travelling up towards the throat, and says that when it keeps happening it may be called gastro-oesophageal reflux disease, or GORD. GERD is the American spelling of the same thing.

So the difference is mainly about how often and how much. A single rich meal followed by a bad evening is not GORD. Heartburn that returns week after week, wakes you at night or limits what you eat is worth treating as a condition in its own right.

NHS inform calls GORD a common condition. The oesophagus (gullet) is the muscular tube between the throat and the stomach. A ring of muscle at its lower end normally opens to let food through and then closes. When that ring is weak, acid reaches tissue that was never designed to cope with it.

The two main symptoms are heartburn and acid reflux, meaning acid or sour fluid coming back up into the mouth. The NHS lists a cough or hiccups that keep coming back, a hoarse voice, bad breath, bloating and feeling sick as other possible features.

NHS inform gives a longer list. Some people have a sore throat, a persistent cough or wheeze that is worse at night, pain or difficulty when swallowing, and tooth decay or gum disease. It also notes that if you have asthma, acid irritating your airways can make asthma symptoms worse.

• Burning behind the breastbone, often after meals or when bending or lying flat.

• A sour or bitter taste, or acid rising into the mouth.

• A cough, hoarseness or sore throat without a cold.

• Bloating, belching and feeling sick.

• Pain or difficulty when swallowing, which needs prompt assessment.

NHS inform says heartburn and GORD can often be treated with self-help measures and over-the-counter medicines. If those do not help, a GP can prescribe stronger medication and may refer you to a specialist to discuss whether surgery could be an option.

From a pharmacy, antacids neutralise acid and alginates form a protective coating. The NHS says antacids and alginates help in the short term, but will not cure the problem and should not be taken regularly for long periods. It suggests taking them with food or soon after eating, which is when heartburn is most likely.

If that is not enough, a GP may prescribe a proton pump inhibitor (PPI) such as omeprazole or lansoprazole, which reduces how much acid the stomach makes. The NHS says you will usually take it for 4 or 8 weeks, depending on severity, and to go back to the GP if symptoms return after stopping, because you may need a long-term prescription. NHS inform says you will usually be given enough medicine to last a month at first.

If a PPI does not control symptoms, the NHS says your doctor may suggest a different type of medicine called an H2 receptor antagonist, such as famotidine. NHS inform says these may be taken alongside a PPI on a short-term basis, or as an alternative. Do not stop any prescribed medicine without speaking to a doctor first.

The NHS and NHS inform do not give a single list of banned foods. Both say certain food and drink can bring symptoms on, naming coffee, tomatoes, alcohol, chocolate and fatty or spicy foods. Because triggers differ between people, noting which foods set off your own symptoms is usually more useful than cutting out everything on a list.

How and when you eat matters as much as what. The NHS advises eating smaller, more frequent meals rather than three large ones, and not having food or drink within 3 or 4 hours of bed. NHS inform makes the same points, and adds not to drink alcohol in that window.

• Do eat smaller, more frequent meals.

• Do avoid the specific food and drink that triggers your symptoms.

• Do not eat or drink within 3 or 4 hours before bed.

• Do not drink too much alcohol.

• Try to lose weight if you are overweight; the NHS lists this as something that can ease heartburn.

Simple lifestyle changes can help stop or reduce heartburn, according to the NHS. Beyond diet, it suggests not wearing clothes that are tight around the waist, not smoking, and finding ways to relax. NHS inform says stress can make heartburn and GORD worse, so relaxation techniques may help if you often feel stressed.

The NHS says you may find that raising the head of your bed by around 10 to 20cm, using wood, bricks or books, helps relieve symptoms, because your chest and head are then above your waist. NHS inform says up to 20cm. Both warn against using extra pillows to get the same effect, because that increases pressure on the belly and can make symptoms worse.

NHS inform says GORD is usually caused by the ring of muscle at the bottom of the gullet becoming weakened. It is not always clear why. The NHS says lots of people get heartburn from time to time with no obvious reason, and lists several things that can cause it or make it worse.

• Certain food and drink, such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods.

• Being overweight, and smoking.

• Pregnancy, and hormone increases such as progesterone and oestrogen.

• Stress and anxiety.

• Some medicines, including anti-inflammatory painkillers such as ibuprofen; NHS inform also names calcium-channel blockers and nitrates.

• A hiatus hernia, a stomach ulcer or a bacterial infection in the stomach.

• Gastroparesis, where the stomach takes longer to empty, according to NHS inform.

NHS inform says a GP will often be able to diagnose GORD from your symptoms and may prescribe medication without any tests. You will usually only be referred for hospital tests if the GP is unsure, if symptoms are persistent, severe or unusual, if prescribed medicines are not controlling them, if surgery is being considered, or if there are signs of a more severe condition such as difficulty swallowing or unexplained weight loss.

There is no single answer. The NHS says PPI courses usually run for 4 or 8 weeks, and that symptoms may return after stopping, in which case you should go back to your GP because a long-term prescription may be needed. NHS inform likewise says some people need to take PPIs on a long-term basis.

In practice GORD is often a condition that is managed rather than cured. Some people settle with lifestyle changes and stop medicine; others find symptoms return whenever treatment ends. A regular review with the GP is sensible if you stay on acid-reducing tablets.

The NHS says indigestion and heartburn are common in pregnancy, caused by hormonal changes and the growing baby pressing on the stomach. They can start at any point but are more common from 12 weeks onwards.

The NHS suggests eating small meals often, not eating within 3 hours of bed, sitting up straight while and after eating, cutting down on caffeine and rich, spicy or fatty foods, propping your head and shoulders up in bed, and sleeping on your left side. Antacids and alginates can be used, but the NHS says to tell the pharmacist you are pregnant because some antacids are not suitable, and not to take antacids within 2 hours of folic acid or iron supplements.

See your midwife or GP if changes do not work, or if you have difficulty swallowing, a hoarse voice, a cough that does not get better, swollen glands on each side of the neck, weight loss, or pain or swelling in the stomach.

Reflux in babies is a different picture from adult GORD. The NHS says reflux is when a baby brings up milk or is sick during or shortly after feeding, that it is very common, and that it usually starts before 8 weeks and gets better by the time a baby is 1. A baby who is happy, healthy and gaining weight does not usually need to see a doctor.

The NHS suggests holding your baby upright during feeding and for as long as possible afterwards, burping regularly, and making sure your baby sleeps flat on their back. It says not to raise the head of the cot or Moses basket.

Ask for an urgent GP appointment or call NHS 111 if your baby has green or yellow vomit or blood in it, projectile vomiting, blood in the poo, a swollen or tender tummy, cannot keep fluid down, or is refusing to feed. See a GP if the baby is not gaining weight, if reflux starts after 6 months, or if it is still happening after the first birthday.

Most people with GORD never develop complications, but NHS inform lists ulcers on the oesophagus that may bleed and make swallowing painful, scarring that narrows the gullet and may need an operation, and Barrett's oesophagus, where the cells lining the gullet change.

Barrett's oesophagus is not cancer. NHS inform says that very occasionally oesophageal cancer can develop from these cells, so you may need to be closely monitored.

Chest pain has many causes, and heart problems can feel like heartburn. If you have sudden, severe or crushing chest pain, pain spreading to the arm, neck or jaw, sweating or breathlessness, call 999.

The NHS says to see a GP if lifestyle changes and pharmacy medicines are not helping, if you have heartburn most days, or if you also have food getting stuck in your throat, frequently being sick, or losing weight for no reason. NHS inform adds vomiting blood and difficulty swallowing as possible signs of a more serious problem. If symptoms get worse at any time, contact a GP, use 111.nhs.uk or call 111.

On the NHS, most care begins with a pharmacist or GP. Referral to a specialist for gastroscopy or other tests follows the criteria above, and waiting times vary by area.

Some people choose to see a private gastroenterologist for faster access to endoscopy or reflux testing, or to discuss anti-reflux surgery. The tests and medicines are the same ones the NHS uses. Take your GP letter and medicine list, ask what a test could change about your treatment, and ask for the full cost of any procedure in writing beforehand.