Latest article: Reflux revisited: Looking beyond excess acid to manage GORD

Gastroesophageal reflux disease (GORD or GERD) is one of the most common gastrointestinal complaints in Australia affecting both adults and paediatrics. Although GORD has long been thought of as a disease mainly affecting middle aged and older persons, prevalence has increased over the last decade particularly in younger patients, with the most significant increase seen in those aged between 30-39 years. This is likely due to increasing obesity rates and poor dietary habits.¹

THE PATHOPHYSIOLOGY: MORE THAN JUST EXCESS ACID

GORD is characterised by involuntary retrograde flow of reflux of gastric contents into the oesophagus.² Common symptoms include heartburn and regurgitation, sore throat, cough, hoarseness and globus (the sensation of a lump in the throat due to irritation from reflux contents).³

While GORD was initially thought to be caused primarily by excessive acid production, up to 50% of individuals with GORD report minimal symptomatic relief with acid suppression medication. This highlights other mechanisms at play, including injury from non-acid agents in the refluxate, such as pepsin, bile constituents and normal gut microbiota (see Figure 1) and underlying mechanisms including oesophageal hypersensitivity, transient lower oesophageal sphincter (LES) relaxation and increased gastric pressure. (See Figure 2).⁴ Dietary components and eating behaviours may also be correlated with the development of GORD.⁵ (See Table 1).