Gastro-oesophageal reflux (GOR) is the process of reflux of stomach contents into the oesophagus. The consequence is a chemical insult to the oesophagus from acid, enzymes, and sometimes bile. Reflux occurs commonly, but infrequently, in most people, and probably causes little harm because the natural movement (peristalsis) of the oesophagus clears the acid and food back into the stomach. When acid reflux from the stomach is frequent and persistent, the result is damage to the lining of the oesophagus known as reflux oesophagitis or peptic oesophagitis.
A hiatus hernia, while commonly associated with reflux, is not essential for reflux to occur.
The major symptoms are heartburn (burning feeling rising up the back of the breastbone or sternum), regurgitation of acid and food into the mouth with a sour taste (waterbrash), and burning pain on swallowing food (oesophageal sensitivity). Other symptoms include difficulty swallowing (dysphagia), irritation of the throat and chronic cough. Lung problems such as asthma and even lung infections can occur.
The diagnosis is usually made by a combination of the typical clinical presentation in conjunction with investigations such as a barium swallow x-ray or gastroscopy.
The treatment consists of weight reduction (if overweight), avoidance of those foods causing the symptoms, avoidance of activities which cause the symptoms (e.g. lying flat or exercise after a meal), and the use of medication to reduce acid and assist acid clearance from the oesophagus. Surgery has an increasingly important role.
See section on diet for gastro-oesophageal reflux under Diet Information.
The following problems may arise: stricture (narrowing due to inflammation and scarring) causing blockage, ulceration, bleeding, regurgitation of acid and food into the lungs (aspiration), Barrett's mucosa (see section on Barrett's), and cancer usually arising in Barrett's mucosa.
Links to useful information about reflux oesophagitis:
The symptoms of reflux oesophagitis
http://www.bdf.org.uk/leaflets/hrtburn.html
A very comprehensive review of reflux oesophagitis and treatment
http://www.jr2.ox.ac.uk/bandolier/bandopubs/gordf/gord.html
Reflux oesophagitis - from the Merck Manual
http://www.merck.com/!!vbdWd0Mm9vbdWd0Mm9/pubs/mmanual/html/qiigecij.htm
Reflux and hiatus hernia, with discussion of anti-reflux surgery
http://www.covesoft.com/surgery/hiatu.html