At Home with Chris Jessen 2018 - 79
Do you suffer from a burning sensation in
the chest and difficulty swallowing? They
could be signs of a condition called GORD
he symptoms caused by the
reflux of stomach contents into
the oesophagus (the food pipe)
are called gastro-oesophageal
reflux, or GORD. Up to a quarter of
people in the UK will have problems
with this condition at some point.
Signs and symptoms
Typically, GORD presents with a burning
pain in the chest, difficulty or pain when
swallowing and a sour taste. Over the
past 10 to 15 years, there has been an
increasing recognition that GORD can
present with atypical symptoms - this
is often called 'silent reflux'. These
symptoms include a lump in the throat,
chronic cough, clearing the throat, sore
throat and hoarseness.
In most cases, the condition can be
treated by simple dietary and lifestyle
measures. For example, not eating
heavy meals or too late at night.
Stopping smoking, avoiding alcohol
and losing weight can also reduce the
symptoms. Antacids, such as Gaviscon
and Rennies, help to neutralise the
acid in the stomach and prevent it
refluxing into the gullet. Medications
including proton pump inhibitors (for
example, omeprazole) reduce the acid
production in the stomach.
Mostly, symptoms occur infrequently
and are readily controlled. However, if
they become more frequent or difficult
to control, they should be investigated.
The medical term for having difficulty
swallowing is dysphagia and refers to
the sensation of something - typically
food - being stuck in the oesophagus
on its way from the mouth to the
stomach. This is a symptom that
should always be investigated to rule
out the chance of oesophageal cancer,
which has become more common over
the past 40 years.
A history of GORD is also associated
with people with Barrett's oesophagus,
a condition where the cells lining the
oesophagus have become abnormal.
Between one and five in every 100 with
this condition will develop oesophageal
cancer. Barrett's oesophagus can be
diagnosed by taking small samples
(biopsies) from the oesophagus.
There has been increasing knowledge
about the mechanisms by which food
allergies can contribute to abdominal
symptoms. Eosinophilic oesophagitis is
an inflammatory condition of the gullet
caused by food allergens. Presentation
is normally with swallowing problems,
often in younger adults. It is more
common in people with other allergic
conditions such as hayfever, eczema
and asthma. It can be readily treated
by topical medication on the gullet
or dietary modification.
To help with diagnosis, tissue samples
can be taken. An endoscope (small
tube) is passed through the mouth to
the stomach to collect the samples.
This procedure usually takes about
ten minutes and can be performed
with either a topical anaesthetic
spray or with a mild sedative.
Occasionally, more sensitive tests
to diagnose swallowing problems and
reflux are necessary. These include pH
monitoring, where a fine tube is passed
via the nose into the oesophagus to
measure the amount of acid that
comes up over a 24-hour period.
A similar test, called oesophageal
manometry, measures the pressure
changes in the oesophagus and is a
sensitive way of diagnosing problems
with the oesophageal muscles.
MEET THE EXPERT
Dr Jamal Hayat,
is a consultant
senior lecturer in
University Hospitals NHS Trust.
After a childhood in London and the
home counties, Dr Hayat studied
medicine at Imperial College before
performing his specialist training
in London. He took time out from
his training for a period of research into
the advancement of diagnostic tests
in upper GI disease, presenting his
work nationally and internationally.
FOR MORE INFORMATION
Parkside Hospital, Wimbledon,
London. Call 020 8971 8000
Spire St Anthony's Hospital, Cheam,
Surrey. Call 020 8337 6691