Reflux and GORD — Symptoms, Causes, Treatment and When You Need Gastroscopy

TL;DR — Reflux is the sensation of stomach contents flowing backwards into the oesophagus. Gastro-oesophageal reflux disease (GERD or GORD) is the chronic, troublesome form. Most reflux is managed with lifestyle change and a proton-pump inhibitor (PPI) tablet. Gastroscopy is recommended when symptoms are severe, persistent, or accompanied by alarm features — both to rule out other conditions and to check for Barrett’s oesophagus, a precancerous change that needs surveillance. Dr Goutham Sivasuthan performs gastroscopy across Brisbane, Redland and Logan; no-gap for insured patients.

What is reflux and GORD?

Reflux happens when the muscular valve at the bottom of the oesophagus (the lower oesophageal sphincter, or LOS) doesn’t close fully — allowing stomach acid and other contents to flow back up into the oesophagus. Occasional reflux is normal. Gastro-oesophageal reflux disease (GERD, also spelled GORD) is the diagnosis when reflux is frequent, troublesome, or causes complications.

Around 15–20% of Australians experience troublesome reflux symptoms at least weekly. Most cases are mild and respond well to lifestyle change and short courses of antacid or PPI medication. A small but important minority go on to develop complications — oesophagitis (inflammation), stricture (narrowing), Barrett’s oesophagus (a precancerous change in the oesophageal lining), and rarely, oesophageal cancer — which is why persistent or worsening symptoms deserve formal investigation.

Symptoms

• Heartburn — a burning sensation behind the breastbone, often after meals or when lying down
• Regurgitation — the sensation of stomach contents (sour or bitter fluid) rising into the throat or mouth
• Difficulty swallowing (dysphagia) — a sensation of food sticking
• Chronic cough, throat clearing, or hoarseness (especially in the morning)
• Asthma-like symptoms or worsening of existing asthma
• Chest pain (must be distinguished from cardiac pain — if in doubt, treat as cardiac until proven otherwise)
• Nausea, bloating, early satiety
• Disturbed sleep from night-time reflux
• Erosion of dental enamel from chronic acid exposure

Causes and risk factors

• Obesity and central adiposity
• Pregnancy
• Smoking
• Large meals, late-evening eating, lying down soon after meals
• Trigger foods — fatty/fried food, chocolate, peppermint, citrus, tomato, spicy food, coffee, alcohol, carbonated drinks
• Hiatus hernia (where part of the stomach slides up through the diaphragm; common, usually asymptomatic, often coexists with GERD)
• Medications — calcium-channel blockers, nitrates, anticholinergics, bisphosphonates, NSAIDs
• Connective tissue disorders (e.g. scleroderma)
• Family history of GERD or Barrett’s

How is reflux diagnosed?

For most people with classic heartburn and regurgitation, the diagnosis is clinical — based on symptoms and response to an empirical 4–8 week trial of a proton-pump inhibitor (PPI). No test is needed in this group.

A gastroscopy (upper GI endoscopy) is recommended when:

• Symptoms have not responded to an adequate trial of PPI
• Symptoms started new in someone aged over 50
• Difficulty swallowing (dysphagia) or painful swallowing (odynophagia)
• Vomiting blood or passing black tarry stools
• Unintentional weight loss
• Persistent vomiting or anaemia
• Long-standing reflux history with risk factors for Barrett’s (male, age > 50, white, central obesity, smoking, family history)

Gastroscopy is a 10-minute procedure under sedation, where a thin flexible scope examines the oesophagus, stomach and first part of the small bowel (duodenum). Biopsies can be taken to check for H. pylori infection, coeliac disease, oesophagitis grade, and Barrett’s changes. Other tests — oesophageal pH monitoring, manometry — are reserved for atypical or refractory cases.

How is reflux treated?

Treatment is a stepwise pathway. Most people respond at the first or second step.

1. Lifestyle change — weight loss if overweight, smaller meals, not eating for 3 hours before bed, raising the head of the bed by 10–15 cm, identifying and reducing personal trigger foods. The single most effective intervention if BMI is high.
2. Over-the-counter antacids for occasional symptoms (Gaviscon, Mylanta).
3. H2-receptor blockers (famotidine) — useful for mild symptoms or as needed.
4. Proton-pump inhibitors (PPIs) — esomeprazole, pantoprazole, rabeprazole. The standard treatment for moderate-to-severe GERD. Most effective when taken 30–60 minutes before the first meal of the day. A 4–8 week trial is the usual first prescription; many people then step down to the lowest effective dose.
5. Long-term PPI — safe for most people; periodic review recommended, with attention to magnesium and B12 levels in long-term users.
6. Endoscopic or surgical anti-reflux procedures — considered when PPI is ineffective, not tolerated, or the patient does not want long-term medication. Options include radiofrequency / endoscopic plication and laparoscopic fundoplication (referred to an upper GI surgeon as appropriate).

Barrett’s oesophagus — why it matters

Long-standing reflux can cause the cells lining the lower oesophagus to change to a more intestine-like type — called Barrett’s oesophagus. Barrett’s is found in around 1–2% of people having gastroscopy for reflux and carries a small but real increased risk of oesophageal cancer. The risk per year is low (around 0.1–0.3% per year), but it is the reason people with confirmed Barrett’s are placed on a surveillance gastroscopy programme — typically every 3–5 years for non-dysplastic Barrett’s. Endoscopic treatment (radiofrequency ablation, endoscopic mucosal resection) is available if dysplasia is detected; this is referred to a specialist Barrett’s centre.

When to see a specialist

• Reflux symptoms not controlled after 4–8 weeks of full-dose PPI
• Any difficulty swallowing or sensation of food sticking
• Vomiting blood, coffee-ground vomit, or black tarry stools — seek urgent care
• Unexplained weight loss or persistent vomiting
• New-onset reflux symptoms after age 50
• Long-standing reflux (> 5 years) with risk factors for Barrett’s
• Known Barrett’s oesophagus due for surveillance gastroscopy
• Iron-deficiency anaemia of unclear cause

What to expect at your appointment with Dr Goutham

At consultation, Dr Goutham will review your symptom pattern, medication history, prior investigations, and risk factors for Barrett’s. If gastroscopy is appropriate, the practice will arrange a date, send written and digital fasting instructions, and answer any questions about the procedure. Gastroscopy itself takes about 10 minutes under sedation; you’ll spend roughly 2–3 hours at the day-surgery facility from arrival to discharge. Findings are explained on the day with images, and any biopsy results follow within 7–14 days.

Frequently asked questions

Is reflux the same thing as GORD?

No. Reflux is the act of stomach contents flowing backwards into the oesophagus — everyone has some. GERD (or GORD) is the diagnosis when reflux happens often enough, or causes enough symptoms or damage, to need treatment.

Do I need a gastroscopy for my heartburn?

Usually not. Classic heartburn and regurgitation in someone under 50, without alarm features, is generally managed with lifestyle change and a 4–8 week PPI trial. Gastroscopy is recommended if symptoms don’t resolve, if alarm features develop, or if you’ve had reflux for many years and want to be checked for Barrett’s.

Are PPIs safe to take long-term?

For most people, yes. PPIs have been used widely for over 30 years and the absolute risks identified in long-term studies (small effect on magnesium, B12, fracture risk, and possibly enteric infection) are small in comparison to the symptom relief and protection from oesophageal damage they provide. The usual approach is to use the lowest effective dose and review annually.

What is Barrett’s oesophagus — should I be worried?

Barrett’s is a change in the cells lining the lower oesophagus caused by chronic acid exposure. Most people with Barrett’s never develop oesophageal cancer — the annual progression rate is around 0.1–0.3%. The reason it matters is that surveillance gastroscopy can detect pre-cancerous (dysplastic) changes early, when they can be removed endoscopically without surgery.

Can reflux cause chest pain that mimics a heart attack?

Yes — oesophageal spasm and severe reflux can cause central chest pain that feels indistinguishable from cardiac pain. If you have new, severe, or unusual chest pain, treat it as cardiac until proven otherwise — call 000 or go to an emergency department. Reflux is only a safe attribution after cardiac causes have been excluded.

Will fundoplication surgery cure my reflux?

Laparoscopic fundoplication is highly effective at reducing typical reflux symptoms and can often allow patients to stop PPI medication. It is not free of long-term side effects (gas-bloat, difficulty belching, occasional dysphagia) and is generally reserved for patients who don’t tolerate PPI, don’t want long-term medication, or have refractory symptoms despite optimal medical therapy. Dr Goutham can discuss whether referral to an upper GI surgeon is appropriate.

Book a consultation

Phone 07 3733 1551 or send a referral via the contact form. No-gap gastroscopy for insured patients across Brisbane, Redland and Logan. See about Dr Goutham or the cost page for fee information.

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