Gut Reaction #20: Why is Gastro-oesophageal Reflux Disease (GORD) getting more common?
GORD is a chronic relapsing condition whereby acid produced in the stomach moves up into the lower part of the gullet, or oesophagus, leading to a “burning” discomfort or heartburn. The actual amount of acid is not increased but the acid spends too long in contact with the oesophagus.
This blog will focus on the factors surrounding GORD, examining why the condition is seemingly becoming more common.
The most common cause for GORD is a hiatus hernia. Here the top part of the stomach is pushed, or herniated, through the normal opening (hiatus) in the diaphragm. This defect impairs the clearance of acid from the lower part of the oesophagus and increases the volume of acid reflux from the stomach especially after eating.
A hiatus hernia is most likely to occur in individuals who gain weight, are overweight or obese. An elegant study from Glasgow reported that increasing abdominal pressure with a belt (mimicking excessive weight gain) increased reflux episodes across a hiatus hernia after eating.
The prevalence of obesity in the UK is increasing and has reached 27%. It is likely therefore that the increase in GORD reflects, at least in part, the rising BMI in the UK population.
Helicobacter pylori infection
H pylori causes most duodenal & stomach ulcers and, especially in developing countries, is associated with stomach cancer. The infection may however protect against the development of GORD. The prevalence of H pylori is falling whilst GORD is increasing.
Research has suggested that H pylori may, in certain individuals, decrease reflux of acid, the development of Barrett’s oesophagus & possibly protect against some forms of oesophageal cancer.
Dietary factors such as increased fat content, cigarette smoking & alcohol excess may worsen GORD.
Public Health England’s campaign to highlight the importance of heartburn as a risk factor for cancer of the oesophagus led to an increase in the diagnosis of GORD.
For more information about GORD, please do not hesitate to contact Dr. Harris.