Most of us over-indulge at Christmas and New Year so heartburn can be a familiar but unpleasant symptom. However, sometimes these symptoms can also represent a more serious and chronic condition that requires closer examination from a healthcare professional. So how can we distinguish between those dyspeptic conditions that are driven by lifestyle choices and those which may need more medical intervention – such as gastro-oesophageal reflux disease, or GORD?
REFORM (the REflux FORuM), is a group of GPs and healthcare professionals with a special interest in reflux disease. If you are planning to write on heartburn, dyspepsia or other digestive disorders following the festive period, these key points may help to inform your article.
The most common types of dyspeptic conditions are GORD, peptic ulcer disease and non-ulcer dyspepsia1
GORD is a condition where acid made in the stomach refluxes up into the oesophagus. This can cause heartburn and can also cause the delicate lining of the oesophagus to erode, resulting in pain and discomfort (oesophagitis - inflammation of the oesophagus)
In certain cases, GORD can be associated with serious complications such as stricture (narrowing) of the oesophagus, Barrett’s oesophagus (severe damage to the oesophagus which may be associated with cancer), ulceration and bleeding
GORD can have a serious impact on quality of life - people with the disease have reported similar quality of life to people who have mild heart failure2
GORD affects all types of people regardless of lifestyle, age or gender
On average, a GP is likely to have one dyspepsia patient consultation every day3.
The typical symptoms of GORD include:
Heartburn - the predominant symptom of GORD described as a burning feeling rising from the stomach or lower chest up towards the neck occurring on two or more days a week
Acid regurgitation - some people experience a bitter or sour taste in the back of the throat
Retro-sternal pain - sharp or dull pain radiating out from the breastbone
There are a number of therapeutic options for treating GORD, including proton pump inhibitors (PPIs), H2 receptor antagonists (H2RAs) and antacids/ alginates, although it is widely accepted that PPIs are the most effective treatment because of their enhanced ability to promote oesophageal healing. However, it has been shown that in 20-25% of patients, symptoms are uncontrolled and that breakthrough symptoms occur on their current PPI. They may therefore require extra efficacy from their treatment4. These patient types include elderly people; those taking non steroidal anti-inflammatory drugs (NSAIDs); those who suffer severe or frequent pain and nocturnal symptoms and this should all be taken into consideration in the management of the disease. The National Institute for Health and Clinical Excellence (NICE) guideline on dyspepsia3 advocates that the empirical management of symptoms of GORD in primary care is appropriate for most patients rather than being referred to hospital for further investigations such as endoscopies.
Dr Ian Allwood, chair of REFORM, has this advice for healthcare professionals managing patients who are presenting with GORD-like symptoms: “It is important that people who regularly suffer heartburn understand the potential seriousness of the condition and also that highly effective treatments are available. More than 80% of patients attempt to alleviate symptoms using over-the-counter medication before eventually consulting their GP and many try to ignore symptoms altogether, perhaps attributing them to Christmas excesses. However, if patients continue to experience heartburn more than twice a week on a regular basis, they should see their GP as it is likely that they will benefit from more effective treatments.”
For further information and/or an interview with a member from the REFORM group please contact:
Rory Berrie, Cohn & Wolfe
020 7331 5317
The REflux FORuM (REFORM) is a multidisciplinary group comprising GPs, pharmacists and Pharmaceutical Advisors with expert advice from gastroenterologists and surgeons and they are committed to raising standards for the diagnosis and management of patients with reflux disease. The REFORM group are sponsored by an unrestricted educational grant from AstraZeneca.
- BSG. Care of Patients with Gastrointestinal Diseases in the Untied Kingdom; Strategy for the future. March 2006.
- Moayyedi P, Mason J. Clinical and economic consequences of dyspepsia in the community. Gut 2002; 50 (Suppl 4): 10–12.
- National Institute for Health and Clinical Excellence. 2004. Dyspepsia: Managing dyspepsia in adults in primary care.
- Donnellan, C., Sharma, N., Preson, C., Moayyedi, P. Medical treatments for the maintenance therapy of reflux oesophagitis and endoscopic negative reflux disease. Cochrane Database Syst Rev 2005; Apr 18 (2): CD003245.