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  • Q&A with Australian Health Practitioners

    What are the symptoms of GORD, and what should I do about them? Is my cough due to GORD?

    Related Topic
    Heartburn/GORD
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    Mr Geoff Kohn

    Upper GI Surgeon (Abdominal)

    Geoff Kohn is an Upper Gastrointestinal Surgeon in Melbourne, specialising in minimally-invasive management of diseases of the oesophagus and stomach. Geoff’s interests include: Cancer of … View Profile

    GORD, or Gastro-Oesophageal Reflux Disease (sometimes called GERD for those who spell oesophagus without the ‘o’) is a condition which develops when the stomach contents rise into the oesophagus (the food pipe) and causes troublesome symptoms. The stomach contents are usually acidic, but not always so.

    At the bottom of the oesophagus there is an anti-reflux valve called the lower oesophageal sphincter. Its job is to stay tightly closed most of the time to prevent escape of the stomach contents, but it also needs to open temporarily to allow food past when swallowing. If this valve is weak, reflux occurs.

    The classical symptom of reflux is heartburn, which is a burning sensation behind the breastbone or in the upper abdomen. It results from the acid burning the lower oesophagus. The other common symptom is regurgitation where food is felt to come back up even reaching as far as the mouth. It is a passive event, different to the forceful contraction of vomiting. Heartburn or regurgitation are nearly always a result of GORD.

    There are also a group of symptoms called “atypical” symptoms. These can be caused by GORD, but there are also many other possible causes. These atypical symptoms include cough, asthma, hoarseness of the voice, recurrent pneumonias and recurrent sinusitis.

    It is quite straightforward to diagnose whether heartburn and regurgitation are due to GORD. Your doctor will likely arrange a gastroscopy (a camera passed into the stomach) to look for damage caused by the acid, and may arrange for testing for acid in the oesophagus (a test called a ‘pH study’)

    It is more difficult to determine if the atypical symptoms are due to GORD. A powerful technique to aid your doctor in the diagnosis is a test called an impedance study. This measures the fluid (whether or not it is acidic) going back up the oesophagus and it can determine if it goes so high as to reach the lungs. If so, this could be the cause of the symptoms of cough, asthma, pneumonia and others. Only a few gastrointestinal physiology laboratories perform the impedance study – ask your doctor if this might be helpful for your situation.

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    Nikki Martin

    Speech Pathologist

    I have over 13 years experience in adult Speech Pathology and specialise in voice and swallowing problems/cancers of the face and throat. I work very … View Profile

    Your cough may be due to a different type of reflux called Laryngopharyngeal Reflux (LPR). That is when the stomach contents go back up the oesophagus and all the way to the back of the throat. Symptoms of LPR are thick mucous in the back of the throat, sore throat, coughing, gagging, feeling like there's a lump in your throat, voice changes, and in extreme cases swallowing issues. You can have one or multiple symptoms. LPR can be diagnosed by an Ear, Nose and Throat Doctor who performs nasendoscopy (a small spagetti-like camera is inserted in the nose and down to the back of the throat). Once diagnosed, treatment may involve diet and lifestyle changes, togther with medication.

    Nikki Martin
    Speech Pathologist

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    Dr Matthew Broadhurst

    Ear Nose and Throat (ENT) Surgeon

    Dr Matt Broadhurst is a fellowship trained laryngeal surgeon specialising in laryngeal surgery and voice restoration. He returned to Brisbane from Boston, Massachusetts in 2007 … View Profile

    Cough can be present in a small group of GORD patients but it is more commonly seen in patients with “silent reflux” or laryngopharyngeal reflux(LPR).  This is quite different to GORD in that symptoms are throat clearing, a sensation of a lump or tightness in the throat, difficulty swallowing saliva at times and intermittent hoarseness to the voice.  LPR still comes from small amounts of stomach contents moving retrograde into the laryngopharynx.

    Treatment must include a strict diet modification to avoid acidic and reflux-promoting foods and to include a proton pump inhibitor(PPI) such as Somac, Nexium, Zoton, Losec etc.  

    Most symptoms settle over 2-4 months and patients can then be weaned of the medication and a slow return to pre-treatment diet can begin.

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