Reflux and GORD: When Heartburn Needs a GP
What Is Reflux and When Does It Become GORD?
Almost everyone experiences heartburn from time to time — that uncomfortable burning sensation behind the breastbone after a heavy meal or a glass of red wine. Occasional reflux is a normal part of life. But when heartburn happens frequently, persists despite over-the-counter remedies, or interferes with daily life, it may have crossed the line into gastro-oesophageal reflux disease (GORD).
GORD is one of the most common chronic conditions managed by Australian GPs. Left untreated, it can damage the lining of the oesophagus, disrupt sleep, and in rare cases lead to serious complications. The good news: GORD is highly treatable, and most patients see significant improvement with the right combination of lifestyle changes and medication.
How Reflux Happens
The lower oesophageal sphincter (LOS) is a ring of muscle at the bottom of the oesophagus that normally stays closed, preventing stomach contents from flowing backwards. When the LOS relaxes inappropriately, stomach acid travels up into the oesophagus, causing the characteristic burning sensation. This is reflux.
Reflux becomes GORD when it happens at least twice a week, persists for several weeks, or causes complications such as inflammation, ulceration, or narrowing of the oesophagus.
Common Symptoms of GORD
- Heartburn — burning behind the breastbone, usually after meals or when lying down
- Regurgitation — sour or bitter taste in the mouth, sometimes with food coming back up
- Difficulty swallowing — food feels stuck or moves slowly
- Chronic cough — especially at night
- Hoarseness or sore throat in the morning
- Chest pain — non-cardiac, often confused with heart issues
- Disturbed sleep — waking up with a cough, choking, or burning
- Dental erosion — acid wears away tooth enamel over time
- Recurrent laryngitis or sinusitis
Red Flag Symptoms — See a GP Without Delay
Most reflux is uncomfortable but not dangerous. However, certain symptoms should be assessed promptly to rule out serious causes:
- Difficulty or pain swallowing (dysphagia or odynophagia)
- Unintended weight loss
- Persistent vomiting
- Vomiting blood or material that looks like coffee grounds
- Black, tarry stools — possible upper GI bleeding
- New reflux symptoms after age 55
- Family history of oesophageal cancer
- Anaemia (often picked up in routine blood tests)
These symptoms warrant a GP review and possibly a referral for gastroscopy (endoscopy) to look directly at the oesophagus and stomach lining.
What Triggers Reflux?
Reflux is caused by a mix of lifestyle, dietary, and physiological factors. Common triggers include:
- Overweight or obesity — extra abdominal pressure pushes stomach contents upward
- Smoking — relaxes the LOS and reduces saliva (which normally neutralises acid)
- Alcohol — particularly wine, beer, and spirits
- Large meals and eating late at night
- Fatty, fried, or spicy foods
- Coffee, tea, and chocolate
- Citrus fruits and tomato-based foods
- Certain medications — anti-inflammatories (NSAIDs), some blood pressure medications, calcium channel blockers
- Pregnancy — hormonal changes and pressure from the growing baby
- Hiatus hernia — when part of the stomach pushes up through the diaphragm
How Your GP Diagnoses GORD
For most patients, GORD can be diagnosed clinically based on symptoms. Your GP will ask about your reflux pattern, triggers, and impact on daily life, and may suggest a trial of lifestyle changes plus a proton pump inhibitor (PPI) to confirm the diagnosis through symptom response.
If your symptoms are severe, persistent, atypical, or include any red flags, your GP may recommend:
- Gastroscopy — a thin camera examines the oesophagus, stomach, and first part of the small intestine. The gold standard for assessing oesophageal damage and ruling out serious causes
- 24-hour pH monitoring — measures acid exposure in the oesophagus over a full day
- Helicobacter pylori testing — a bacterial infection linked to ulcers and dyspepsia
Treatment Options
Lifestyle Changes (First Line)
- Lose excess weight if overweight
- Quit smoking
- Reduce alcohol, especially in the evening
- Eat smaller, more frequent meals
- Avoid eating within 3 hours of bedtime
- Raise the head of your bed by 10–20 cm (extra pillows alone are not enough)
- Avoid known dietary triggers
- Wear loose-fitting clothing around the waist
Medications
- Antacids (Mylanta, Gaviscon, Quick-Eze) — fast-acting relief, useful for occasional symptoms
- H2 receptor antagonists (famotidine) — reduce acid production, available over-the-counter
- Proton pump inhibitors (PPIs) — esomeprazole, pantoprazole, omeprazole. Most effective. Available on prescription and PBS-subsidised for many patients. Should be reviewed regularly to use the lowest effective dose
- Alginate preparations — form a protective raft over stomach contents
Surgical Options
For patients with severe GORD, complications, or who cannot tolerate long-term PPIs, surgical options including laparoscopic fundoplication may be considered. Your GP can refer you to a gastroenterologist or upper GI surgeon for assessment.
Why GORD Should Not Be Self-Managed Forever
Pharmacy PPIs are widely available and many Australians self-medicate for years without seeing a GP. This is risky for several reasons:
- Masking serious disease — reflux symptoms can occasionally indicate stomach or oesophageal cancer. PPIs control symptoms but do not address underlying disease
- Long-term PPI side effects — including increased risk of bone fractures, vitamin B12 and magnesium deficiency, and certain infections
- Missed alternative diagnoses — symptoms identical to GORD can be caused by H. pylori infection, gallstones, or even cardiac issues
- Suboptimal dosing — your GP can determine the right dose, duration, and step-down plan
Frequently Asked Questions
Can reflux cause asthma symptoms?
Yes. Acid reflux can trigger or worsen asthma, particularly nocturnal symptoms. Treating GORD often improves asthma control in patients who have both conditions.
Is GORD curable?
GORD is a chronic condition for most patients, meaning it requires ongoing management rather than a one-off cure. However, weight loss, lifestyle changes, and the right medication can result in long-term symptom freedom for many people. A small subset of patients with severe GORD may benefit from surgery.
How long can I take a PPI safely?
Short-term PPI use (up to 8 weeks) is well-tolerated. For longer-term use, your GP will review the dose periodically and aim to use the lowest effective dose. Most patients can safely use PPIs long-term when monitored, but unnecessary long-term use should be avoided.
Is reflux dangerous in children?
Mild reflux is very common in babies and usually resolves by 12 months without treatment. Older children with persistent reflux should be assessed by a GP or paediatrician.
Can I get tested for H. pylori at my GP?
Yes. H. pylori can be tested via a breath test, stool test, or blood test, and is treated with a 7–14 day course of antibiotics plus a PPI. If you have recurring reflux or upper abdominal pain, ask your GP about testing.
Get Persistent Reflux Assessed at Your Family Doctor Clinic
If you have heartburn more than twice a week, regurgitation, difficulty swallowing, or any red flag symptoms, do not rely on pharmacy antacids alone. Book an appointment with your local Family Doctor GP to get a proper assessment, identify any underlying cause, and create a treatment plan that works.