GORD — gastro-oesophageal reflux disease — is what happens when stomach acid repeatedly flows back up into your oesophagus (your food pipe). This happens because the valve at the bottom of the oesophagus isn't closing properly. It affects around 10–20% of Australian adults, making it one of the most common digestive conditions around. Sometimes GORD is associated with a hiatus hernia — where a small part of the stomach slides up through the opening in the diaphragm. If left untreated for a long time, acid reflux can eventually cause changes or damage to the lining of your oesophagus.
The most common symptom is heartburn — a burning feeling in your chest or throat, often after eating or when lying down. You might also notice acid coming back up into your mouth, difficulty swallowing (called dysphagia), a persistent cough or need to clear your throat, a hoarse voice in the morning, chest discomfort, or — in some people — worsening of asthma. Symptoms tend to be worse after meals, at night, and when you're lying flat.
A gastroscopy — a camera examination of your oesophagus, stomach, and the junction between them — is the most important diagnostic test. It allows the doctor to see directly whether your oesophagus is inflamed (oesophagitis), whether you have a hiatus hernia, whether there are any narrowings (strictures), and whether you have a condition called Barrett's oesophagus. Additional tests may include oesophageal pH monitoring (which measures how much acid is coming up over 24 hours) and oesophageal manometry (which checks how well the muscles in your oesophagus are working).
The first steps are always lifestyle changes and medication. On the lifestyle side, losing weight if needed, raising the head of your bed, avoiding large meals before bed, and cutting back on things that tend to trigger reflux — alcohol, coffee, spicy or fatty foods — can all make a real difference. Acid-suppressing tablets called proton pump inhibitors (PPIs) — brand names include omeprazole, esomeprazole, and pantoprazole — are very effective for most people and are the mainstay of medical treatment. The majority of people with GORD do well on this approach alone.
Surgery becomes an option when medication isn't controlling your symptoms well enough, when you'd prefer not to take tablets for the rest of your life, or when you have a complication such as a large hiatus hernia, Barrett's oesophagus, or a stricture. The operation is called laparoscopic fundoplication — keyhole surgery performed under general anaesthetic. The surgeon wraps the upper part of your stomach around the lower end of your oesophagus to recreate the natural anti-reflux valve. Most people stay in hospital for one or two nights. For the right patients, it provides long-lasting relief from reflux symptoms.
Barrett's oesophagus is a change that can develop in the lining of the lower oesophagus when it's been exposed to acid over a long period of time. It's not cancer — but it does carry a small, real risk of progressing towards cancer (oesophageal adenocarcinoma) over time. That's why, if you're diagnosed with Barrett's, your doctor will recommend regular endoscopy check-ups (surveillance) to monitor for any changes, so that if anything does develop, it can be caught and treated early.
Mr Nguyen's starting point is always to make sure your medication is optimised before considering anything else. Surgery is only on the table when your symptoms are still significantly affecting your life despite appropriate treatment with PPIs, or when you're keen to stop taking tablets long-term, or when there's a complication that needs addressing. Before any discussion of surgery, he arranges a proper workup — including a gastroscopy and oesophageal manometry — to confirm the diagnosis and understand your anatomy clearly. Mr Nguyen works closely with specialist upper gastrointestinal surgeons who perform laparoscopic fundoplication, and he will refer you directly to a trusted colleague when surgery is the right next step for you.
Your GP will send a referral and most patients are seen within one to two weeks. At the consultation, Mr Nguyen will take a careful history, review the medications you have tried, and discuss what is most likely to be going on. For ongoing symptoms despite proper PPI treatment, he will arrange the necessary workup — typically a gastroscopy at Warringal Private Hospital or Epworth Eastern, and where appropriate oesophageal manometry and pH studies — to confirm the diagnosis and clarify your anatomy.
Once the workup is complete, you will come back for a follow-up consultation to discuss the results and the next step. For most people, optimised medical treatment is enough. If surgery is the right option, Mr Nguyen will refer you directly to a trusted upper gastrointestinal surgical colleague for laparoscopic fundoplication, and stay involved alongside your GP so you have continuity throughout.
Surgery is generally considered when your reflux symptoms are still bothering you significantly despite a proper trial of proton pump inhibitor medication, or when you'd rather not be on lifelong tablets, or when there's a complication such as a large hiatus hernia. A gastroscopy and a conversation with Mr Nguyen will help work out whether surgery is the right option for your situation.
For the right patients, yes — the large majority experience long-term freedom from reflux symptoms. The key is careful patient selection and choosing a surgeon experienced in the technique. That's why the workup beforehand matters so much.
If chronic reflux isn't treated, it can lead to Barrett's oesophagus — a change in the oesophageal lining. In a small proportion of people, Barrett's can progress to oesophageal cancer over many years. This is why ongoing monitoring with regular endoscopy is recommended if you have a Barrett's diagnosis.
Most people are able to stop their reflux medication after fundoplication. A small number may need a low dose of acid suppression occasionally, but the aim is to free you from tablets altogether.
Mr Ba Nguyen sees patients at his consulting rooms in Heidelberg. To book an appointment, you'll need a referral from your GP or another specialist. If you're not sure where to start, your GP is the right first step.