GORD — gastro-oesophageal reflux disease — is what happens when stomach acid repeatedly flows back up into your oesophagus (your food pipe). The valve at the bottom of the oesophagus, which normally keeps stomach contents where they belong, is not closing properly. It affects around 10–20% of Australian adults, which makes it one of the most common digestive conditions there is.
GORD is often associated with a hiatus hernia — where a small part of the stomach slides up through the natural opening in the diaphragm. Most hiatus hernias are small and cause no symptoms by themselves; they matter because they make reflux more likely. If reflux is left untreated for many years, the acid can gradually cause changes or damage to the lining of the lower oesophagus — see Barrett's oesophagus below.
The most common symptom is heartburn — a burning feeling in the chest or throat, often after eating or when lying down. Other things you might notice:
- Acid or food coming back up into the mouth (regurgitation)
- Difficulty swallowing (called dysphagia) or a sense of food sticking
- A persistent dry cough or the need to clear your throat
- A hoarse voice in the morning
- Chest discomfort that can sometimes mimic heart pain
- Worsening of asthma in some patients
Symptoms are typically worse after meals, at night, and when lying flat — and better when standing or sitting upright.
A gastroscopy — a camera examination of your oesophagus, stomach, and the junction between them — is the most important diagnostic test. It is a short day procedure under sedation, and it lets the doctor see directly whether the lining is inflamed (oesophagitis), whether there is a hiatus hernia, whether there are any narrowings (strictures), and whether there is any sign of Barrett's oesophagus.
Additional tests are arranged when the picture is not straightforward or when surgery is being considered:
- Oesophageal pH monitoring — measures how much acid is coming up over 24 hours, with a thin probe sitting in the lower oesophagus. It quantifies the reflux objectively.
- Oesophageal manometry — checks how well the muscles of the oesophagus are working. This is particularly important before any reflux surgery to make sure the operation is right for you.
The first steps are always lifestyle changes and medication — and for the great majority of people, these are enough.
Lifestyle measures that help include: losing weight if it is a contributor, raising the head of the bed, avoiding large meals within two to three hours of bedtime, and cutting back on the things that commonly trigger reflux — alcohol, coffee, spicy or fatty foods, and (for some people) chocolate or mint.
Acid-suppressing medication — most commonly a proton pump inhibitor (PPI) such as omeprazole, esomeprazole, or pantoprazole — is the mainstay of treatment. PPIs are very effective for most people, and most patients with GORD do well on a PPI alone, with or without lifestyle changes.
Surgery is considered in three main situations:
- Your symptoms are still substantially affecting your life despite a proper trial of PPI therapy.
- You would prefer not to take tablets indefinitely.
- You have a complication of reflux — a large hiatus hernia, Barrett's oesophagus, or a stricture — that needs addressing.
The operation is called laparoscopic fundoplication — keyhole surgery performed under general anaesthetic, with a hospital stay of one to two nights. The upper part of the stomach is wrapped around the lower end of the oesophagus, recreating the natural anti-reflux valve. For carefully selected patients, it provides long-lasting relief from reflux.
Barrett's oesophagus is a change that can develop in the lining of the lower oesophagus after years of acid exposure — the normal cells are replaced by cells that look more like those of the intestine. Barrett's itself is not cancer, but it does carry a small risk of progressing towards cancer (oesophageal adenocarcinoma) over time.
If you have been diagnosed with Barrett's, regular endoscopy check-ups (surveillance) are recommended — typically every 2–5 years depending on the specific features seen at gastroscopy. The aim is to catch any change at the earliest, most treatable point. Most people with Barrett's are monitored for years without anything significant developing.
Mr Nguyen's role for reflux patients is assessment, workup, and coordination. He will perform the gastroscopy himself to confirm the diagnosis, refer you for oesophageal manometry and pH studies when these are indicated, optimise your medical treatment, and — if surgery is the right step — refer you directly to a trusted upper gastrointestinal surgical colleague who performs laparoscopic fundoplication.
Mr Nguyen stays involved alongside your GP and the operating surgeon, so you have continuity throughout the pathway. The aim is for the right treatment at the right time, with no part of the picture falling through the cracks.
Your GP will send a referral and most patients are seen within one to two weeks. At the consultation a careful history is taken, the medications you have tried are reviewed, and what is most likely going on is discussed.
If you have ongoing symptoms despite proper PPI treatment, the necessary workup is organised — typically a gastroscopy performed by Mr Nguyen at Warringal Private Hospital or Epworth Eastern, with a referral for manometry and pH studies where these are indicated. A follow-up appointment is arranged once all results are back to discuss what they show and what to do next. For most people, this ends in optimised medical treatment; for those who need surgery, the onward referral to the upper GI surgical colleague happens at that visit.
Surgery is generally considered when your symptoms are still bothering you substantially despite a proper trial of PPI medication, when you would rather not be on lifelong tablets, or when there is a complication such as a large hiatus hernia. A gastroscopy and a follow-up conversation will help work out whether surgery is the right option for you.
For the right patients, yes — the large majority experience long-term freedom from reflux symptoms. The key is careful patient selection and a surgeon experienced in the technique. This is why a proper workup beforehand matters.
For most people, yes. PPIs have a good long-term safety record and have been used in millions of patients for decades. There are some small associations (with bone density, certain nutrient absorption, and some infections) that have been the subject of research, but for patients who clearly benefit symptomatically, the balance generally favours continued use. If you are concerned, this is a good conversation to have with your GP or a specialist.
Long-standing untreated reflux can lead to Barrett's oesophagus — a change in the lining of the oesophagus. In a small proportion of people, Barrett's can progress to oesophageal cancer over many years. This is why regular surveillance endoscopy is recommended if you have a Barrett's diagnosis — to catch any change at the earliest, most treatable point.
Most people are able to stop their reflux medication after fundoplication. A small number need a low dose of acid suppression occasionally, but the aim is to free you from tablets altogether.
Have questions about gastro-oesophageal reflux disease (gord)?
Mr Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private and Epworth Eastern. A GP or specialist referral is required.