GORD (Gastro-Oesophageal Reflux Disease): Symptoms, Diagnosis & Treatment

You’ve been told you have GORD — or suspect you do. What the diagnosis actually means, how it’s confirmed in the UK, and how it’s managed long term.

Part of the Complete Acid Reflux Guide.

What GORD is — and when reflux becomes a diagnosis

Almost everyone refluxes: small amounts of stomach contents escape upwards through the lower oesophageal sphincter now and then, especially after big meals. Gastro-oesophageal reflux disease (GORD) is the point at which that normal event becomes a condition. The internationally agreed Montreal definition calls it reflux that causes troublesome symptoms or complications; in practice, UK clinicians use the working threshold of heartburn or regurgitation twice a week or more, persisting over weeks, or any evidence of acid damage to the oesophagus.

The distinction matters because the management differs. Occasional reflux is handled with antacids and common sense; GORD warrants proper treatment — because persistent acid exposure is what causes the complications described below. For the condition basics, see the full acid reflux overview.

Symptoms: typical and silent

The classic pair is heartburn (burning rising behind the breastbone, worse after meals, on bending or lying down) and regurgitation (sour fluid or food returning to the throat). Around them cluster belching, bloating, upper abdominal discomfort, hoarseness or a sore throat in the mornings, and a persistent dry cough. Symptoms range from a nuisance after rich meals to a condition that disrupts sleep and eating — the full symptom picture is covered in the acid reflux overview.

How GORD is diagnosed in the UK

For most people, GORD is a clinical diagnosis: a typical story plus a good response to a 4–8 week PPI trial confirms it, with no tests needed. NICE CG184 explicitly supports this treat-and-review approach. Investigations enter the picture in specific situations:

• Endoscopy (gastroscopy) — a camera examination of the oesophagus and stomach, arranged when there are red-flag symptoms, when treatment fails, or for people over 55 with new persistent symptoms. It can show oesophagitis, hiatus hernia, Barrett’s oesophagus, or nothing at all — a normal endoscopy with typical symptoms is still consistent with GORD.
• 24-hour pH monitoring — a thin probe measures acid exposure in the oesophagus over a day, used when the diagnosis is uncertain, symptoms persist despite treatment, or surgery is being considered.
• Oesophageal manometry — measures the pressure and coordination of the oesophageal muscles and valve, mainly before anti-reflux surgery or when a motility problem is suspected.

GORD grading: the LA classification in plain English

If your endoscopy report mentions a “grade”, it is describing what the acid has done to the oesophageal lining, using the Los Angeles (LA) classification:

Grades C and D are among the situations where long-term PPI treatment is clearly the right call rather than a habit to question.

What causes it

GORD is a mechanical problem at heart: a lower oesophageal sphincter that is weak, relaxes too often, or is undermined by a hiatus hernia — the most common structural cause. The pressure side of the equation comes from weight around the middle, pregnancy, large meals and tight clothing; the trigger side from fatty food, alcohol, coffee, chocolate, smoking and certain medicines (NSAIDs, calcium channel blockers, nitrates, some antidepressants). The food side is covered in depth in foods to avoid and everyday triggers.

Complications of untreated GORD

This section is GORD’s real case for taking treatment seriously. Years of unchecked acid exposure can cause:

• Oesophagitis — inflammation and erosion of the lining (graded A–D above); can bleed or ulcerate when severe
• Oesophageal stricture — scar tissue narrowing the oesophagus, making food stick; treated by endoscopic stretching plus long-term acid suppression
• Ulceration — acid-eroded sores in the oesophagus; related peptic ulcers of the stomach and duodenum have their own causes and treatment, covered in our peptic ulcer and H. pylori guide
• Barrett’s oesophagus — a change in the lining cells after long-standing reflux, affecting roughly 1–2% of UK adults. Most people with Barrett’s never develop cancer, but it needs surveillance and long-term acid suppression — explained fully, with the risk in honest proportion, in our Barrett’s oesophagus guide

Treatment: the NICE-recommended approach

NICE CG184 sets out a clear sequence. Lifestyle measures for everyone: weight loss if overweight (the single best-evidenced change), smaller meals finished 3 hours before bed, bed-head elevation, less alcohol and coffee, stopping smoking. A full-dose PPI for 4–8 weeks as initial treatment — typically omeprazole 20mg or lansoprazole 30mg once daily, with esomeprazole for severe oesophagitis or poor response. Antacids and alginates cover breakthrough symptoms but cannot substitute for acid suppression in GORD. For a small minority who fail optimised medical treatment, laparoscopic fundoplication surgically rebuilds the valve — a specialist decision. Doses, side effects and safety are covered in the complete PPI guide.

Living with GORD long term

After the initial course, treatment is tailored to the lowest level that keeps you well. The three patterns: step-down to a lower daily dose (omeprazole 10mg, lansoprazole 15mg); on-demand use — taking the PPI only on symptomatic days, which suits mild relapsing GORD; and continuous maintenance for severe oesophagitis, Barrett’s or rapid relapse. Whatever the pattern, an annual review is the standard of care — checking the dose is still right, the diagnosis still fits, and stopping is considered where appropriate (done gradually: see stopping PPIs safely).

When to seek urgent help

Treatment from Access Doctor

Access Doctor’s pharmacist independent prescribers can prescribe NICE-aligned GORD treatment following a short online consultation — no GP referral needed, with discreet delivery across the UK.