GORD is an abbreviation for gastro-oesophageal reflux disease. In North America, it is known as GERD because they spell oesophagus ‘incorrectly’ without the O. But we won’t dwell on that! It is a very common condition affecting a significant number of people but it is undoubtedly exacerbated by being overweight and by obesity.

The normal anatomy of the upper digestive tract is fairly simple in that after swallowing, food travels down the oesophagus through the chest and as soon as this latter structure pierces the diaphragm which is the muscular sheet between the chest and the abdomen it opens up into the stomach. The stomach of course is a specific organ within the abdomen itself.

The function of the stomach is to retain the food for an hour or so and to initiate mechanical digestion by peristalsis or muscular waves that break up the food before passing on to the next part of the gut called the duodenum. The stomach also secretes enzymes in particular pepsin which initiates protein digestion.

Importantly it secretes acid, rendering the contents of the stomach very acidic – pH2 most of the time. The lining of the stomach has evolved to protect itself from these very acidic conditions but the rest of the gut has not and therefore damage can occur to the lining of these other parts if the gastric contents are allowed to find their way into these areas.

Under ordinary circumstances there is a valve-type mechanism between the oesophagus and the stomach which effectively keeps the acid in the stomach and stops it refluxing up into the oesophagus. However, for reasons that are not entirely clear this valve mechanism becomes ineffective allowing acid to move back up into the oesophagus and cause inflammation of the lining of the oesophagus, otherwise known as oesophagitis. So, the symptoms that arise are grouped under the condition gastro-oesophagus reflux disease (GORD).

The main symptom typically is “heartburn” which is obviously a misnomer because it does not originate from the heart at all. It is just that the heart is close by and one supposes that people originally thought that the pain was coming from this organ. It typically causes a burning sensation behind the sternum or breast plate. This is typically exacerbated by eating or soon after a meal as this is when the stomach is full and acid is being produced. It is also exacerbated by foods that are acidic or spicy themselves and also by alcohol.

The reason why it is worse in obesity is probably through a mechanical phenomenon in that the abdomen has limited space and if this space is taken up by a significant amount of fat, as is the case in the overweight and patients suffering from obesity, then this tends to increase intra-abdominal pressure and force any gastric contents backwards thereby exacerbating GORD and making the symptoms worse.

The treatment of GORD is largely symptomatic in the form of antacids which are alkali and which will effectively neutralise the acid in the stomach. More recently a class of drug called a protein pump inhibitor - or PPI - has been developed that effectively stops the stomach from producing the acid in the first place.

Clearly however an important aspect of the disease is prevention of course if you are overweight or suffering from obesity then dealing with this problem will stand a good chance of rendering you symptom free and not requiring any medication at all.