There are so many acronyms and buzzwords associated with reflux that it can be confusing to know what they all mean. Especially as symptoms range from heartburn, silent reflux, nausea, ‘wet burps’, coughs to throat clearing.
Let’s dive in!
Dyspepsia describes a range of symptoms arising from the upper gastrointestinal (GI) tract – generally considered to be the mouth, oesophagus, stomach, and finally the first part of the small intestine (duodenum).
The upper gastrointestinal (GI) tract produces a range of symptoms that we call dyspepsia.
The British Society of Gastroenterology (BSG) defines dyspepsia as a group of symptoms that alert doctors to consider disease of the upper GI tract, and states that dyspepsia itself is not a diagnosis. These symptoms, which typically are present for 4 weeks or more, include upper abdominal pain or discomfort, heartburn, gastric reflux, nausea or vomiting.
The lower esophageal/ oesophageal (LES/ LOS) sphincter is a stomach valve at the bottom of the oesophagus. It is a ring of muscle that opens to allow food to pass into the stomach and closes to prevent contents flowing back into the oesophagus.
Normally, the LOS closes immediately after swallowing to prevent back-up of stomach juices. GORD occurs when the LOS does not function properly allowing contents to flow back into the lower oesophagus and beyond.
Gastro-esophageal reflux disease (GERD) or Gastro-oesophageal reflux disease (GORD) are the same thing. The only difference is the vowel – oesophagus being the British variant of the American spelling of esophagus.
GORD or GERD refers to when the stomach contents reflux back up into the oesophagus (also known as the food pipe or gullet). It is characterised by the classical reflux symptoms of heartburn and regurgitation.
GORD/ GERD is one of the most prevalent chronic diseases in the world with millions suffering from daily reflux episodes. Untreated GORD/GERD can lead to painful inflammation and possible cancer of the oesophagus.
Non-erosive reflux disease (NERD) is a subcategory of gastroesophageal reflux and is very common.
NERD refers to GERD where there is no evidence of damage to the oesophagus, but the person still experiences symptoms such as heartburn and acid reflux. NERD is diagnosed based on symptoms and response to treatment, rather than the presence of oesophageal damage.
Potential explanations for symptoms associated with NERD include microscopic inflammation, stress and sleep disturbance and sustained oesophageal contractions.
According to gastrointestinal experts, NERD sufferers are unlikely to respond to anti-reflux medication like PPIs. Some studies suggest that NERD may be caused by bile reflux instead of stomach acid.
REFRACTORY GERD/ GORD
Refractory means ‘stubborn or unmanageable’ and is a term used to describe gastro-oesophageal reflux disease that doesn’t respond to PPIs.
There are various approaches medical experts take to refractory GORD in adults in order to determine why PPI treatment fails. These include checking proper dosing, metabolism differences or other underlying diseases.
The article ‘Approach to refractory gastroesophageal reflux disease in adults’ provides useful information.
Functional heartburn is when there are persistent symptoms of reflux with no objective evidence of gastroesophageal reflux disease.
It refers to heartburn symptoms that are not caused by GERD, but by other factors such as stress, anxiety, or other functional gastrointestinal disorders. These symptoms may mimic GERD, but they are not caused by the backward flow of stomach contents into the oesophagus.
In summary, NERD is a subtype of GERD, while functional heartburn is not caused by GERD, but by other factors.
Extra-esophageal (EE) reflux is where symptoms appear outside the stomach and oesophagus.
EE manifestations can involve lungs, upper airways, and mouth, with symptoms such as asthma, laryngitis, throat clearing, sinusitis, chronic cough, dental erosions, and non-cardiac chest pain.
Experts have estimated that one-third of patients suffering from GERD/GORD may experience EE symptoms.
The term silent reflux is often used to describe laryngopharyngeal reflux (LPR) but this can be confusing and misleading as the majority of the symptoms within the term LPR are not silent at all.
This can include symptoms, such as hoarseness, voice disorders, chronic coughing and throat clearing.
EE reflux is associated with reflux aspiration, which occurs when stomach contents reflux as an aerosol and then get inhaled into the airways, causing respiratory symptoms.
The main difference between LPR and EER is the location of symptoms.
LPR refers to reflux symptoms that affect the larynx (voice box) and pharynx (throat), such as hoarseness, sore throat, and difficulty swallowing.
On the other hand, EER refers to reflux symptoms that occur outside of the oesophagus and affect the airways, such as coughing, wheezing, and asthma.
Esophagitis is irritation or inflammation of the oesophagus and can be very painful and makes it hard to swallow. Heartburn is the main symptom.
An early and objective diagnosis of reflux, such as Peptest provides, opens the door to lifestyle changes, and future treatment. Peptest can also be used after reflux treatments to assess the success or failure of any treatment.