Reflux (gastro-oesophageal reflux disease)

What is reflux?

Our food and drink pass through the oesophagus into the stomach. Where the oesophagus meets the stomach, there is a round muscle that ensures that the stomach contents do not enter the oesophagus. This is important because gastric acid can damage the oesophagus. Problems with this muscle may allow gastric acid to enter the oesophagus. This condition is known as gastro-oesophageal reflux disease (GORD or GERD). The gastric acid can damage the mucosa of the oesophagus and cause inflammation.

Risk factors are overweight, smoking, fatty foods, chocolate, alcohol, coffee and certain medication. In addition, in people with intellectual disabilities, GORD is more common in people with scoliosis and spasticity, in people who use anti-epileptics and benzodiazepines, and in people with an IQ of less than 35. ²¹⁸

What are the complaints associated with reflux disease?

The main complaint of people with GORD is heartburn or an 'acid stomach'. The acid entering the oesophagus causes a burning sensation in the middle of the chest that can get worse when someone lies down.

A systematic literature review reveals that there is probably a relationship between GORD and behaviour problems such as self-injurious behaviour, regurgitation and agitation. ²⁸²

Research ²⁸¹  found the following additional symptoms in people with intellectual disabilities: vomiting, vomiting blood, regurgitation and depressed mood.

Chronic irritation and inflammation can cause scarring that results in a narrowing of the oesophagus: a stricture. The flexibility of the oesophagus can sometimes be affected, resulting in swallowing problems. There may also be a change in the mucosa that can lead to a malignant tumour: this is known as a Barrett's oesophagus.

Alarm symptoms for GORD are vomiting blood, blood in stools and stomach complaints in conjunction with ongoing vomiting, passage disorders (food cannot get through the oesophagus/stomach), unwanted weight loss or anaemia. ²⁸³

People with intellectual disabilities sometimes find it impossible to communicate this pain. The people around them may then notice only a change in behaviour.

How common is reflux in the general population?

Gastro-oesophageal reflux disease is seen occasionally in healthy people: only a very small amount of acid will enter the oesophagus for a short period of time. The prevalence rate for GORD in general practice is 0.8%. ²⁸³

How common is reflux in people with intellectual disabilities?

The Böhmer study of people with intellectual disabilities living in institutions in the Netherlands and Belgium showed that 48.2% had GORD, 33.4% oesophageal inflammation, 4.7% Barrett's oesophagus, and 1.3% an oesophageal stricture. ²⁸¹

A prevalence rate of 38% for GORD was found in people with intellectual disabilities admitted for psychiatric problems. ⁵⁵²

A Dutch study of older people with intellectual disabilities found that 20% had a history of GORD. ⁵⁵³

GORD is more common in people scoliosis and spasticity, in people who use anti-epileptics and benzodiazepines and in people with an IQ of less than 35. ^{281   554}