Gastro-oesophageal reflux disease

Also called GORD, Acid reflux, Heartburn

Stomach acid rising into the gullet. Common, usually manageable, and a genuine hidden cause of distress in people who cannot describe pain.

What it is

Most people know reflux as heartburn after a big meal. Worth including here for a different reason: in people with a learning disability, cerebral palsy or advanced dementia, reflux is common, painful and very frequently missed.

The muscle at the bottom of the gullet does not close properly, so acid rises. Repeated exposure inflames the lining, and over years can change the cells, which is called Barrett's oesophagus and needs monitoring.

Anybody who cannot say "my chest burns" will tell you some other way.

Signs you might notice

Burning behind the breastbone, worse lying down or bending.

An acid or bitter taste. Chronic cough or hoarseness, especially at night.

Difficulty or pain swallowing, which needs investigating rather than treating blind.

In someone without reliable speech: refusing food, arching, self-injury to the chest or face, agitation at mealtimes, disturbed sleep, teeth erosion. Behaviour described as challenging is very often pain.

How it can affect day-to-day life

The commonest mistake is treating it forever without review. Long-term acid suppression is sometimes right and sometimes just easier than reassessing, and it carries its own risks including poorer absorption of B12, magnesium and calcium.

The commonest missed diagnosis is the opposite: somebody whose distress is recorded as behaviour for years while the actual problem is acid.

Red flags matter here. Difficulty swallowing, vomiting blood, black stools or unexplained weight loss need urgent assessment, not another prescription.

Supporting someone well

Raise the head of the bed rather than piling up pillows, which bends the body and makes it worse.

Leave three hours between the last meal and lying down.

Smaller, more frequent meals. Identify personal triggers rather than applying a generic list.

Review medication. Some drugs relax the valve or irritate the lining directly.

For anyone who cannot report symptoms, treat a change in behaviour around meals as a possible pain signal and ask for it to be investigated. Say the words "could this be reflux" at the appointment.

Fiducia Together links behaviour recording to the clinical record, so a pattern of distress at mealtimes reaches the person doing the health review instead of staying in an incident log.

Where to get help

A GP or pharmacist can start treatment. Ask for review after a few weeks rather than an open-ended repeat.

Ask for endoscopy if there are red flags, or if symptoms persist despite treatment.

For a person with a learning disability, raise it at the annual health check specifically.