What the research says
Reflux: the event
Gastro-oesophageal reflux simply means stomach contents passing back up into the oesophagus. Everyone refluxes a little every day, most often after meals. Most episodes are brief, cleared quickly by swallowing and saliva, and go unnoticed.[1]
Heartburn: the symptom
Heartburn is a burning discomfort rising behind the breastbone. It is one of the two “typical” reflux symptoms, alongside regurgitation (sour fluid or food coming back into the throat or mouth).
Importantly, not all heartburn is reflux. The Rome IV criteria describe “functional heartburn”: burning symptoms with normal testing and no link between symptoms and reflux episodes. Oesophageal hypersensitivity can also amplify normal amounts of reflux into real discomfort.[2][3]
GORD: the disease
GORD is diagnosed when reflux causes troublesome symptoms and/or complications such as oesophagitis. The Montreal consensus considers mild symptoms on two or more days a week, or moderate to severe symptoms on one or more days a week, to be troublesome in population studies.
GORD can be erosive (visible inflammation on endoscopy) or non-erosive (symptoms with a normal-looking oesophagus). Non-erosive reflux is common, which is why a normal endoscopy does not mean symptoms are imagined.[2][4]
Douglas’s clinical observations
Practice experience from 65,000+ consultations since 1990, not research findings. Individual results vary.
Douglas frequently meets people who have been told they “just have reflux” without anyone explaining what that means. Understanding whether the problem is frequent reflux events, a sensitive oesophagus, or symptoms driven by bloating and pressure changes the conversation — and the plan.
Many patients describe their symptoms as heartburn when the dominant feeling is actually fullness, pressure and belching after meals. In his experience, that pattern often points to gas and fermentation as a contributing factor worth exploring.
Key takeaways
- Reflux = event; heartburn = symptom; GORD = disease.
- Heartburn can occur without abnormal reflux (functional heartburn).
- Non-erosive reflux disease is common and real.
Educational information only. Douglas is a Clinical Nutritionist and does not diagnose medical conditions or advise on prescribed medication. Never stop or change medication without your doctor. Seek prompt medical care for difficulty swallowing, weight loss, vomiting, bleeding or chest pain (call 000 in an emergency). Red-flag symptoms
References
- 1.Mittal RK, Holloway RH, Penagini R, Blackshaw LA, Dent J. Transient lower esophageal sphincter relaxation. Gastroenterology. 1995;109(2):601–10. (Review) View source
- 2.Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900–20. (Consensus statement) View source
- 3.Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F. Esophageal Disorders (Rome IV). Gastroenterology. 2016;150(6):1368–79. (Consensus statement) View source
- 4.Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67(7):1351–62. (Consensus statement) View source
Written by
Douglas Mizzi, Clinical Nutritionist
ATMS member #8079 · In practice since 1990 · 65,000+ consultations
Douglas specialises in diet, fermentation, gut health and gut recovery. He is a nutritionist, not a medical practitioner: he does not diagnose medical conditions or prescribe or change medication. Clinical observations in these articles reflect his practice experience and are presented separately from the published research. About Douglas