GERD or Gastro-esophageal reflux disease is one of the most common digestive problems worldwide. Nearly 1 in 5 persons will have the symptoms any time in a year and 1 in 10 will suffer the symptoms of the condition regularly or daily. As patients age, the symptoms worsen. Symptoms are also worse in pregnant women, smokers, obese and overweight individuals. 1-6
The lower esophageal sphincter (LES) muscle
In most cases gastro-esophageal reflux disease (GERD) is said to be caused if there is a problem with the lower esophageal sphincter (LES) muscle.
The LES is placed at the lower end of the esophagus where it joins the stomach. The esophagus is a muscular tube that contracts and pushes the food into the stomach. This movement of the food into the stomach requires opening of the sphincter.
Once the food bolus is pushed into the stomach the sphincter firmly closes again to stop the contents of the stomach from moving backwards into the gullet. In this way the LES acts as a valve.
In patients with GERD the LES becomes weakened and allows some of the stomach’s contents and acid to seep back into the esophagus. This causes symptoms of heartburn and chest pain in patients with GERD.
The exact causes of weakening of the LES are unknown but there are a number of risk factors that may lead to this condition.
Risk factors for GERD
Risk factors that lead to GERD include pregnancy, obesity, a high fat diet and so forth.
Pregnancy and GERD
Pregnant women are at risk of GERD. It is found that changes in hormone levels during pregnancy, especially the raise in levels of Progesterone, can weaken the LES.
In addition, due to the growing fetus the upward pressure on the stomach rises. This may push contents of the stomach into the esophagus.
Overweight and obese persons and GERD
Due to increased pressure on the LES and on the stomach there may be symptoms of GERD in these individuals. This increased pressure also weakens the LES.
High fat diet and GERD
Those on a high fat diet may also develop GERD. The fat in the stomach takes longer to be digested and moved into the intestines. This causes stagnation of food in the stomach. This increased pressure turns backwards and may weaken the LES.
Tobacco, alcohol and caffeine and GERD
Smoking tobacco, alcohol, caffeine containing products, like coffee or chocolate, all relax and weaken the LES leading to symptoms of GERD.
Stress and emotional upset and GERD
Stress and emotional upsets are cause for weakening of the LES leading to symptoms of GERD.
Patients with hiatus hernia and GERD
In patients with hiatus hernia there is a risk of GERD. This is a condition where part of the stomach pushes up through the diaphragm, that is a muscle layer that separates the chest cavity from the abdominal cavity. Usually the lower part of the esophagus passes through a hole in this diaphragm. In patients with hiatus hernia this hole is enlarged and part of the stomach pushes into the chest cavity.
Patients with gastroparesis and GERD
In patients with gastroparesis, where the stomach takes longer to dispose of stomach acid, the acid can seep back into the esophagus causing symptoms of GERD.
This is seen in patients with diabetes. Diabetics have a high blood sugar that can damage the nerves that control the muscles of the stomach and the esophagus.
Medications and GERD
Some medications may also lead to symptoms of GERD. These may relax the LES or may increase gastric acid secretion. They include:
calcium-channel blockers (e.g. Amlodipine, Nifedipine etc. used in high blood pressure control)
Pain relievers or Nonsteroidal anti-inflammatory drugs (NSAIDs like Ibuprofen
antidepressants (Selective serotonin reuptake inhibitors SSRIs e.g. Fluoxetine, Paroxetine etc.)
tricyclic antidepressants (e.g. Amitriptyline), anticholinergics, corticosteroids (e.g. prednisolone)
bisphosphonates (used in bone diseases like osteoporosis)
nitrates (used in treatment of angina or chest pain)
Other factors that increase the risk of GERD
Other factors that increase the risk of GERD symptoms include:
wearing tight clothes
having big meals
having citrus fruits (orange, grapefruit, or cranberry juice)
black pepper and onions
tomato-based foods, like spaghetti sauce, salsa, chili, and pizza etc.
Disease conditions that raise risk of GERD include systemic sclerosis, esophageal dysmotility, scleroderma, decreased salivary production etc.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)