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Causes and risk factors of GERD

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Causes  of GERD (Pathophysiology of gerd)

Gastroesophageal reflux disease is usually caused by a defect in the relaxation of the lower esophageal sphincter (LES), which consequently allows the stomach contents to reflux into the unprotected lining of the esophagus. 

A 2003 study have suggested that small intestinal bacterial overgrowth may have a role in the pathogenesis of gastroesophageal reflux although it is not clear how bacterial overgrowth can lead to GERD.5


Risk factors for GERD
The following conditions that interfere with digestion can increase the risk of GERD.6,7


Excess weight gain puts extra pressure on the stomach and diaphragm, thereby forcing open the LES and allowing regurgitation of the stomach acids into the esophagus. Consumption of very large meals and foods such as oily and spicy foods, chocolate, caffeine, onions and carbonated beverages has similar effects.
Smoking promotes acid reflux by impairing LES function, slowing esophageal acid clearanceand increasing the frequency of acid reflux episodes.
Hiatal hernia:
In hiatus hernia condition, a small part of the upper stomach attached to the esophagus pushes up through the diaphragm causing the stomach and LES to lie in the chest. Consequently, the pressure owing to the LES and diaphragm contraction, which occurs at two different points, fails to form an effective pressure barrier leading to reflux of contents of the stomach.
Pregnancy results in greater pressure on the stomach and a higher production of the hormone progesterone. Progesterone relaxes many muscles including the LES.
Although the exact mechanism is not known, coughing and disturbed breathing may lead to pressure changes in the chest, triggering regurgitation of stomach acid into the esophagus. Some asthma medications may also cause LES relaxation and allow reflux.
In the presence of diabetes gastroparesis, a disorder in which stomach emptying is prolonged, the stomach contents can regurgitate into the esophagus and cause heartburn.
Connective tissue disorders:
Diseases such as scleroderma cause muscular tissue thickening and interfere in the functioning of the digestive muscles, and allowing acid reflux.
Zollinger-Ellison syndrome:
Zollinger-ellison syndrome is a rare disorder, which causes increased acid production in the stomach.
Genetic Factors:
A first-degree relative with GERD symptoms or upper gastrointestinal (GI) disease is independently associated with GERD symptoms.
Medications such as anticholinergics, benzodiazepines and calcium channel blockers cause relaxation of LES and subsequent acid reflux.

Next page: Complications of gerd


Written by: Healthplus24 team
Date last updated: October 20, 2012

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