What causes GERD? Several factors contribute to GERD, including anatomical, physiological, dietary, and lifestyle elements.
1. Lower Esophageal Sphincter (LES) Dysfunction
- Weak LES: The LES is a muscle at the junction of the esophagus and stomach that acts as a valve to prevent backflow. If it becomes weak or relaxes inappropriately, it can allow stomach acid to flow back into the esophagus.
- Transient LES Relaxation: Normally the LES relaxes briefly after swallowing. In GERD, these relaxations can occur at inappropriate times, allowing acid to reflux.
2. Hiatal Hernia
- Anatomical Factor: A hiatal hernia occurs when the upper part of the stomach pushes up through the diaphragm into the chest cavity. This can affect the normal functioning of the LES and contribute to reflux.
3. Impaired Esophageal Clearance
- Reduced Peristalsis: The esophagus may have reduced muscle contractions (peristalsis), leading to inefficient clearance of refluxed acid.
- Saliva Deficiency: Saliva helps neutralize acid. Reduced saliva production, as seen in conditions like Sjögren’s syndrome or from smoking, can impair acid clearance.
4. Delayed Gastric Emptying
- Gastroparesis: This condition, characterized by slow stomach emptying, can cause increased pressure in the stomach and promote reflux of acid into the esophagus.
5. Increased Intra-Abdominal Pressure
- Obesity: Excess weight increases pressure on the stomach, pushing acid into the esophagus.
- Pregnancy: The growing uterus increases abdominal pressure, which can push acid into the esophagus.
6. Diet and Lifestyle Factors
- Certain Foods and Beverages: Fatty or fried foods, chocolate, peppermint, alcohol, and caffeine can relax the LES or increase stomach acid production.
- Large Meals: Eating large meals or lying down soon after a meal can promote reflux.
- Smoking: Tobacco can relax the LES and decrease saliva production.
- Medications: Some drugs, including anticholinergics, calcium channel blockers, and sedatives, can relax the LES or irritate the esophageal lining.
7. Hormonal Influences
- Hormonal Changes: Hormones like progesterone (in pregnancy) can relax the LES and contribute to GERD.
Find out more information about GERD.