Gastroesophageal Reflux Disease (GERD)

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Risk Factors and Causes

GERD results from a problem with the lower esophageal sphincter—the circular muscle between the esophagus and stomach that opens and closes when food or liquid is swallowed. If this muscle weakens or does not work properly, acid or bile from the stomach can move back into the esophagus (reflux). When this occurs often, damage to the esophagus can result in GERD.

Common risk factors for GERD include the following:

• Obesity—Extra weight causes extra pressure on the stomach and diaphragm and can result in reflux.
• Peptic ulcers cause reflux because food does not move from the stomach to the small intestine efficiently.
• Hiatal hernia (also called diaphragmatic hernia) can weaken the lower esophageal sphincter.
• Pregnancy—Levels of the hormone progesterone, which increase during pregnancy, can loosen the lower esophageal sphincter. Also, the growth of the fetus can exert pressure on the stomach.
• Diabetes—Some patients who have diabetes also have gastroparesis, a condition in which the stomach takes longer to empty, allowing the contents of the stomach to reflux. (This also can happen in people whose stomach nerves and/or muscles do not work properly.)
• Asthma—Researchers are still investigating exactly how asthma increases the risk for GERD. In some cases, reflux starts as a result of continuous coughing and pressure in the lungs. Also, some medications prescribed for asthma may loosen the lower esophageal sphincter.
• Connective tissue disorders sometimes cause reflux because thicker muscular tissues keep the stomach muscles from relaxing and contracting properly.
• Zollinger-Ellison syndrome is a condition characterized by high levels of stomach acid, usually caused by a tumor in the pancreas or small intestine (called a gastrinoma). Zollinger-Ellison syndrome increases the risk for reflux.

Foods do not cause GERD, but in some people, certain foods can trigger reflux. Common foods that can worsen symptoms include onions, tomato sauce, mint, carbonated drinks, chocolate and other foods containing caffeine, as well as spicy foods and foods with a high fat content. Other triggers include alcohol, smoking, large meals, and lying down too soon after eating.

Some medications and dietary supplements can worsen GERD symptoms. In some cases, medications interfere with how the lower esophageal sphincter works. Examples include sedatives, tranquilizers, antidepressants, calcium channel blockers, and narcotics, among others.

Regular use of certain antibiotics and nonsteriodal anti-inflammatory drugs (NSAIDs) can increase inflammation of the esophagus, as can iron, potassium, and vitamin C supplements. A physician or pharmacist can give specific advice on whether a certain medication can affect GERD symptoms.

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