causes of GERD

Causes of Gastroesophageal Reflux Disease

By Sharon Gillson, About.com Guide

Updated February 24, 2010

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

If you suffer from Gastroesophageal reflux disease, you may wonder why you are suffering from it, and if there are certain conditions that can cause GERD.

It Starts With the Lower Esophageal Sphincter (LES)

This muscular tissue opens and closes the lower end of the esophagus. The LES helps maintain a pressure barrier that keeps the contents of the stomach from moving up into the esophagus. This is done by an area of smooth muscles and hormones. If the muscles weaken and lose tone, the LES can't close completely after food enters the stomach, which allows acid from the stomach to back up into the esophagus. There are several things that cause the LES to malfunction:

Impaired Stomach Function

More than half of GERD sufferers have abnormal nerve or muscle function in the stomach which, in turn, causes food and stomach acid to be digested too slowly. This will cause a delay in stomach emptying its contents, increasing pressure in the stomach and increasing the risk of acid reflux.

Medications May Cause GERD

There are various drugs, both over-the-counter and prescription, that can increase the risk for GERD, and worsen the symptoms in those who already suffer from GERD.

• NSAIDs
• Nonsteroidal anti-inflammatory drugs include aspirin, ibuprofen (Motrin, Advil, Nuprin) and naproxen (Aleve). They are commonly associated with causing peptic ulcers, and also may cause GERD or increase the severity of symptoms in people who already have GERD. Research has shown that long-term NSAID users were twice as likely to have GERD symptoms as non-NSAID users.
• Other Drugs That Can Cause GERD
• This list is not an inclusive list of drugs that can cause GERD. Other drugs may also cause or worsen GERD. It is important to consult your doctor if you start experiencing any symptoms.
• Calcium channel blockers - used to treat high blood pressure and angina.
• Anticholinergics - used in drugs that treat urinary tract disorders, allergies and glaucoma.
• Beta adrenergic agonists - used for asthma and obstructive lung diseases.
• Dopamine - used in Parkinson's disease.
• Bisphosphonates - used to treat osteoporosis.
• Sedatives
• Antibiotics
• Potassium
• Iron pills

Asthma May Cause GERD

More than half of asthmatic sufferers also have GERD. It is still debated whether asthma causes the GERD, or if GERD causes the asthma for these persons.

• Some experts think the coughing that accompanies asthmatic attacks can lead to changes in pressure in the chest, which can trigger reflux. Also, certain asthmatic medications that are used to dilate the airways may also relax the LES, leading to reflux.
• Some experts think that since GERD has been associated with several other upper respiratory problems, it may also be a cause of asthma, rather than a result of asthma.

Pregnancy and Hormones May Cause GERD

Hormones also affect the LES. For example, the increase of the hormone progesterone during pregnancy relaxes the LES. Thus, it's not abnormal for pregnant women to experience heartburn.

Diabetes

People with diabetes, especially Type 1 diabetes, often develop a condition called gastroparesis. This condition affects about 20 perecnt of diabetics and is characterized by delayed stomach emptying. Pressure within the stomach can increase, which in turn can result in reflux.

Hiatal Hernias May Cause GERD

The hiatus is a small hole in the diaphragm muscle, and the esophagus fits through as it joins the stomach. This hole is usually a snug fit, but for some people it may weaken and enlarge. When this happens, part of the stomach may protrude into it, producing a condition that is called hiatal hernia. The hernia may impair LES function. So far, there is no evidence that a hiatal hernia causes GERD, but it may increase GERD symptoms in persons with both conditions.

Abnormalities in the Esophagus Can Cause GERD

There are some studies that show that most people with atypical GERD symptoms, such as feeling like there is a lump in the throat, hoarseness or chronic cough, have abnormalities in the esophagus. These abnormalities include:

• Motility Abnormalities - Problems with spontaneous muscle action in the esophagus, called peristalsis, commonly occurs in GERD sufferers. Studies haven't determined if peristalsis is the cause or the result of long-term GERD.

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