Heartburn/GERD Causes

Although the exact reason why GERD develops is still unclear, there are a number of factors that are known to increase one's risk of this health problem. Read more about GERD and risk factors

Doctors believe that GERD is largely attributable to the way the lower esophageal sphincter (LES) works. The LES is the valve on the bottom part of the esophagus, it is a complex segment of smooth muscles which works under the control of nerves as well as various hormones. This valve normally relaxes to allow food or liquid to pass into the stomach, then closes again to keep food and stomach acid from flowing back into the esophagus.

• GERD and risk factors

Mild or temporary heartburn can be experienced by anyone who eats a lot of acidic foods. This is especially true when bending over or lying down after a large meal high in fatty, acidic foods. Persistent heartburn, however, may result from various factors such as biological or structural problems. Below are some of the conditions that may contribute to GERD:

A weak lower esophageal sphincter. There are certain conditions that can impair the function of the lower esophageal sphincter causing it to become weak or relax when it shouldn't. When this happens, stomach acid can flow back up into your esophagus, this will cause frequent heartburn which can even interfere with your everyday life.

Impaired motility. Motility is the ability of the stomach muscles to normally contract. Some reflux patients may have abnormal nerve or muscle function in the stomach which results in impaired motility, Problems with motility can delay the emptying of the stomach, this increases the likelihood of stomach acid to move back to the esophagus.

Abnormalities in the esophagus. Normal anatomy is required for the esophagus to carry out its functions. Studies suggest that some GERD patients have structural abnormalities in the esophagus such as adult ringed esophagus and hiatal hernia.

Adult-ringed esophagusoccurs mostly in men. It is characterized by having many rings on the esophagus and persistent difficulty swallowing.

Hiatal hernia is a structural problem that occurs at the opening of diaphragm where the esophagus joins the stomach. In hiatal hernia, the uppermost part of the stomach bulges through the diaphragm. This structural abnormality is strongly associated with GERD.

Impaired peristalsis is another problem that commonly occurs in GERD patients, however it is not clear whether this contributes to the disorder, or results from chronic GERD.

Decreased saliva production. Saliva carries out a number of important functions. It neutralizes the acid that refluxes into the esophagus. The saliva has digestive enzymes that break down some of the carbohydrates in the food before it leaves the mouth. It also lubricates the esophagus so that we can swallow. We often swallow spontaneously, and this is helps protects us against reflux because it clears substances in the esophagus including possible refluxed acid from the stomach. Decreased saliva production may occur as a consequence of aging or may be due to certain medications.

Medications. Some over the counter and prescription drugs are known to exacerbate heartburn. These medications include oral contraceptives, post-menopausal hormone preparations that contain progesterone, anti hypertensive agents and some NSAID's.

1. Lippincott. Pathophysiology: a 2-in-1 reference for nurses. 1st edition. 2004.
2. Lippincott Williams & Wilkins.
3. Granderath, F., Kamolz, T., Pointner, R
4. Gastroesophageal reflux disease: principles of disease, diagnosis, and treatment. 2006. Springer.
5. http://www.umm.edu/patiented/articles/whogetsgastroesophagealrefluxdisease0000853.htm