Choroba refluksowa przełyku – Etiologia i przyczyny

Choroba refluksowa przełyku
Etiologia i przyczyny

Choroba refluksowa przełyku (GERD) jest przewlekłym schorzeniem wynikającym z dysfunkcji dolnego zwieracza przełyku (LES), który normalnie zapobiega cofaniu się kwaśnej treści żołądkowej do przełyku. Głównym mechanizmem patologicznym są przejściowe rozluźnienia LES (TLESR), osłabienie jego napięcia oraz czynniki anatomiczne, takie jak przepuklina rozworu przełykowego, która obniża ciśnienie zwieracza. GERD może być także wywołane przez zaburzenia motoryki przewodu pokarmowego, opóźnione opróżnianie żołądka (gastropareza), choroby tkanki łącznej (np. twardzina), a także czynniki ryzyka takie jak otyłość, ciąża, palenie tytoniu, spożycie alkoholu, stres oraz niektóre leki (benzodiazepiny, blokery kanału wapniowego, NLPZ, trójpierścieniowe leki przeciwdepresyjne). Warto podkreślić, że GERD nie wynika z nadprodukcji kwasu, lecz z nieprawidłowego cofania się jego zawartości do przełyku, który nie posiada ochronnej wyściółki jak żołądek, co prowadzi do podrażnienia i zapalenia śluzówki przełyku.

Przewlekły refluks kwasu może skutkować poważnymi powikłaniami, takimi jak zapalenie przełyku, owrzodzenia, zwężenia przełyku oraz metaplazja jelitowa w postaci przełyku Barretta, stanowiącego czynnik ryzyka rozwoju raka przełyku. GERD może również manifestować się objawami pozaprzełykowymi, w tym astmą, przewlekłym kaszlem, chrypką, zapaleniem krtani i płuc oraz próchnicą zębów. Diagnostyka i leczenie GERD powinny uwzględniać modyfikację czynników ryzyka, takich jak redukcja masy ciała (w przypadku otyłości), unikanie palenia i alkoholu, zmianę diety oraz kontrolę leków wpływających na funkcję LES. W terapii istotne jest także zarządzanie objawami i monitorowanie potencjalnych powikłań, zwłaszcza u pacjentów z długotrwałym refluksem i objawami alarmowymi.

Etiologia choroby refluksowej przełyku

Choroba refluksowa przełyku (GERD, ang. Gastroesophageal Reflux Disease) to przewlekła choroba górnego odcinka przewodu pokarmowego, w której zawartość żołądka, w tym kwas solny, systematycznie cofa się (refluksuje) do przełyku, powodując charakterystyczne objawy i/lub powikłania. Główną przyczyną GERD jest zaburzona funkcja dolnego zwieracza przełyku (LES), który w normalnych warunkach zapobiega cofaniu się treści żołądkowej.¹²³

Patofizjologia choroby refluksowej

GERD rozwija się, gdy mechanizmy ochronne organizmu przestają prawidłowo funkcjonować. W warunkach fizjologicznych dolny zwieracz przełyku działa jak jednokierunkowy zawór między przełykiem a żołądkiem, otwierając się podczas połykania i zamykając się, by zapobiec cofaniu się treści żołądkowej. Choroba refluksowa pojawia się, gdy LES staje się osłabiony lub ulega niewłaściwemu rozluźnieniu, co pozwala na przepływ kwasu żołądkowego z powrotem do przełyku.¹²

Refluksowa choroba przełyku nie jest zwykle spowodowana nadmierną produkcją kwasu w żołądku. Problem polega na cofaniu się kwasu do przełyku. W przeciwieństwie do żołądka, który posiada specjalną wyściółkę chroniącą go przed uszkodzeniem przez kwas żołądkowy, przełyk nie ma takiej ochrony. W rezultacie, gdy przełyk jest narażony na działanie kwasu żołądkowego, staje się podrażniony i zapalny.¹²

Choroba refluksowa ma charakter przewlekły i mechaniczny. Oznacza to, że mechanizmy, które powinny chronić przełyk przed działaniem kwasu żołądkowego, nie funkcjonują prawidłowo.¹ Chociaż refluksowa choroba przełyku jest często uważana za zaburzenie dolnego zwieracza przełyku, wiele czynników może przyczynić się do jej rozwoju, zarówno fizjologicznych jak i patologicznych.¹

Przejściowe rozluźnienia dolnego zwieracza przełyku

Najczęstszą przyczyną refluksu żołądkowo-przełykowego są przejściowe rozluźnienia dolnego zwieracza przełyku (TLESR – transient lower esophageal sphincter relaxations). Są to spontaniczne rozluźnienia zwieracza, niezwiązane z przełykaniem, które umożliwiają cofanie się treści żołądkowej do przełyku.¹¹¹

GERD może wystąpić, gdy zwieracz osłabnie lub rozluźnia się, gdy nie powinien. Niektóre czynniki, które mogą wpływać na LES i prowadzić do GERD, to między innymi słaby lub uszkodzony dolny zwieracz przełyku, zwiększona podatność połączenia przełykowo-żołądkowego, wyższy gradient ciśnień w rejonie połączenia przełykowo-żołądkowego oraz nieprawidłowości anatomiczne tego regionu.¹¹

Czynniki anatomiczne i strukturalne

Przepuklina rozworu przełykowego przepony

Jedną z najczęstszych przyczyn anatomicznych GERD jest przepuklina rozworu przełykowego przepony (przepuklina rozworu przełykowego, hiatal hernia). Występuje ona, gdy górna część żołądka przemieszcza się przez przeponę do klatki piersiowej. Ten stan może znacząco zmniejszyć ciśnienie zwieracza niezbędne do utrzymania bariery antyrefluksowej.¹¹¹

Przepuklina rozworu przełykowego może osłabiać dolny zwieracz przełyku i zwiększać ryzyko wystąpienia GERD. W przepuklinie rozworu przełykowego górna część żołądka przemieszcza się powyżej przepony, która jest mięśniem oddzielającym jamę klatki piersiowej od jamy brzusznej. Stan ten obniża ciśnienie w zwieraczu przełyku i zwiększa ryzyko GERD.¹¹

Ten stan fizyczny może występować u osób w każdym wieku i wpływa na funkcjonowanie LES, zmniejszając jego skuteczność w zapobieganiu refluksowi. Przepuklina rozworu przełykowego jest bardzo powszechna, a jej częstość występowania zwiększa się wraz z wiekiem i otyłością.¹¹

Wady wrodzone i choroby tkanki łącznej

Wady wrodzone, takie jak zarośnięcie przełyku i przepukliny, mogą wpływać na funkcję LES, predysponując do rozwoju GERD. Choroby tkanki łącznej, jak twardzina (sklerodermia), mogą również wpływać na mięśnie przełyku, upośledzając ich prawidłowe funkcjonowanie.¹¹¹

Twardzina i inne choroby układowe mogą osłabiać mięśnie przełyku i żołądka, co zakłóca normalną perystaltykę i opróżnianie żołądka, zwiększając ryzyko refluksu. Inne zaburzenia, które mogą przyczyniać się do GERD, to cukrzyca, wszelkie zaburzenia żołądkowo-jelitowe (w tym wrzody trawienne), chłoniaki i inne rodzaje nowotworów.¹¹

Wcześniejsze operacje w obrębie klatki piersiowej lub górnej części brzucha mogą również prowadzić do uszkodzenia przełyku i zwiększać ryzyko rozwoju GERD.¹

Zaburzenia motoryki przełyku i żołądka

Dysfunkcje motoryczne przewodu pokarmowego mogą przyczyniać się do rozwoju GERD. Osoby z GERD mogą mieć nieprawidłową czynność nerwową lub mięśniową w żołądku. Te nieprawidłowości uniemożliwiają mięśniom żołądka prawidłowe kurczenie się, co powoduje opóźnione opróżnianie żołądka i zwiększa ryzyko cofania się kwasu.¹¹

Zaburzenia motoryki przełyku i opóźnione opróżnianie żołądka (gastropareza) mogą być również czynnikami w rozwoju GERD. Jeśli przełyk nie porusza się normalnie, wszelki refluks, który dostaje się do przełyku, nie jest dobrze oczyszczany, co naraża na ryzyko objawów i uszkodzenia przełyku.¹¹¹

Problemy z perystaltyką przełyku mogą również prowadzić do utrzymywania się kwasu w przełyku przez dłuższy czas, co zwiększa ryzyko uszkodzenia jego śluzówki.¹¹¹

Czynniki ryzyka i choroby współistniejące

Otyłość i nadwaga

Otyłość jest istotnym czynnikiem ryzyka GERD. Nadmierna masa ciała zwiększa ciśnienie w jamie brzusznej, które może wpływać na LES podobnie jak w przypadku ciąży. Otyłość ma również tendencję do utrzymywania się dłużej niż ciąża, co może osłabiać mięśnie bardziej trwale.¹¹

Wraz ze wzrostem wskaźnika masy ciała (BMI) związanego z cięższą postacią GERD, utrata masy ciała jest często zalecana w celu zmniejszenia częstości występowania i nasilenia objawów GERD. Badania wskazują na silny związek między otyłością a objawami GERD. Otyłość jest tak silną przyczyną refluksu, że znaczna utrata masy ciała i umożliwienie jej utrzymania przynosi pozytywne efekty w zmniejszeniu objawów refluksu.¹¹

Nadmierna masa ciała zwiększa ryzyko przepukliny rozworu przełykowego przepony, która z kolei przyczynia się do GERD. Zarządzanie otyłością poprzez interwencje w zakresie stylu życia, takie jak ćwiczenia i zmiany w diecie, może pomóc w zmniejszeniu ryzyka.¹¹

Ciąża

Ciąża jest częstą przyczyną przejściowego refluksu kwasu. Ciśnienie i objętość w jamie brzusznej mogą naciskać, rozciągać i osłabiać mięśnie przepony, które podtrzymują LES. Hormony ciążowe mogą również sprzyjać rozluźnieniu LES.¹¹

Zmiany hormonalne i zwiększone ciśnienie na żołądek podczas ciąży mogą prowadzić do refluksu kwasu, szczególnie w trzecim trymestrze. U niektórych kobiet w ciąży może rozwinąć się przewlekły refluks kwasu, wymagający starannego zarządzania.¹¹

Wiele kobiet doświadcza refluksu kwasu po raz pierwszy podczas ciąży. Od 40% do 85% kobiet w ciąży doświadcza GERD, co najprawdopodobniej związane jest ze zwiększonym poziomem progesteronu, powodującym rozluźnienie dolnego zwieracza przełyku.¹¹

Palenie tytoniu i spożycie alkoholu

Palenie tytoniu rozluźnia LES, niezależnie od tego, czy to ty palisz, czy jesteś narażony na bierne palenie. Palenie wywołuje również kaszel, który otwiera LES. Palenie i przewlekły kaszel mogą osłabiać mięśnie przepony i przyczyniać się do rozwoju przepukliny rozworu przełykowego przepony.¹¹

Palenie może przyczyniać się do choroby refluksowej przełyku poprzez: uszkadzanie błon śluzowych, osłabianie odruchów mięśniowych w gardle, zwiększenie wydzielania kwasu, zmniejszenie funkcji mięśnia LES i zmniejszenie wydzielania śliny, która neutralizuje działanie kwasu.¹¹

Badania sugerują, że spożywanie alkoholu może zwiększać ryzyko GERD. Im większa ilość i częstość spożycia alkoholu, tym większa korelacja. Alkohol może rozluźniać dolny zwieracz przełyku i zwiększać podrażnienie przełyku.¹¹

Wiek i czynniki genetyczne

Wraz z wiekiem skurcze przełyku i mięśnie LES mogą się osłabiać. Badania wykazały, że GERD jest częstszy u osób starszych, a ryzyko jego rozwoju wzrasta wraz z wiekiem.¹¹

Około 30-40% przypadków refluksu jest najprawdopodobniej dziedzicznych, według kilku badań bliźniąt i rodzinnych. Istnieje dziedziczne ryzyko w wielu przypadkach GERD, prawdopodobnie z powodu dziedzicznych problemów mięśniowych lub strukturalnych w żołądku lub przełyku. Czynniki genetyczne mogą odgrywać szczególnie silną rolę w podatności na przełyk Barretta, stan przedrakowy spowodowany bardzo ciężkim GERD.¹¹

GERD może czasami dotyczyć kilku członków tej samej rodziny i zasugerowano, że geny odziedziczone po rodzicach mogą również wpływać na szanse rozwoju tej choroby.¹

Czynniki związane ze stylem życia i dietą

Wpływ diety na GERD

Niektóre pokarmy mogą wywoływać objawy GERD częściej niż inne. Obejmują one pokarmy o wysokiej zawartości tłuszczu, takie jak smażone i fast foody, pikantne potrawy, niektóre owoce i warzywa, takie jak ananas, pomidor i owoce cytrusowe, oraz niektóre płyny, takie jak kawa, herbata i napoje gazowane.¹¹

Pokarmy, które mogą wyzwalać lub zaostrzać objawy GERD, to czekolada, mięta pieprzowa, alkohol, pieprz, kawa lub napoje z kofeiną, pokarmy pikantne i kwaśne oraz pokarmy bogate w tłuszcze. Badania pokazują, że pikantne potrawy mogą powodować objawy GERD z powodu naturalnego agonisty receptora kapsaicyny, znajdującego się w papryczce chili. Badania opublikowane w czasopiśmie „Nutrients” wykazały, że kapsaicyna zmniejsza kurczliwość żołądka i zwiększa rozciąganie proksymalnej części żołądka.¹¹

Istnieje stała korelacja między spożywaniem dużych ilości słodyczy i deserów a zwiększonym ryzykiem GERD. Natomiast wysokie spożycie błonnika i produktów mlecznych zmniejsza szanse zachorowania na GERD.¹¹

Nawyki żywieniowe i styl życia

Regularne jedzenie dużych posiłków lub przejadanie się może powodować rozciągnięcie górnej części żołądka, wywierając nacisk na dolny zwieracz przełyku. Częste kładzenie się zaraz po jedzeniu może wpływać na funkcję zwieracza, osłabiając go z czasem.¹¹

To, jak jesz, może być tak samo ważne, jak to, co jesz. Jedzenie dużych posiłków, jedzenie szybko lub krótko przed snem może zwiększać ryzyko refluksu kwasu. Nadmierne spożywanie alkoholu i palenie tytoniu mogą również zwiększać podrażnienie przełyku i pogarszać objawy.¹¹

Brak aktywności fizycznej może nasilać objawy GERD. Badania wskazują, że siedzący tryb życia jest czynnikiem ryzyka GERD, a wysiłek fizyczny wysokiej intensywności może pomóc w zmniejszeniu objawów.¹¹

Stres i czynniki psychologiczne

Stres może zaostrzać refluks kwasu żołądkowego poprzez zwiększenie produkcji kwasu żołądkowego, osłabienie mięśnia LES, opóźnienie opróżniania żołądka i zwiększenie wrażliwości przełyku. Lęk i depresja mogą również wpływać na objawy GERD.¹¹

Istnieje związek między refluksem a zaburzeniami lękowymi i depresją. Badania wykazały, że prawdopodobieństwo wystąpienia GERD u osób z depresją jest o 46% wyższe niż u osób bez depresji.¹¹

Wpływ leków na GERD

Leki obniżające ciśnienie LES

Niektóre leki mogą powodować GERD lub pogarszać objawy GERD. Leki mogą mieć działanie rozluźniające na dolny zwieracz przełyku, w tym benzodiazepiny (rodzaj środków uspokajających), blokery kanału wapniowego (stosowane w leczeniu nadciśnienia tętniczego), trójpierścieniowe leki przeciwdepresyjne (stosowane w leczeniu depresji i bólu), NLPZ (niesteroidowe leki przeciwzapalne), takie jak aspiryna i ibuprofen, teofilina (popularny lek na astmę) oraz hormonalna terapia zastępcza (HTZ) w przypadku menopauzy.¹¹

Leki, które obniżają ciśnienie LES, to leki antycholinergiczne, leki przeciwhistaminowe, trójpierścieniowe leki przeciwdepresyjne, blokery kanału wapniowego, progesteron i azotany. Przejściowe rozluźnienie dolnego zwieracza przełyku może być spowodowane przez pokarmy (kawa, alkohol, czekolada, tłuste posiłki), leki (beta-agoniści, azotany, blokery kanału wapniowego, leki antycholinergiczne), hormony (np. progesteron) i nikotynę.¹¹

Niektóre leki na astmę, benzodiazepiny, blokery kanału wapniowego, niektóre leki przeciwhistaminowe, leki przeciwbólowe, leki uspokajające i leki przeciwdepresyjne mogą powodować GERD lub pogarszać jego objawy, powodując rozluźnienie dolnego zwieracza przełyku lub podrażnienie przełyku.¹¹

Leki drażniące przełyku

Niektóre leki mogą bezpośrednio podrażniać błonę śluzową przełyku, zwiększając ryzyko uszkodzenia przy refluksie. Należą do nich niesteroidowe leki przeciwzapalne (NLPZ), takie jak aspiryna i ibuprofen, które mogą uszkadzać błonę śluzową przełyku i zwiększać wydzielanie kwasu żołądkowego.¹¹

Leki, które najczęściej są związane z GERD, to niesteroidowe leki przeciwzapalne (NLPZ), antybiotyki, takie jak tetracykliny i klindamycyna, oraz statyny. Te leki mogą zwiększać ryzyko refluksu kwasu poprzez bezpośrednie drażnienie wyściółki przełyku lub zmieniając skład mikrobioty jelitowej.¹¹

Konsekwencje i powikłania nieleczonego GERD

Uszkodzenie przełyku i zapalenie

Długotrwała ekspozycja dolnej części przełyku na powtarzający się refluks może powodować zapalenie przełyku (ezofagitis), owrzodzenia przełyku (erozyjne zapalenie przełyku), zwężenie przełyku (zwężenie przełyku), zmiany w komórkach wyściełających przełyk (przełyk Barretta) oraz nieprawidłowe komórki w przełyku, które mogą stać się rakotwórcze.¹¹

Czynniki, które przyczyniają się do rozwoju zapalenia przełyku, to żrący charakter refluksatu, niezdolność do oczyszczenia refluksatu z przełyku, objętość treści żołądkowej oraz lokalne funkcje ochronne błony śluzowej. Przewlekły refluks może prowadzić do zmian komórkowych w wyściółce przełyku, co prowadzi do stanu zwanego przełykiem Barretta, który jest związany z podwyższonym ryzykiem raka przełyku.¹¹

GERD może prowadzić do poważnych powikłań, jeśli nie jest leczony, w tym zapalenia przełyku i przełyku Barretta. Nawet gdy objawy refluksu ustępują po leczeniu, zmiany w śluzówce przełyku mogą postępować, a przejście z normalnej wyściółki do przełyku Barretta może być bezobjawowe.¹¹

Przełyku Barretta i ryzyko raka przełyku

Przewlekłe podrażnienie powoduje, że komórki wyściełające przełyk ulegają zmianie, co prowadzi do stanu zwanego przełykiem Barretta. Zmiany mogą występować bez objawów. Te nieprawidłowe komórki są przedrakowe i czasami mogą przekształcić się w raka.¹¹

Pacjenci z utrzymującym się refluksem kwasu mogą być narażeni na ryzyko rozwoju przełyku Barretta, definiowanego jako metaplazja jelitowa przełyku. Ta metaplazja ma związek z ryzykiem raka przełyku. Choroba refluksowa może prowadzić do bardziej poważnych problemów zdrowotnych, takich jak zmiany przedrakowe lub nawet rakowe w przełyku.¹¹

Przewlekły stan zapalny i uszkodzenie przełyku spowodowane przez GERD mogą z czasem prowadzić do przełyku Barretta – stanu, w którym tkanka jelitowa zastępuje tkankę przełyku. Chociaż większość osób z GERD nie rozwinie raka przełyku, obecność przełyku Barretta zwiększa to ryzyko.¹¹

Objawy poza-przełykowe GERD

GERD może również wpływać na krtań, tchawicę i płuca, powodując takie stany jak astma (przewlekły stan zapalny i zwężenie dróg oddechowych), przewlekły kaszel, przewlekły chrypliwy głos, zapalenie krtani (zapalenie krtani), zapalenie płuc (zapalenie płuc) i próchnica zębów.¹¹

Niektóre badania sugerują, że większość osób z nietypowymi objawami GERD (takimi jak chrypka, przewlekły kaszel lub uczucie obecności grudki w gardle) ma specyficzne nieprawidłowości w przełyku. Problem zdrowotny, taki jak astma, może być spotęgowany przez rozwój GERD, a badania wykazały, że od 34% do 89% pacjentów z astmą ma GERD.¹¹

U dzieci GERD może powodować trudności w oddychaniu, epizody zapalenia płuc oraz przewlekły kaszel lub świszczący oddech. GERD stanowi problem u dzieci, ponieważ gdy zawartość żołądka dostaje się do przełyku podczas refluksu, niemowlęta i dzieci mogą doświadczać trudności w oddychaniu, epizodów zapalenia płuc oraz przewlekłego kaszlu lub świszczącego oddechu.¹¹

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#1 Gastroesophageal reflux disease (GERD) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940
Acid reflux happens when the sphincter muscle at the lower end of the esophagus relaxes at the wrong time, allowing stomach acid to back up into the esophagus. This can cause heartburn and other symptoms. Frequent or constant reflux can lead to GERD. […] Gastroesophageal reflux disease happens when stomach acid flows back up into the esophagus and causes heartburn. It’s often called GERD for short. This backwash is known as acid reflux, and it can irritate the lining of the esophagus. […] Many people experience acid reflux now and then. However, when acid reflux happens repeatedly over time, it can cause GERD. […] GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach. […] If the sphincter does not relax as is typical or it weakens, stomach acid can flow back into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed.
#1 GERD (Gastroesophageal Reflux Disease) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/gerd-gastroesophageal-reflux-disease
GERD occurs when stomach contentsgastric secretions with or without foodregurgitate into your esophagus, resulting in a bad taste and burning sensation in the chest and throat. […] GERD is a digestive disorder that occurs when the lower esophageal sphincter, a ring-shaped muscle at the lower end of the esophagus, malfunctions. […] When the lower esophageal sphincter is too relaxed, stomach acid can splash up into the esophagus. […] This backward flowing of stomach contents is called gastroesophageal reflux, or sometimes acid reflux. […] The stomach has a special lining that protects it from being damaged by gastric acid, but the esophagus does not. […] As a result, when the esophagus is exposed to stomach acid, it becomes irritated and inflamed. […] Acid reflux happens to just about everyone from time to time and usually causes only mild symptoms. But GERD occurs when acid reflux is chronic and repeatedly causes heartburn or other symptoms or complications.
#1 Quick Facts:Gastroesophageal Reflux Disease (GERD) – Merck Manual Consumer Version
https://www.merckmanuals.com/home/quick-facts-digestive-disorders/esophageal-and-swallowing-disorders/gastroesophageal-reflux-disease-gerd
GERD happens when that muscle doesn’t work properly. […] GERD is not usually caused by having too much acid in your stomach. The problem is the acid backing up into the esophagus. […] Whatever risk factors you have, you’re more likely to have GERD symptoms when you lie down. […] Over time, acid reflux can hurt your esophagus and cause: […] GERD can also affect your voice box, windpipe, and lungs.
#1 Acid Reflux & GERD: Symptoms, What It Is, Causes, Treatment
https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd
GERD stands for gastroesophageal reflux disease. Depending on where you live, it may be spelled GORD for gastro-oesophageal reflux disease. However you spell it, GERD is chronic acid reflux in your esophagus. Acid reflux is considered chronic when you’ve had it at least twice a week for several weeks. […] Temporary conditions can cause temporary acid reflux. But GERD is a constant, mechanical problem. It means that the mechanisms that are supposed to keep acid out of your esophagus aren’t working right. […] Common causes of acid reflux and GERD include: Hiatal hernia. A hiatal hernia happens when the top of your stomach pushes up through the hole in your diaphragm where your esophagus passes through. It squeezes in next to your esophagus, compressing them both and trapping acid. It also moves your LES above your diaphragm, where it loses some of its muscular support. Hiatal hernias are very common, especially as you get older. They usually occur gradually, and they can gradually worsen.
#1 Gastroesophageal Reflux Disease (GERD)
https://pmc.ncbi.nlm.nih.gov/articles/PMC6140167/
Gastroesophageal reflux disease (GERD) is a common clinical problem, affecting millions of people worldwide. […] Risk factors for GERD include older age, excessive body mass index (BMI), smoking, anxiety/depression, and less physical activity at work. […] Gastroesophageal reflux is primarily a disorder of the lower esophageal sphincter (LES) but there are several factors that may contribute to its development. The factors influencing GERD are both physiologic and pathologic. The most common cause is transient lower esophageal sphincter relaxations (TLESRs). […] Patients with persistent acid reflux may be at risk for Barretts esophagus, defined as intestinal metaplasia of the esophagus. […] GERD is usually diagnosed clinically with classic symptoms and response to acid suppression. […] Medication therapy for GERD is targeted at symptom reduction and minimizing mucosal damage from acid reflux. […] The only proven lifestyle modification for the management of GERD is head of bed (HOB) elevation. […] Left untreated, GERD can result in several serious complications, including esophagitis and Barretts esophagus.
#1 Gastroesophageal Reflux Disease: Practice Essentials, Background, Anatomy
https://emedicine.medscape.com/article/176595-overview
Excessive retrograde movement of acid-containing gastric secretions or bile and acid-containing secretions from the duodenum and stomach into the esophagus is the etiologic effector of GERD. […] A functional (frequent transient LES relaxation) or mechanical (hypotensive LES) problem of the LES is the most common cause of GERD. Transient relaxation of the LES can be caused by foods (coffee, alcohol, chocolate, fatty meals), medications (beta-agonists, nitrates, calcium channel blockers, anticholinergics), hormones (eg, progesterone), and nicotine.
#1 Gastroesophageal reflux disease – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/gastroesophageal-reflux-disease/
GERD develops when reflux-promoting factors, such as corrosiveness of the gastric juice, overcome protective mechanisms, such as the gastroesophageal junction and esophageal acid clearance. […] Gastroesophageal junction dysfunction can occur because of the following factors: Increased frequency of transient lower esophageal sphincter relaxations (TLESRs) […] Imbalance between intragastric and lower esophageal sphincter (LES) pressures […] Anatomic abnormalities of gastroesophageal junction (e.g., hiatal hernia, tumors) […] Impaired esophageal acid clearance […] Risk factors for GERD include smoking, caffeine and alcohol consumption, stress, obesity, pregnancy, angle of His enlargement, iatrogenic factors, inadequate esophageal protective factors, gastrointestinal malformations and tumors, scleroderma, sliding hiatal hernia, and asthma.
#1 Symptoms & Causes of GER & GERD – NIDDK
https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes
Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) commonly cause symptoms such as […] GERD may develop if your lower esophageal sphincter becomes weak or relaxes when it shouldnt. Factors that may affect the lower esophageal sphincter and lead to GERD include […] Some medicines can cause GERD or make GERD symptoms worse. Examples include […] A hiatal hernia can also increase the chance of getting GERD or make GERD symptoms worse.
#1 Gastroesophageal reflux disease and heartburn Information | Mount Sinai – New York
https://www.mountsinai.org/health-library/report/gastroesophageal-reflux-disease-and-heartburn
A hiatal hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity or smoking. […] About 30% to 40% of reflux is most likely hereditary, according to several twin and family studies. An inherited risk exists in many cases of GERD, possibly because of inherited muscular or structural problems in the stomach or esophagus. Genetic factors may play an especially strong role in susceptibility to Barrett esophagus, a precancerous condition caused by very severe GERD. […] Other disorders that may contribute to GERD include diabetes, any gastrointestinal disorder (including peptic ulcers), lymphomas, and other types of cancer.
#1 Causes of GERD – About GERD
https://aboutgerd.org/what-is/introduction-to-gerd/causes-of-gerd/
Reflux occurs when that barrier is relaxed at inappropriate times, is weak, or is otherwise compromised. […] There is no known single cause of gastroesophageal reflux disease (GERD). It occurs when the esophageal defenses are overwhelmed by gastric contents that reflux into the esophagus. […] Gastroesophageal reflux occurs when the LES barrier is somehow compromised. […] Some, but not all, people with hiatal hernia have GERD and vice versa. […] If the diaphragm is not intact, it can compromise the ability of the LES to prevent acid reflux. […] A hiatal hernia may decrease the sphincter pressure necessary to maintain the anti-reflux barrier. […] Even when the LES and the diaphragm are intact and functioning normally, reflux can still occur. […] The extent of injury to the esophagus and the degree of severity of GERD depends on the frequency of reflux, the amount of time the refluxed material stays in the esophagus, and the quantity of acid in the esophagus.
#1 GERD: Symptoms, causes, and treatment
https://www.medicalnewstoday.com/articles/14085
Gastroesophageal reflux disease (GERD) is a long-term condition in which acid from the stomach comes up into the esophagus. […] GERD may result from a weak or damaged valve between the stomach and the esophagus. […] GERD occurs in people of all ages and sometimes for unknown reasons. It happens when the valve that prevents stomach contents from going back up to the esophagus becomes weak or opens when it should not. […] GERD occurs more commonly in people: with obesity or people who are overweight because of increased pressure on the abdomen; who are pregnant, affecting around 40-85% of people during pregnancy; who are taking certain medications, including some asthma medications, calcium channel blockers, antihistamines, sedatives, and antidepressants; who smoke and those with exposure to secondhand smoke. […] In addition, hiatal hernia is a condition in which an opening in the diaphragm lets the top of the stomach move up into the chest. This lowers the pressure in the esophageal sphincter and increases the risk of GERD.
#1 GERD: Symptoms, Causes, Treatments, Remedies for Relief
https://www.webmd.com/heartburn-gerd/reflux-disease-gerd-1
Gastroesophageal reflux disease (GERD), commonly known as heartburn, can come with other symptoms, too, including chest pain, trouble swallowing, feeling like there’s a lump in your throat, or even a cough. […] Doctors think that some people may have it because of a condition called hiatal hernia. […] Some doctors believe a hiatal hernia may weaken the LES and raise your chances of gastroesophageal reflux. […] GERD is especially common when you’re pregnant. Most people will have it by the time they reach their third trimester. The reason is that pregnancy hormones can affect muscles in your stomach and esophagus, making acid reflux more likely. […] GERD is more common when you’re overweight or obese. Your risk for it will go up as you put on extra pounds. […] Certain medications can cause heartburn or make it worse. Some things that could give you GERD include: […] Recent studies show that GERD in infants and children is more common than doctors thought. […] Other risk factors for GERD in babies or children include:
#1 Gastroesophageal reflux disease (GERD) – AGA GI Patient Center
https://patient.gastro.org/gastroesophageal-reflux-disease-gerd/
Gastroesophageal reflux disease (GERD), or just acid reflux, is when stomach acid frequently flows back into the esophagus. Heartburn is the most common symptom of GERD. […] Many things can cause GERD. […] Causes include: Being overweight, obese or pregnant. Some medications (talk to your provider and tell them exactly what you take). Smoking. Alcohol. Getting older. Some foods, how fast you eat and how much you eat. […] You have a muscle, the lower esophageal sphincter (valve), which is found between your stomach and esophagus (the tube that links your mouth and stomach). If this muscle is weak or inappropriately opens, the valve does not work the right way and what is in your stomach can come back up (reflux). […] A hiatal hernia, which is a bulging of the stomach into the chest through the hole in your diaphragm normally occupied by the lower esophageal sphincter, can cause reflux. This condition is more common with aging and obesity. Hiatal hernias are very common. Most people who have hiatal hernia have no symptoms.
#1 Acid Reflux & GERD: Symptoms, What It Is, Causes, Treatment
https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd
Pregnancy is a common cause of temporary acid reflux. The pressure and volume in your abdomen can push, stretch and weaken the muscles in your diaphragm that support your LES. Pregnancy hormones may also encourage your LES to relax. […] Obesity increases the pressure and volume in your abdomen, which affects your LES similarly to how pregnancy does. Obesity also tends to last longer than pregnancy, which can weaken the muscles more permanently. […] Smoking. Tobacco smoke relaxes your LES, whether you’re the one smoking or you’re exposed to second-hand smoke. Smoking also triggers coughing, which opens your LES. Smoking and chronic coughing can weaken your diaphragm muscles and contribute to developing a hiatal hernia. […] Other possible causes of GERD include: Birth defects. Congenital defects like esophageal atresia and hernias can affect your LES.
#1 Acid Reflux & GERD: Symptoms, What It Is, Causes, Treatment
https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd
Connective tissue diseases. Diseases like scleroderma may affect your esophagus muscles. […] Prior surgery. Surgery in your chest or upper abdomen may have injured your esophagus. […] Medications. Certain medications can have a relaxing effect on your LES, including: Benzodiazepines, a type of sedative. […] Calcium channel blockers, which treat high blood pressure. […] Tricyclic antidepressants, which treat depression and pain. […] NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin and ibuprofen. […] Theophylline, a common asthma medication. […] Hormone therapy (HT) medications for menopause.
#1
https://www.gleneagles.com.sg/conditions-diseases/gastro-oesophageal-reflux-disease/symptoms-causes
Gastroesophageal reflux disease (GERD), also known as acid reflux or heartburn, is a chronic digestive disease. […] GERD usually occurs when the muscular valve between the stomach and the oesophagus is weak or faulty. This allows the stomach acid to flow back into the oesophagus. […] There is no identifiable sole cause of gastroesophageal reflux disease. […] The following factors can lead to the onset of GERD or aggravate acid reflux: […] Certain diseases, such as Zollinger-Ellison syndrome or scleroderma. […] Increased abdominal pressure due to obesity or pregnancy. […] Increased production of gastrin, a hormone that regulates the release of stomach acid. […] Hiatal hernia, a condition where the upper part of the stomach moves up into the chest through an opening in the diaphragm. This condition lowers the pressure in the oesophageal sphincter.
#1 Gastroesophageal Reflux Disease (GERD) | Loma Linda University Health
https://lluh.org/conditions/gastroesophageal-reflux-disease-gerd
Pregnant women are at high risk for developing GERD because pregnancy can cause the upper part of the stomach and lower esophageal sphincter (LES) to move above the diaphragm. This is referred to as a hiatal hernia. […] People with connective tissue diseases are also at a high risk of developing GERD.
#1 Gastroesophageal reflux disease and heartburn Information | Mount Sinai – New York
https://www.mountsinai.org/health-library/report/gastroesophageal-reflux-disease-and-heartburn
The band of muscle tissue called the LES is responsible for closing and opening the lower end of the esophagus, and is essential for maintaining a pressure barrier against contents from the stomach. For it to function properly, there needs to be interaction between smooth muscles and various hormones. If it weakens and loses tone, the LES cannot close completely after food empties into the stomach, and acid from the stomach backs up into the esophagus. Dietary substances, drugs, and nervous system factors can weaken the LES and impair its function. […] People with GERD may have abnormal nerve or muscle function in the stomach. These abnormalities prevent the stomach muscles from contracting normally, which causes delays in stomach emptying, and increasing the risk for acid back-up. […] Some studies suggest that most people with atypical GERD symptoms (such as hoarseness, chronic cough, or the feeling of having a lump in the throat) have specific abnormalities in the esophagus.
#1 Gastroesophageal Reflux Disease: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/1999/0301/p1161.html
Gastroesophageal reflux disease (GERD) is thought to have a multifactorial etiology rather than a single cause. Contributing factors include the caustic materials that are refluxed, a breakdown in the defense mechanisms of the esophagus and a functional abnormality that results in reflux. […] The causes for the transformation of this normal process into a chronic, relapsing illness have not been well defined, but numerous factors are thought to be involved. […] Acidic gastric material is undoubtedly the primary offending agent in the development of GERD, with duration of exposure being a key factor. […] The role of bile acids from the duodenum is also being investigated. As many as 60 percent of patients with GERD reflux both gastric and duodenal juices. […] Esophageal motility disorders and delayed gastric emptying may also be factors in the development of GERD. […] Other possible causal factors in GERD include delayed clearance of physiologic reflux by saliva, decreased secretion of bicarbonate by esophageal submucosal glands and attenuated ability of the cells lining the esophagus to resist acid injury.
#1 Gastroesophageal Reflux Disease (GERD) | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/gerd
The most common reason that gastric contents enter the esophagus in infants and children is because the lower esophageal sphincter (LES) relaxes, letting gastric fluid escape into the esophagus. This relaxation is normal, but can happen more frequently in some children. […] The diaphragm and stomach are also important in supporting the LES, so when one or both arent working properly, reflux may worsen. Finally, if your childs esophagus doesnt move normally, any reflux that enters the esophagus isnt cleared well, putting children at risk for symptoms and esophageal damage. […] Because GERD often gets blamed for a variety of symptoms, its important to see a clinician who is not only able to help to make an accurate diagnosis of GERD but who also considers other possible diagnoses to avoid unnecessary treatment.
#1 Common Causes of Acid Reflux and How to Manage It – Birmingham Gastroenterology Associates
https://bgapc.com/common-causes-of-acid-reflux-and-how-to-manage-it/
Smoking damages the LES and reduces saliva production, which is necessary for neutralizing stomach acid, increasing the likelihood of gastroesophageal reflux disease (GERD). […] Hormonal changes and increased pressure on the stomach during pregnancy can lead to acid reflux, especially in the third trimester. Chronic acid reflux may develop in some pregnant individuals, requiring careful management. […] Certain medications, such as pain relievers (aspirin, ibuprofen), sedatives, and some blood pressure drugs, can relax the LES or irritate the esophagus. […] Some health issues, such as delayed stomach emptying (gastroparesis) and connective tissue disorders like scleroderma, can increase the risk of acid reflux.
#1 Gastroesophageal Reflux Disease (GERD) – Gastrointestinal Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/gastroesophageal-reflux-disease-gerd
The presence of reflux implies lower esophageal sphincter (LES) incompetence, which may result from a generalized loss of intrinsic sphincter tone or from recurrent inappropriate transient relaxations (ie, unrelated to swallowing). […] Factors that may contribute to reflux include weight gain, fatty foods, caffeinated or carbonated beverages, alcohol, tobacco smoking, and medications. […] Medications that lower LES pressure include anticholinergics, antihistamines, tricyclic antidepressants, calcium channel blockers, progesterone, and nitrates. […] Factors that contribute to the development of esophagitis include the caustic nature of the refluxate, the inability to clear the refluxate from the esophagus, the volume of gastric contents, and local mucosal protective functions. […] Complications include esophagitis, esophageal stricture, Barrett esophagus, and esophageal adenocarcinoma.
#1 Gastroesophageal Reflux Disease (GERD): Symptoms & Treatment
https://www.health.com/gerd-overview-7510730
Gastroesophageal reflux disease (GERD) is a gastrointestinal disorder that occurs when your stomach acid repeatedly flows back into your esophagus (the tube that carries food from your mouth to your stomach). […] Technically, there is no known cause as to why someone develops GERD; although, researchers have identified a number of possible explanations. […] One possible explanation is motor abnormalities in your digestive system. Esophageal dysmotility is when the muscles in your digestive system do not work properly and your body experiences changes in the speed, strength, or coordination of your digestive organs. This can make it difficult for your body to clear the acid from your esophagus. […] Another possibility is that the tone of the lower esophageal sphincter becomes chronically relaxed, leaving it open and making it easier for acid reflux to occur.
#1 Gastroesophageal Reflux Disease (GERD): Symptoms & Treatment
https://www.health.com/gerd-overview-7510730
Scientists also speculate that gastroparesis, or delayed gastric emptying, could contribute to GERD. Gastroparesis occurs when your digestive system is slowed and it takes a longer period of time for your stomach and small intestines to pass their contents. […] There are certain conditions and anatomical factors that can increase your risk of developing GERD. For instance, your risk increases if you have a hiatal hernia or an increase in intra-abdominal pressure. Other risk factors for GERD include eating a high-fat diet, smoking, and consuming alcohol. […] There is also a greater chance you will experience GERD if you are pregnant or taking certain medications. For instance, 40%-85% of pregnant people experience GERD, which is most likely related to increased progesterone (a key reproductive hormone) causing relaxation of the lower esophageal sphincter. Meanwhile, the medications most commonly associated with GERD are non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics like tetracyclines and clindamycin, and statins.
#1 GERD (Gastroesophageal Reflux Disease) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/gerd-gastroesophageal-reflux-disease
Several factors can increase the risk of developing GERD, including: Weight gain, being overweight or obese; Family history of GERD; Hiatal hernia (condition in which the top of the stomach at the esophageal junction bulges into the chest); Smoking or inhaling secondhand smoke; Eating fatty foods; Drinking alcohol, coffee, or carbonated beverages; Lying down within 3 hours of eating; Taking certain medications including some antidepressants, calcium channel blockers (high blood pressure medications), sedatives, and some medications used to treat asthma. […] Treatment for GERD typically involves lifestyle modification, medications, and in rare cases, surgery. […] Three classes of medications, all of which work by reducing acid levels in the stomach, may alleviate symptoms caused by GERD.
#1 Gastroesophageal reflux disease – Wikipedia
https://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease
Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is a chronic upper gastrointestinal disease in which stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/or complications. […] Risk factors include obesity, pregnancy, smoking, hiatal hernia, and taking certain medications. […] Acid reflux is due to poor closure of the lower esophageal sphincter, which is at the junction between the stomach and the esophagus. […] Factors that can contribute to GERD: Hiatal hernia, which increases the likelihood of GERD due to mechanical and motility factors. […] Obesity: increasing body mass index is associated with more severe GERD. […] The etiology of GERD appears to include the reflux of bile from the stomach into the esophagus leading to the production of reactive oxygen species and oxidative stress and then inflammation and induction of DNA damage.
#1 GERD (acid reflux): Causes, symptoms & treatment | Live Science
https://www.livescience.com/34727-gerd-heartburn-symptoms-treatment.html
Gastroesophageal reflux disease (GERD), is a chronic condition that occurs when stomach contents wash up into the throat. […] GERD is characterized by frequent bouts of heartburn, regurgitation of food or stomach acid, and sometimes chest pain and nausea. […] A high fat intake, coffee consumption, chocolate, spicy foods and alcohol all increase incidents of reflux, although there is less data around fried food or carbonated beverages and their links to GERD, according to research in the journal of Current Medicinal Chemistry. […] Dr Deborah Lee, MD, from Dr Fox Online Pharmacy, tells us there is a strong link between obesity and GERD symptoms. Obesity is such a potent cause of reflux that assisting significant weight loss, and enabling the weight loss to be maintained, has positive benefits in reducing reflux symptoms, she says.
#1 Causes of GERD: Conditions, Medications, and Lifestyle
https://www.healthline.com/health/gerd/causes-of-gerd
Research links obesity to a higher prevalence of GERD. In a large global study, people with obesity were 35% more likely to develop GERD than people without obesity. […] Tobacco smoking is another risk factor for GERD. Smoking can lower the LES pressure, causing stomach contents to come back into the esophagus. […] Certain medications can also cause GERD or make its symptoms worse. Depending on the medication, this might be because it lowers LES pressure, irritates the lining of the esophagus, or increases the time it takes for food to move through the esophagus. […] Your risk of GERD depends on many factors, meaning there are many potential causes. The primary cause is a problem with your lower esophageal sphincter (LES), but many factors can contribute to its dysfunction. […] Several risk factors for GERD are related to lifestyle, such as smoking. Stopping smoking might reduce your chances of developing GERD. Obesity management might also help reduce the risk, so lifestyle interventions like exercise and dietary changes can help.
#1 Risk factors for gastroesophageal reflux disease: a population-based study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-024-03143-9
Based on the results, smoking, alcohol, inactivity, high intake of sweets and desserts, low intake of fiber, depression, visceral fat, and obesity are considered as risk factors for GERD. Modifying lifestyle and behavioral habits prevent GERD. […] According to scientific documentation, GERD is considered as a multifactorial disorder. Physiological and lifestyle factors are among the main reasons for GERD. The physiological factors include increased compliance of the esophagus-gastric junction (OGJ), higher pressure gradient across the OGJ, and weakness of the lower esophageal sphincter (LES). Smoking, stress, dietary factors (coffee and spicy foods), obesity, inactivity, alcohol intake, and family history of reflux were identified as risk factors for GERD. […] A positive relationship was observed between consuming a large amount of sweets and desserts with an elevated risk of experiencing GERD. Conversely, a high intake of fiber and dairy products reduced odd of developing GERD. […] The results represented that the WHR and VFA increased odds of GERD. […] Here, the odds of GERD in depressed individuals were 46% higher than non-depressed. Previous studies indicate a connection between reflux and anxiety disorders and depression.
#1 Gastroesophageal Reflux Disease (GERD) â Symptoms & Treatment | MedStar Health
https://www.medstarhealth.org/services/gastroesophageal-reflux-disease-gerd
Smoking: Tobacco relaxes the lower esophageal sphincter and can slow down digestion, both of which can contribute to GERD. […] Pregnancy: Pregnancy hormones can cause the lower esophageal sphincter to relax, and the pressure of the baby can push the stomach. As a result, many women experience temporary acid reflux while pregnant. […] Eating habits: Eating large meals or right before lying down can cause heartburn and other signs of indigestion.
#1 Causes of Acid Reflux Disease: Hiatal Hernia, Pregnancy, Foods, and More
https://www.webmd.com/heartburn-gerd/common-causes-acid-reflux-disease
Several factors may increase your risk for acid reflux disease. […] One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia, which can occur in people of any age. […] Many women experience acid reflux for the first time during pregnancy. […] Smoking may contribute to acid reflux disease by doing any of the following: damaging mucus membranes, impairing muscle reflexes in the throat, increasing acid secretion, reducing LES muscle function, and reducing salivation, which neutralizes the effect of acid. […] Other common causes of acid reflux disease include being overweight or obese, eating a heavy meal and lying on your back or bending over at the waist, snacking close to bedtime or lying down right after a meal, and taking aspirin or ibuprofen, some muscle relaxers, or certain blood pressure medications.
#1 GERD (Acid Reflux): Symptoms, Treatment, Causes and More
https://www.healthline.com/health/gerd
Lifestyle factors that may contribute to persistent reflux with esophageal inflammation include: smoking or being exposed to secondhand smoke, eating large meals before lying down, using an abundance of nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen. […] Health factors such as the following may contribute to GERD: obesity, pregnancy, connective tissue disorders, older age. […] Other health conditions that can worsen the symptoms of GERD include: anxiety, pregnancy, asthma, irritable bowel syndrome. […] Studies suggest that drinking alcohol may increase the risk of GERD. The greater the quantity of alcohol and frequency of consumption, the greater the correlation. […] Some foods may trigger GERD symptoms more than others, including: high fat foods such as fried and fast foods, spicy foods, certain fruits and vegetables, such as pineapple, tomato, and citrus, certain liquids, such as coffee, tea, and carbonated drinks.
#1 Risk factors for gastroesophageal reflux disease: a population-based study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-024-03143-9
Gastroesophageal reflux disease (GERD) in the long term reduces the quality of life, leading to digestive diseases. The present study aims to determine the risk factors for GERD. […] The prevalence of GERD was 10.99% (n=1,058). The GERD was higher among older age and women. After adjusting for age and sex, the odds of GERD among current smokers was 23% higher than non-smokers. Drinking increased odds of GERD (OR: 1.51; 95% CI: 1.13, 1.99). The odds of GERD among depressed individuals were 46% higher than non-depressed. In addition, a significant relationship was observed between the high intake of sweets and desserts with increased GERD (OR: 1.02, 95% CI: 1.01, 1.03). Further, high intake of fiber (OR: 0.98, 95% CI: 0.97, 0.99) and dairy (OR: 0.99, 95% CI: 0.98, 0.99) was related to reducing the odds of GERD.
#1 Causes of gastroesophageal reflux – Harvard Health
https://www.health.harvard.edu/healthbeat/causes-of-gastroesophageal-reflux
As you age, esophageal contractions and the muscles of the LES may weaken. […] Smoking irritates the digestive tract, and nicotine relaxes the LES. […] Diet can contribute to dysfunction of the LES. […] How you eat can be as important as what you eat. […] Some prescription drugs can worsen your heartburn. […] Hiatal hernia is a common condition that develops when part of the stomach extends up through the diaphragm, […] This may impair the LES’s ability to prevent reflux.
#1 Gastroesophageal reflux disease | NHS inform
https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gastro-oesophageal-reflux-disease-gord/
Gastro-oesophageal reflux disease (GORD) is usually caused by the ring of muscle at the bottom of the oesophagus (gullet) becoming weakened. […] Normally, this ring of muscle opens to let food into your stomach and closes to stop stomach acid leaking back up into your oesophagus. […] But for people with GORD, stomach acid is able to pass back up into the oesophagus. This causes symptoms of GORD, which can include heartburn and acid reflux. […] Its not always clear what causes this ring of muscle to become weakened, but certain things can increase the risk of it happening. […] The following factors may increase your risk of developing GORD: being overweight or obese this can place increased pressure on your stomach and weaken the muscles at the bottom of the oesophagus, eating large amounts of fatty foods the stomach takes longer to get rid of stomach acid after digesting a fatty meal and the resulting excess acid may leak up into the oesophagus, smoking, alcohol, coffee or chocolate these may relax the muscles at the bottom of the oesophagus, pregnancy temporary changes in hormone levels and increased pressure on your stomach during pregnancy can cause GORD, hiatus hernia when part of your stomach pushes up through your diaphragm (thin sheet of muscle between the chest and tummy), gastroparesis when the stomach takes longer to get rid of stomach acid, which means excess acid can leak up into the oesophagus, certain medicines some medicines can cause GORD or make the symptoms worse, including calcium-channel blockers (used to treat high blood pressure), nitrates (used to treat angina) and non-steroidal anti-inflammatory drugs (NSAIDs), stress. […] GORD can sometimes affect several members of the same family and its been suggested that the genes you inherit from your parents may also affect your chances of developing the condition.
#1 Gastroesophageal Reflux Disease (GERD)/Heartburn | Cedars-Sinai
https://www.cedars-sinai.org/health-library/diseases-and-conditions/g/gastroesophageal-reflux-disease-gerdheartburn.html
GERD (gastroesophageal reflux disease) is a digestive disorder. It’s caused when gastric acid from your stomach flows back up into your food pipe (esophagus). […] GERD happens when gastric acid from your stomach backs up into your food pipe (esophagus). […] A muscle at the bottom of the esophagus opens to let food from the bottom of the esophagus into the stomach. And it closes to keep food in the stomach. This muscle is called the lower esophageal sphincter (LES). When your LES relaxes too often or for too long, acid from your stomach backs up into your esophagus. This causes heartburn and may damage the esophagus. […] Some lifestyle issues that can cause GERD may include: Being overweight, lying down or reclining after eating, overeating, eating foods such as citrus, peppermint, chocolate, and fatty or spicy foods, having caffeine, having alcohol, smoking, using aspirin and over-the-counter pain and fever medicines.
#1 GERD (acid reflux): Causes, symptoms & treatment | Live Science
https://www.livescience.com/34727-gerd-heartburn-symptoms-treatment.html
Lee also says that spicy foods can cause GERD symptoms, due to a natural Capsaicin Receptor Agonist found in chillis. Research in the journal Nutrients has shown that capsaicin reduces gastric contractility and increases gastric distension in the proximal part of the stomach, she says. Patients with reflux have a greater number of TRPV1 receptors in the stomach than those without reflux. These are specific receptors, which transmit the sensation of a burning pain. […] An Expert Review of Gastroenterology and Hepatology analysis indicates that a hiatal hernia, which is sometimes found during the endoscopic investigations, can be another risk factor that increases incidents of GERD. The entrance of the esophagus is abnormally shaped or misplaced in the thoracic cavity when one has a hiatal hernia, causing stomach acid to get trapped above the diaphragm.
#1 GERD Causes, Symptoms & Treatment | Oshi Health
https://oshihealth.com/conditions/gerd/
Gastroesophageal reflux disease (GERD) is a chronic condition in which the contents of your stomach flow back (reflux) into your food pipe (esophagus). […] This backflow action usually happens because of issues with the lower esophageal sphincter. […] Causes of GERD include: Regularly eating large meals or overeating. This can cause your upper stomach to become distended, putting pressure on your lower esophageal sphincter. […] Frequently lying down right after eating. While a quick nap after eating sounds like a good time, lying down right after mealtime can impact sphincter function, weakening it over time. […] Having a hiatal hernia. A hiatal hernia develops when the stomach pushes above the diaphragm. It can cause problems with your esophageal sphincter. […] Eating certain foods. Spicy, acidic, and high-fat foods and beverages containing caffeine can trigger GERD symptoms.
#1 GERD Causes, Symptoms & Treatment | Oshi Health
https://oshihealth.com/conditions/gerd/
Drinking alcohol and smoking. Both can increase esophageal irritation and worsen your symptoms. […] Taking certain medications. Some medications can cause the esophageal sphincter to relax, making GERD worse. […] Additionally, factors like stress (hello, gut-brain connection) can make your GERD symptoms worse.
#1 Gastroesophageal Reflux Disease | CHRISTUS Health
https://www.christushealth.org/get-care/services-specialties/gastroenterology/gerd
Physical inactivity: A sedentary lifestyle can exacerbate the condition […] Smoking: Tobacco use is a known risk factor […] Certain medications: use of certain medications such as nonsteroidal anti-inflammatory drugs or calcium channel blockers used in high blood pressure medicines may increase the risk of GERD.
#1 GERD (Gastroesophageal reflux disease): Symptoms | MedPark Hospital
https://www.medparkhospital.com/en-US/disease-and-treatment/gerd-gastroesophageal-reflux-disease
Eating too much food causes the upper stomach to expand and stretch, resulting in lower pressure on the distal esophageal sphincter, or LES muscle, causing the sphincter to loosen close. […] Abnormalities in stomach contraction cause stomach food retention, resulting in excessive consumption of high-fat foods, fried foods, oily foods, or chocolate. […] Eating food close to bedtime causes food retention in the stomach until bedtime, facilitating gastric juices to backflow into the esophagus and throat, causing a burning sensation and irritation. […] The use of certain medications, such as asthma drugs, aspirin, blood pressure medications, or antidepressant medications. […] Stress can precipitate acid reflux by increasing stomach acid production, weakening the LES muscle, delaying gastric emptying, and increasing esophageal sensitivity. […] Other factors include obesity, scleroderma, and pregnancy.
#1 Heartburn and acid reflux
https://www.nhs.uk/conditions/heartburn-and-acid-reflux/
Lots of people get heartburn from time to time. There’s often no obvious reason why. […] Sometimes it’s caused or made worse by: […] certain food and drink such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods […] being overweight […] smoking […] pregnancy […] stress and anxiety […] an increase in some types of hormones, such as progesterone and oestrogen […] some medicines, such as anti-inflammatory painkillers (like ibuprofen) […] a hiatus hernia when part of your stomach moves up into your chest […] a stomach ulcer […] a bacterial infection in your stomach.
#1 Causes of GERD (Gastroesophageal Reflux Disease) | Health Answers | Walgreens
https://www.walgreens.com/health/p2/a/1900001/causes-of-gerd/2449134
Smoking or being exposed to secondhand smoke. Tobacco may relax the lower esophageal sphincter, cause the body to make more stomach acid and stop saliva production. […] Having asthma. Asthma flare-ups may cause the lower esophageal sphincter to relax, and some asthma medications can make GERD symptoms worse. […] Taking certain medications. Benzodiazepines (sedatives), calcium channel blockers (medicines used to treat high blood pressure), certain asthma medicines, nonsteroidal anti-inflammatory drugs (NSAIDs) and tricyclic antidepressants can cause GERD or make symptoms worse.
#1 Gastroesophageal Reflux Disease (GERD): Causes, Symptoms, Diagnosis, and Treatment
https://www.houstonent.com/blog/gastroesophageal-reflux-disease-gerd-causes-symptoms-diagnosis-and-treatment
GERD happens when the muscles do not close properly. […] The stomach acids then move back up to the esophagus causing GERD symptoms. […] The following can worsen the symptoms of GERD in people: Obesity, Alcohol use, Smoking or tobacco use, Pregnancy, Scleroderma, Lying down within three hours of eating, Hiatal hernia, a condition where a part of the stomach moves above the diaphragm. […] The use of certain medications can also cause heartburn and other symptoms of GERD: Beta-blockers for high blood pressure and heart disease, Bronchodilators for asthma and other lung disease, Dopamine active medicine for Parkinson’s disease, Sedatives used for insomnia or anxiety.
#1 GERD Acid Reflux: Its Definition, Causes & Treatments
https://www.verywellhealth.com/gerd-acid-reflux-11697899
Acid reflux occurs when acid flows up from the stomach into the esophagus (food tube) and the mouth. […] Many different factors can weaken the esophageal sphincter. In acid reflux, which happens only occasionally, the cause may be certain trigger foods or drinks or lying down after eating or drinking. GERD, however, is chronic and can occur for more serious reasons and lead to complications. […] Risk factors increasing the likelihood of developing GERD include: A hiatal hernia, in which the stomach protrudes through the muscular diaphragm that separates the abdominal cavity from the chest cavity; Overweight or obesity, which increase pressure on the abdomen; Pregnancy; Smoking (including secondhand smoke), which is a digestive irritant; Medications that relax the esophageal sphincter (including antidepressants, antihistamines, asthma medications, calcium channel blockers, painkillers, and sedatives).
#1
https://www.gleneagles.com.sg/conditions-diseases/gastro-oesophageal-reflux-disease/symptoms-causes
Certain medications, including asthma medicine, calcium channel blockers, antihistamines, painkillers, sedatives, and antidepressants. […] Certain foods and beverages, such as fried, spicy, or fatty foods, chocolate, peppermint, coffee, or alcoholic beverages. […] Smoking or inhaling second-hand smoke.
#1 Gastroesophageal Reflux Disease (GERD) – Digestive Disorders – MSD Manual Consumer Version
https://www.msdmanuals.com/home/digestive-disorders/esophageal-and-swallowing-disorders/gastroesophageal-reflux-disease-gerd
Prolonged exposure of the lower part of the esophagus to repeated reflux may cause inflammation of the esophagus (esophagitis), ulcers of the esophagus (erosive esophagitis), narrowing of the esophagus (esophageal stricture), changes to the cells lining the esophagus (Barrett esophagus), and abnormal cells in the esophagus that may become cancerous. […] Prolonged irritation causes the cells lining the esophagus to change, which results in a condition called Barrett esophagus. Changes may occur without symptoms. These abnormal cells are precancerous and can sometimes progress to cancer.
#1 Gastroesophageal Reflux Disease (GERD) – Harvard Health
https://www.health.harvard.edu/a_to_z/gastroesophageal-reflux-disease-gerd-a-to-z
Long-term exposure to acid also can lead to a condition called Barrett’s esophagus. Barrett’s esophagus increases the risk of esophageal cancer. […] Treatment for most people with GERD includes lifestyle changes as described above and medication. If symptoms persist, surgery or endoscopy treatments are other options. […] There are several medications that can be used to treat GERD. […] Prescription medications include H2 blockers, proton-pump inhibitors (PPIs), motility drugs, and mucosal protectors. […] Surgery is an option for people with severe, difficult-to-control GERD symptoms. It may also be considered for people who have complications such as asthma or pneumonia, or scar tissue in the esophagus.
#1 Refractory Gastroesophageal Reflux Disease: Diagnosis and Management
https://www.jnmjournal.org/view.html?uid=1890&vmd=Full
Gastroesophageal reflux disease (GERD) is common, with increasing worldwide disease prevalence and high economic burden. A significant number of patients will remain symptomatic following an empiric proton pump inhibitor (PPI) trial. Persistent symptoms despite PPI therapy are often mislabeled as refractory GERD. For patients with no prior GERD evidence (unproven GERD), testing is performed off antisecretory therapy to identify objective evidence of pathologic reflux using criteria outlined by the Lyon consensus. […] While refractory symptoms may arise from esophageal hypersensitivity or functional heartburn, proven refractory GERD requires personalization of the management approach, tapping from an array of non-pharmacologic, pharmacologic, endoscopic, and surgical interventions. Proper diagnosis and management of refractory GERD is critical to mitigate undesirable long-term complications such as strictures, Barretts esophagus, and esophageal adenocarcinoma.
#1 What doctors wish patients knew about GERD | American Medical Association
https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-gerd
For example, medications which cause impaired emptying of the stomachthey cause relative gastroparesis, Dr. Hubka said. […] GERD is oftentimes dismissed and treated medically even with patients who have a paraesophageal hernia who should really have an operation, said Dr. Hubka. […] The types of conditions that reflux can lead to are precancerous changes or cancerous changes in the esophagus, Dr. Hubka said. […] When we see these patients, they need to go on a myriad of tests, Dr. Hubka said. […] One very important thing to remember is that when patients have classic symptoms of reflux such as heartburn, regurgitation and if the esophageal lining changes from normal lining to Barrett’s esophagus, those symptoms may disappear. […] Theres this broad spectrum of medications that are antacids and they are either aimed at minimizing production of acid by the stomachsuch as proton pump inhibitorsor simple medications such as Tums, which is calcium carbonate that neutralizes the acid, Dr. Hubka said.
#1 Gastroesophageal Reflux Disease (GERD) – UChicago Medicine
https://www.uchicagomedicine.org/conditions-services/esophageal-diseases/gastroesophageal-reflux-disease
Gastrointestinal reflux disease (GERD) is more than just heartburn. Untreated, GERD can develop into more serious conditions, including cancer for a small percentage of individuals. […] A one-way valve called the lower esophageal sphincter (LES) allows food to pass into your stomach and prevents stomach acid from flowing back up into the esophagus. When this valve is weakened and not functioning properly, gastric juice comes up from the stomach and back into the esophagus causing irritation and inflammation (esophagitis). Over time, this can damage to the lining of the esophagus. Nearly half of patients with GERD will develop esophagitis, and up to 15 percent of patients with GERD may develop a pre-cancerous condition called Barretts esophagus. A small percentage of people with Barretts esophagus will progress to esophageal adenocarcinoma a form of cancer in the esophagus. A second type of esophageal cancer squamous cell carcinoma is not related to GERD or Barretts esophagus. […] GERD can lead to more serious conditions if not diagnosed and treated properly. If you have experienced GERD for a number of years, it is important to have your esophagus checked for changes.
#1 GERD Causes | Stanford Health Care
https://stanfordhealthcare.org/medical-conditions/digestion-and-metabolic-health/gastroesophageal-reflux-disease-gerd/causes.html
Gastroesophageal reflux disease (GERD), also called acid reflux, occurs when stomach acid backs up into the esophagus. […] If you have GERD, your lower esophageal sphincter (LES) is weakened or is not functioning properly. Because of this issue, the contents of your stomach including stomach acid flow backward into your esophagus, causing the symptoms of GERD. […] Long-term exposure to stomach acid damages the lining of your esophagus and can lead to serious complications, including Barretts esophagus and esophageal strictures. […] Some research shows a link between GERD and hiatal hernia, a condition in which part of the stomach pushes into the diaphragm, the muscle separating the chest cavity from the abdominal cavity. […] You may develop GERD because of this lack of support. However, not all people with hiatal hernia will develop GERD.
#1 GERD Acid Reflux: Its Definition, Causes & Treatments
https://www.verywellhealth.com/gerd-acid-reflux-11697899
GERD is chronic, and the long-term effects of acid and inflammation could lead to complications. Anyone who has questions about their risks should speak to a healthcare provider. […] Complications include: Asthma (chronic inflammation and narrowing of the airways); Barretts esophagus (intestinal tissue replaces esophageal tissue and may be connected to a risk of cancer); Chronic cough; Chronic hoarse voice; Esophagitis (inflammation in the esophagus that may lead to bleeding or ulcers); Esophageal stricture (a narrowing of the esophagus); Laryngitis (inflammation of the voice box); Pneumonia (inflammation of the lungs); Tooth decay. […] In GERD, the lining of the esophagus may be affected. GERD can cause inflammation, a thickening of the inner lining, ulcers, and other changes that can be seen with a biopsy (a sample of tissue analyzed in the lab).
#1 A narrative review of the prevalence of gastroesophageal reflux disease (GERD) – Boulton – Annals of Esophagus
https://aoe.amegroups.org/article/view/6041/html
Other potential risk factors for GERD include increasing age, genetics, pregnancy and dietary/lifestyle choices, alcohol consumption and cigarette smoking. […] A health issue such as asthma can be enhanced by developing GERD and studies have reported that between 34% and 89% of asthmatic patients have GERD. […] Many categories of drugs are associated with increasing GERD symptoms, by causing mucosal damage lowering sphincter pressure or by affecting esophagogastric motility. […] A study by Mungan and Pinarbasi Simsek 2017 concluded that estrogen replacement therapy, calcium channel blockers (CCB), nitrates and tricyclic antidepressant drugs are amongst some of the drugs known to either cause or increase GERD symptoms.
#1 GERD & Heartburn in Kids: Signs, Causes, & Treatment | CHOC
https://choc.org/programs-services/gastroenterology/gerd/
GERD is a concern in kids because when stomach contents come up into the esophagus during reflux, infants and children can experience difficulty breathing, episodes of pneumonia and chronic coughing or wheezing. […] Gastroesophageal reflux is usually diagnosed through physical examination and a review of your childâs medical history. […] In most cases GERD can be relieved through diet and lifestyle changes. Your childâs doctor might recommend the following diet and lifestyle adjustments to help alleviate their symptoms: For infants, Infants with GERD should be held upright for 30 minutes after feedings. […] When symptoms of GERD arenât improved with diet and lifestyle changes, or in more severe cases, treatment can also include: Medications. If needed, our specialists may prescribe medications to help with reflux.
#1 Gastroesophageal Reflux (GER) in Kids and Teens (for Parents) | Nemours KidsHealth
https://kidshealth.org/en/parents/gerd-reflux.html
Gastroesophageal reflux (GER), or reflux, is when food and acid from the stomach go back up into the esophagus. […] Reflux that happens a lot or causes problems like poor growth, vomiting, or damage to the esophagus is called GERD (gastroesophageal reflux disease). […] A ring of muscle (the lower esophageal sphincter) separates the esophagus from the stomach. Reflux symptoms happen if this ring relaxes at the wrong time or doesn’t close as it should. This lets acidic fluid from the stomach flow backward into the esophagus, into the back of the throat, and sometimes out the mouth or nose. […] Repeated reflux of stomach acid into the esophagus can lead to: breathing problems like choking, wheezing, or asthma; repeated episodes of pneumonia; dental cavities (especially in the back teeth), despite good brushing; redness and irritation in the esophagus, called esophagitis; damage to the esophagus, which can make it hard to swallow; poor weight gain or losing weight. […] Kids with developmental or neurological conditions, such as cerebral palsy, are more at risk for reflux and can have more severe, lasting symptoms.
#2 Gastroesophageal Reflux Disease (GERD)/Heartburn | Cedars-Sinai
https://www.cedars-sinai.org/health-library/diseases-and-conditions/g/gastroesophageal-reflux-disease-gerdheartburn.html
GERD (gastroesophageal reflux disease) is a digestive disorder. It’s caused when gastric acid from your stomach flows back up into your food pipe (esophagus). […] GERD happens when gastric acid from your stomach backs up into your food pipe (esophagus). […] A muscle at the bottom of the esophagus opens to let food from the bottom of the esophagus into the stomach. And it closes to keep food in the stomach. This muscle is called the lower esophageal sphincter (LES). When your LES relaxes too often or for too long, acid from your stomach backs up into your esophagus. This causes heartburn and may damage the esophagus. […] Some lifestyle issues that can cause GERD may include: Being overweight, lying down or reclining after eating, overeating, eating foods such as citrus, peppermint, chocolate, and fatty or spicy foods, having caffeine, having alcohol, smoking, using aspirin and over-the-counter pain and fever medicines.
#2 GERD (Gastroesophageal Reflux Disease) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/gerd-gastroesophageal-reflux-disease
GERD occurs when stomach contentsgastric secretions with or without foodregurgitate into your esophagus, resulting in a bad taste and burning sensation in the chest and throat. […] GERD is a digestive disorder that occurs when the lower esophageal sphincter, a ring-shaped muscle at the lower end of the esophagus, malfunctions. […] When the lower esophageal sphincter is too relaxed, stomach acid can splash up into the esophagus. […] This backward flowing of stomach contents is called gastroesophageal reflux, or sometimes acid reflux. […] The stomach has a special lining that protects it from being damaged by gastric acid, but the esophagus does not. […] As a result, when the esophagus is exposed to stomach acid, it becomes irritated and inflamed. […] Acid reflux happens to just about everyone from time to time and usually causes only mild symptoms. But GERD occurs when acid reflux is chronic and repeatedly causes heartburn or other symptoms or complications.
#3 Acid Reflux & GERD: Symptoms, What It Is, Causes, Treatment
https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd
GERD stands for gastroesophageal reflux disease. Depending on where you live, it may be spelled GORD for gastro-oesophageal reflux disease. However you spell it, GERD is chronic acid reflux in your esophagus. Acid reflux is considered chronic when you’ve had it at least twice a week for several weeks. […] Temporary conditions can cause temporary acid reflux. But GERD is a constant, mechanical problem. It means that the mechanisms that are supposed to keep acid out of your esophagus aren’t working right. […] Common causes of acid reflux and GERD include: Hiatal hernia. A hiatal hernia happens when the top of your stomach pushes up through the hole in your diaphragm where your esophagus passes through. It squeezes in next to your esophagus, compressing them both and trapping acid. It also moves your LES above your diaphragm, where it loses some of its muscular support. Hiatal hernias are very common, especially as you get older. They usually occur gradually, and they can gradually worsen.