Causes of GERD, Acid Reflux and Heartburn

Malfunction of Lower Esophageal Sphincter (LES) Muscles

This muscular tissue opens and closes the lower end of the esophagus, and vital for maintaining a pressure barrier against contents in the stomach. This function is produced by an area of smooth muscles and hormones. If this area weakens and loses tone, the LES can't close up completely after food enters the stomach. This allows acid from the stomach to back up into the esophagus. Different factors can cause this:

• The nervous system

• Dietary substances

• Drugs

Abnormalities in the Esophagus
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 in spontaneous muscles action in the esophagus, called peristalsis, commonly occur in GERD
  sufferers. Studies haven't determined if peristalsis is the cause or the result of long-term GERD.

• Adult-Ringed Esophagus
  This is a condition that is characterized by multiple rings in the esophagus and trouble with swallowing. This occurs mostly in men.

Impaired Stomach Function
Over half of GERD sufferers show abnormal nerve or muscle function in the stomach which, in turn, cause impaired motility. This impaired motility means there is an inability of the muscles to act spontaneously. When this happens, the stomach muscles don't contract normally. This will cause a delay in stomach emptying, increasing pressure in the stomach and increasing the risk of acid reflux.

Hiatal Hernia
The hiatus is a small hole in the diaphragm the esophagus 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 GERDsymptoms in persons with both conditions.

Drugs
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, which are commonly associated with causing peptic ulcers, may also cause GERD, and increase the severity of symptoms in people who already have GERD. In one three-year study, NSAID users were found to be twice as likely to have GERD symptoms as non-NSAID users. This isn't short-term, occasional use. These persons may not experience any adverse effects. It's the persons who have used NSAIDs regularly for six months or more who will experience GERD symptoms. NSAIDs include aspirin, ibuprofen (Motrin, Advil, Nuprin) and naproxen (Aleve).
  
  Other Drugs
  This list is not an all 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
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.

Diabetes
Those persons who have diabetes, especially Type 1, often develop a condition called gastroparesis. This condition, occurring in at least 20 percent of persons with long-standing diabetes, is characterized by delayed stomach emptying. If delayed stomach emptying occurs, pressure within the stomach can increase, which in turn can result in reflux.