Heartburn_bombonaplateGastroesophageal reflux disease (GERD) is a complex upper-gastrointestinal condition that presents in many different ways and can have many different causes.  It is important to find out WHY you are experiencing GERD and/or heartburn in order identify the best treatment options. This article will address some of the suspected and unsuspected causes of GERD.

As you read, I encourage you to think about your case and some of the possible contributing factors.

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Suspected Suspects:

  • Obesity

    • Those with an increased waist circumference (>35in for women or >40in for men) have a 43-94% higher risk of having reflux symptoms than those of normal weight
    • Obesity causes an increase in abdominal and gastric pressure and distension
    • Increases risk for hiatal hernia, another common cause of GERD
  • Stress

    • More stress actually increases heartburn symptoms in GERD patients and impairs the ability of the digestive system to work efficiently 
    • Higher stress levels can also lead to higher incidence of heartburn-provoking behaviors including smoking, overeating, and poor food choices
  • Cigarette Smoking

    • Increases the amount of acid in the stomach, which can then lead to acid in the esophagus causing heartburn symptoms
  • Poor Diet

    • Particularly high intake of fatty foods like french fries, cream-based sauces and soups, fatty cuts of meat, etc.
  • Irritating Foods

    • Common foods include chocolate, alcohol, coffee, spicy foods, caffeine, mint, carbonated beverages, citrus and tomato-based products
    • Additionally, there may be other less common foods that specifically cause irritation

Unsuspected Suspects:

  • Hiatal Hernia (when the stomach pushes up through a hole in the diaphragm muscle)

    • Weakens the gastroesophageal barrier
    • May require surgery to fix (Nissen fundoplication)
    • 75% of those with esophagitis have a hiatal hernia
    • 90% of those with Barrett’s esophagus have a hiatal hernia
  • Hypochlorhydria/Achlorhydria (low or absent levels of stomach acid)

    • This condition is considered non-acid reflux
    • Causes poor breakdown and digestion of food in the stomach
    • Slows down the movement of food from the stomach to the small intestine
    • Increases the likelihood of developing food allergies and infections
  • Helicobacter pylori (H. pylori bacterial infection)

    • Common cause of stomach ulcers and stomach cancer
    • This infection is contracted by coming into contact with contaminated food, water, utensils, saliva and other bodily fluids
    • Once diagnosed by your doctor, it is often treated with antibiotic/probiotic regimen and acid-lowering medications
  • Eosinophilic Esophagitis (EoE)

    • Allergic/immune condition that causes inflammation and swelling in the esophagus that may mimic symptoms of GERD
    • Most common in caucasian males and may occur at any age
    • Environmental and food allergies can provoke symptoms
    • Once diagnosed by your doctor, it is often treated with oral steroids and/or PPIs in addition to an elimination diet
  • Gastroparesis (delayed gastric emptying)

    • Slowed movement of food from the stomach to the small intestine increases the likelihood of reflux
    • Other symptoms include nausea, vomiting, feeling very full, bloating, and upper abdominal discomfort
    • Most common in females and is typically caused by diabetes (type 1 or 2), post surgical complications, and idiopathic (unknown) causes which accounts for 1/3 of cases
  • Genetic Factors

  • Weak lower esophageal sphincter (LES)

    • The LES is a 3-4cm segment of smooth muscle at the esophagogastric junction (EGJ)
    • Pressure of this sphincter is impacted by gastric pressure and distension caused by air or food, peptides, hormones, foods, medications

Finally, it’s important to remember that acid reflux and GERD are complex conditions with a wide range of causes. If you are ready to explore your condition further and need help figuring out the next step, then let’s get started working together today!