GERD (Gastroesophageal Reflux Disease)

Causes & Risk Factors

The exact cause of GERD is not known and it is believed to be caused by complex multiple factors in different individuals which may include:

Lower Esophageal Sphincter (LES):
Abnormal functioning of the LES is expected to cause refluxing of food, acid, pepsin and bile into the esophagus. Two of the various abnormalities of LES leading to regurgitation are weak contraction and abnormal relaxation (also called transient LES relaxations). Laxity of LES is another cause leading to refluxing of contents of stomach in patients suffering from GERD (2).

Hiatal Hernia:
Most patients suffering from GERD have a hiatal hernia, though the contributing factors are not known exactly. With a hiatal hernia, a small part of the upper stomach attached to the esophagus pushes up through the diaphragm causing the stomach and Lower Esophageal Sphincter (LES) to lie in the chest and the LES is not level with diaphragm. It needs to be understood that the effect of LES and diaphragm occurs at the same location (forming an effective barrier) in those not suffering from hiatal hernia, avoiding reflux of contents of the stomach. Whereas in people suffering from GERD, the pressure due to contraction of LES and diaphragm occurs at two different spots (not forming an effective pressure barrier) leading to reflux of contents of the stomach (2).

Medications:
Medications such as sedatives, tranquilizers, and calcium channel blockers used for hypertension could be the causal agents for GERD (4).

Many drugs cause relaxation of Lower Esophageal Sphincter or lead to improper functioning of LES resulting into GERD. The examples of these drugs are as follows:

• Theophylline and anticholinergics
• Beta-adrenergic agonists including bronchodilators such as albuterol (Proventil) and heart medications such as isoproterenol (Isuprel)
• Nitrates, such as nitroglycerin
• Tricyclic antidepressants like amitriptyline (Elavil)
• Muscle relaxants like diazepam (Valium)
• The hormone progesterone
• Antibiotics like doxycycline and tetracycline
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve)
• Potassium chloride or vitamin C supplements
• Quinidine
• Biphosphates such as alendronate (Fosamax) i.e., drug used to treat osteoporosis (9).

Hormonal Changes:
Hormonal changes during pregnancy may lead to abdominal pressure and loose closure of the LES valve leading to refluxing of stomach contents causing irritation of esophageal lining.

Overfull Stomach:
A large meal can cause the LES to remain relaxed, resulting in reflux of stomach juices into the esophagus (5).

Risk factors:
Some of the risk factors of GERD are as follows:

• Obesity
• Asthma
• Diabetes
• Peptic Ulcer
• Connective tissue disorders such as scleroderma
• Zollinger-Ellison Syndrome (6)
• Overweight, Cigarette smoking and aging (7).

Article by Kona Vishnu, MS
Medical Writer,
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