What causes gastroesophageal reflux disease?
Gastroesophageal reflux disease is often the result of conditions that affect the lower esophageal sphincter (LES). The LES, a muscle located at the bottom of the esophagus, opens to let food in and closes to keep food in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing vomiting or heartburn. The action of the lower esophageal sphincter (LES) is perhaps the most important factor (mechanism) for preventing reflux. The esophagus is a muscular tube that extends from the lower throat to the stomach. The LES is a specialized ring of muscle
that surrounds the lower-most end of the esophagus where it joins the stomach. The muscle that makes up the LES is active most of the time. This means that it is contracting and closing off the passage from the esophagus into the stomach. This closing of the passage prevents reflux. When food or saliva is swallowed, the LES relaxes for a few seconds to allow the food or saliva to pass from the esophagus into the stomach, and then it closes again.
In most people with GERD, the esophageal sphincter does not seal tightly. It remains relaxed between swallows, and allows digestive juices to move up into the esophagus and irritate the esophageal lining. Certain foods, smoking, alcohol, pregnancy and many medications can weaken or loosen the lower esophageal sphincter. Increased abdominal pressure, because of obesity or pregnancy, can push against the sphincter, forcing it open. It is also possible for the sphincter to loosen if a bulge in the stomach, called a hiatal hernia, protrudes above the diaphragm.
Some doctors believe a hiatal hernia may weaken the LES and cause reflux. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the stomach from the chest. Recent studies show that the opening in the diaphragm acts as an additional sphincter around the lower end of the esophagus. Studies also show that hiatal hernia results in retention of acid and other contents above this opening. These substances can reflux easily into the esophagus. Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people age 50 and over have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages. Hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply, i.e., paraesophageal hernia) or is complicated by severe GERD or esophagitis (inflammation of the esophagus). The doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.
Dietary and lifestyle choices may contribute to GERD. Certain foods and beverages, including chocolate, peppermint, fried or fatty foods, coffee, or alcoholic beverages, may weaken the LES causing reflux and heartburn. Studies show that cigarette smoking relaxes the LES. Obesity and pregnancy can also cause GERD. Most reflux during the day occurs after meals. This reflux probably is due to transient LES relaxations that are caused by distention of the stomach with food. A minority of patients with GERD, about 20%, has been found to have stomachs that empty abnormally slowly after a meal. The slower emptying of the stomach prolongs the distention of the stomach with food after meals. Therefore, the slower emptying prolongs the period of time during which reflux is more likely to occur.
More information on gastroesophageal reflux disease (acid reflux, GERD)
What is gastroesophageal reflux disease (acid reflux)? - Gastroesophageal reflux disease (GERD) is a condition in which stomach contents, including acid, back up (reflux) into the esophagus, causing inflammation and damage to the esophagus.
What causes gastroesophageal reflux disease? - Gastroesophageal reflux disease is often the result of conditions that affect the lower esophageal sphincter (LES). Dietary and lifestyle choices may contribute to GERD.
What are the symptoms of gastroesophageal reflux disease? - Heartburn, also called acid indigestion, is the most common symptom of reflux. The most common symptoms in children are repeated vomiting, coughing, and other respiratory problems.
What're the complications of gastroesophageal reflux disease? - Chronic gastroesophageal reflux disease can lead to a number of serious problems, such as bleeding ulcers in the esophagus, and scarring leading to narrowing of the esophagus.
How is gastroesophageal reflux disease diagnosed? - Useful diagnosing methods include barium swallow X-rays, esophageal manometry, esophageal pH monitoring and EGD.
What're the treatments for gastroesophageal reflux disease? - Doctors recommend lifestyle and dietary changes for most people with GERD. Lifestyle modifications are a key component in the management of GERD and should be incorporated into all treatment stages.
What GERD medications treat gastroesophageal reflux disease? - Antacids remain the drugs of choice for quick relief of symptoms associated with GERD. H2-Receptor blockers are indicated for the prevention and relief of heartburn, acid indigestion and sour stomach.
What surgery treats gastroesophageal reflux disease? - Surgery is indicated for a small group of patients with GERD. The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication.
How to prevent gastroesophageal reflux disease with lifestyle? - A correct life style is effective to prevent the symptoms of GERD. Avoid foods that promote opening of the esophageal sphincter and increase acid reflux.
Gastroesophageal reflux disease in infants and children - Infants are more likely to have the lower esophageal sphincter (LES) relax when it should remain shut. Infants are easier for the stomach contents to reflux up into the esophagus.
What is hiatal hernia? - A hiatal hernia is named for the hiatus, an opening in the diaphragm between your chest and your stomach. There are two types of hiatal hernias.