What causes newonset GERD

GERD is a disease that is caused by stomach acid abnormally moving up into the esophagus and possibly higher into the mouth or airway structures. Many different factors can contribute to the development and presence of acid reflux.

Normally, your body's natural protective factors limit reflux. We produce 1 pint to 1 quart of saliva per day that is swallowed. Saliva has many jobs. Saliva neutralizes acid, which means it buffers any acid that refluxes into the esophagus. It also helps to digest food, protect the teeth, and lubricate the esophagus so we can swallow. We swallow hundreds of times a day. The purpose of a swallow is to move material from the mouth to the esophagus and ultimately to the stomach. Frequently, swallowing occurs spontaneously without our intentional control. This spontaneous swallowing is protective against reflux because it clears material from the esophagus, including refluxed acid that may be present. Decreased saliva production either as a consequence of aging or because you are taking medications can be a contributing factor to new-onset GERD.

Also, if your esophageal muscle is weak, it may decrease clearance of refluxed acid from the esophagus.

Gravity passively protects the esophagus from material moving up from the stomach, but there are local factors. Normally, there is an anatomic barrier to reflux. This barrier is made up of several structures that are at the junction of the stomach and esophagus. But first, a short anatomy lesson. The diaphragm is a muscle that separates the chest from the abdomen and enables us to breathe. The esophagus passes from the chest into the abdomen through a hole, or hiatus. Fibrous tissues in the abdomen called ligaments hold the stomach and esophagus in place. At the bottom of the esophagus within its wall is a circular band of muscle called the lower esophageal sphincter (LES). This muscle is usually contracted or closed between swallows to prevent movement of material down to the stomach or up from the stomach, as in reflux. When you swallow, this muscle relaxes and allows food material to pass from the esophagus to the stomach. The LES blocks reflux by staying closed.

This normal anatomy is required to maintain normal esophageal function because the diaphragm, ligaments, and circular muscle all contribute to the amount of pressure the LES can generate to block reflux. Normal anatomy can be lost as part of the aging process. The ligaments can stretch and the hole, or hiatus, in the diaphragm can enlarge. If this happens, part of the stomach can move up into the chest instead of normally staying in the abdomen. This condition is called a hiatus or hiatal hernia (see Figure 5). Because the normal relationships between the structures that contribute to the strength of the lower esophageal sphinc-

Hernia Uterus Region
Figure 5 Hiatal Hernia Only.

ter are lost, the LES loses its ability to remain contracted with its normal strength, and the result is reflux.

Weight gain and obesity increase the risk of developing acid reflux disease. Extra body weight within the wall of the abdomen leaves less room within the abdominal cavity and increases pressure on the stomach. Increased pressure within the abdomen counteracts the benefits of gravity as a protective factor against reflux. Similarly, a pregnant woman's enlarged uterus, which takes up space in the abdomen, can also push the stomach and its contents up into the esophagus, causing reflux. These factors contribute even more to reflux at night when the enlarged abdominal wall or pregnant uterus press on the stomach.

In addition to weight, dietary issues, alcohol consumption, and anatomic factors, other medical conditions or medications for other problems can also lead to GERD symptoms. As they age, people tend to take more medications, and many medications can affect stomach acid production, the speed at which the stomach empties, and the ability of the LES to maintain its strength. High blood pressure medications called calcium channel blockers, such as nifedipine, can relax the LES. Drugs used for depression such as tricyclic antidepres-sants and drugs for psychosis impair stomach emptying.

We have tried to touch on a few of the reasons that people may develop new-onset GERD. However, people can experience reflux for a variety of reasons. It is important that you read through the remainder of this book and find the specific areas that may interest you to help explain your GERD.

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