What factors cause GERD

GERD is affected by many different factors. It can be caused by factors out of your control as well as other factors that you can change or eliminate. A major cause of

GERD and regurgitation is an incompetent valve, or barrier, between the esophagus and stomach. The circular muscle at the bottom of the esophagus is called the lower esophageal sphincter (LES). The LES contributes to the high-pressure zone at the junction of the esophagus and stomach that keeps ingested material out of the esophagus once it has passed through the sphincter. Other components of the high-pressure zone include the ligaments that hold the stomach in place and the diaphragm, which is the muscle separating the chest and abdomen. A hiatal hernia (or hiatus hernia) is a defect in this zone, when the ligaments are loosened and the top of the stomach moves inappropriately into the chest area (see Figure 3). The development of a hiatal hernia decreases the strength of the LES and promotes reflux.

Figure 3 Hiatal Hernia.

Hiatal hernias likely are the greatest contributor to or cause of GERD.

Factors out of a patient's control include genetics and personal background. Some people have a family history of GERD that is passed on through genes. People may have family members across several generations who are affected by GERD because of a genetic component. Other inherited factors are body weight and tendency toward obesity. These characteristics tend to run in families and are further contributions to the development of reflux. Sometimes, however, genetic predisposition to a disease can be confused with other family factors. For instance, GERD in family members may be caused by family members who eat the same types of foods or develop the same eating or exercise habits, and not necessarily by a genetic factor.

Other factors called lifestyle choices are within your control; you can change your choices to decrease your symptoms of GERD. Keep in mind that some lifestyle modifications are easier said than done because they are habits that you have developed over years. You might find it necessary to modify these lifestyle issues slowly over time. Lifestyle factors include such choices as limiting alcohol, losing weight, quitting smoking, avoiding certain medications, limiting carbonated beverages, eating smaller meals, and being careful about eating habits (i.e., avoiding spicy, fatty, and fried foods, etc.). Caffeine consumption increases GERD because it relaxes the LES that protects the esophagus from backflow of acidic stomach contents. Caffeine is one lifestyle factor that can easily be reduced, and caffeine is not just contained in coffee; most teas, hot or iced, and many sodas contain caffeine, so it is important for you to read the label to identify foods and drinks that may make your GERD symptoms worse.

New cases of GERD are commonly associated with recent weight gain. In the United States, the epidemic of obesity is likely related to easy availability of food, low cost of food, and the opportunity to "super size" your meals. Obesity causes secondary problems, including complicating diseases such as diabetes, high blood pressure, stroke, heart disease, cancer, elevated cholesterol, and GERD.

New cases of GERD are commonly associated with recent wei am.

Because food is readily available, people may eat one large meal a day rather than three smaller meals. A full or overstuffed stomach is subject to increased pressure and takes longer to empty. Foods high in fat content also slow stomach emptying, giving more opportunity for contents to backflow into the esophagus. The eating habits of Americans are changing. Increasingly, people eat meals at irregular hours rather than at relatively fixed times each day. Normally, we might eat our last meal of the day, and then remain upright for several hours so that gravity helps keep fluid and food down in the stomach. Eating within 2 hours of bedtime increases reflux by adding "more fuel to the fire" by providing material to reflux as well as a stimulus for acid production. Thus, the lack of gravity works against you at night when you lie flat in bed.

The reasons given here are only a small number of all the factors that explain why people suffer from GERD.

Figure 4 Obesity in the United States.

Two-thirds of Americans are overweight, and 1 in 3 are obese or about 30 pounds overweight and at increased risk ofobesity-related disease.

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