Causes of Acid Reflux Disease and GERD

The exact cause of gastroesophageal reflux disease (GERD) differs from person to person.
In all cases, the lower esophageal sphincter (LES), which is responsible for keeping stomach contents from flowing back into the esophagus, is open at the wrong time. This results in the uncomfortable and frequently painful burning sensation known as heartburn where stomach acid and digestive enzymes irritate the lining of the esophagus.

Common Causes of GERD:

Abnormal Muscle or nerve function: The LES depends on muscle strength to remain closed against the pressure of stomach contents as well as nerve impulses to tell it when to close tight and when it can relax to let food pass through it. Additionally, problems with muscle and nerve function in the stomach can cause increased pressure because of delayed emptying.
Medications: Many prescription and over the counter drugs are known to cause GERD, or increase the severity of symptoms. The list of medications is long, but some of the most frequent culprits are:

  • Oral contraceptives and hormones: Progesterone containing medications such as birth control pills and post menopause hormones.
  • Nonsteroidal Anti-Inflammatory drugs (NSAIDs): Used for pain control, NSAIDs are a commonly used group of medications that include aspirin, ibuprofen (Motrin, Advil, Nuprin) and naproxen (Aleve).
  • Calcium channel blockers: Used to treat high blood pressure and angina.
  • Anticholinergics: Used in drugs that treat urinary tract disorders, allergies and glaucoma.
  • Beta adrenergic agonists: Used for asthma and obstructive lung diseases.
  • Dopamine: Used to reduce symptoms in Parkinson’s disease.
  • Bisphosphonates: Used to treat osteoporosis.
  • Sedatives, antibiotics, potassium, iron pills, corticosteroids, and vitamin supplements

Asthma: Although there is some question over which condition, asthma or GERD, occurs first and cause the other, a large number of asthma sufferers have GERD and vice versa. It is possible that the coughing common in asthma attacks raises abdominal pressure and causes reflux. It is also possible that chronic reflux of acid irritates the windpipe and results in upper respiratory problems like asthma.
Pregnancy: During pregnancy, increased abdominal pressure as the baby grows, along with increased levels of hormones that relax the LES muscles, contribute to heartburn.
Diabetes: Some diabetics develop a condition that slows stomach emptying. This condition, called gastroparesis, allows stomach pressure to increase and, in turn, increases the chances of reflux.
Hiatal Hernia: As it travels from the mouth to the stomach, the esophagus passes through a layer of muscle called the diaphragm which separates the lung cavity from the lower abdomen and helps with breathing.  The hole through the diaphragm can sometimes become large enough for part of the stomach to bulge through it. This changes the angle that the esophagus joins the stomach, weakens the ligaments holding the stomach and esophagus in place, and  prevents the LES from working properly. Surgical repair of hiatal hernias is often required.
Food and drink: People react differently to the foods that they eat which makes defining a list of foods that cause or worsen GERD difficult.  Some of the more common problem foods and drinks are:

  • Alcohol: irritates the esophagus and  loosens the LES
  • Caffeine: Coffee and other caffeine containing drinks stimulate stomach acid production
  • Chocolate: relaxes the LED
  • Mint: relaxes the LED
  • Fried and fatty foods
  • Spicy foods and acidic foods

Lifestyle: Eating too quickly, skipping meals and then eating a large meal to make up for it, exercising or lying down after eating, all contribute to the possibility of reflux.
Smoking: The irritant effect of smoke and the tendency to swallow air while smoking and increase stomach pressure can cause reflux.
Next: Symptoms of GERD »