Gastroesophageal reflux disease, or GERD, affects roughly 20% of the U.S. population. Understanding the causes and risk factors of this condition can help you decide if you should discuss GERD with your healthcare provider.

GERD is a spectrum of diseases marked by chronic acid reflux, which occurs when acidic digestive juices leak out of the stomach and into the esophagus. The most common symptoms of GERD are frequent heartburn and regurgitating acid. Other symptoms include:

• Difficulty swallowing
• Sensation of having a lump in your throat
• Coughing
• Bad breath
• Nausea
• Hoarseness of the voice
• Sore throat

If you suffer from GERD, you may not experience all of these symptoms. In fact, it’s possible to have GERD and not get heartburn.

To understand the root cause of GERD, you first need to know a little bit about how the upper digestive system works.

After you chew and swallow food, it travels down the esophagus, propelled by muscle contractions. When it reaches your stomach, a ring-like muscle called a sphincter opens, allowing the food to pass through. It then closes again to keep the stomach’s contents contained. In the stomach, a combination of acidic digestive juices and muscle contractions break down the food so your body can absorb nutrients.

In people with GERD, the sphincter muscle at the top of the stomach relaxes abnormally, allowing food and digestive fluid to escape and enter the esophagus, causing irritation.

Certain characteristics and health conditions can make a person more likely to develop a weak sphincter muscle and suffer from GERD. The following are some major risk factors for the condition.

1.    Obesity: Excess body fat places pressure on the sphincter muscle, making it more likely to relax when it shouldn’t. As a result, people who are overweight or obese are more likely to develop GERD.

2.    Pregnancy: As the belly grows during pregnancy, more pressure gets applied to the stomach sphincter muscle, and hormones involved in pregnancy can affect the sphincter tone and gastric emptying. Some women develop daily heartburn and acid reflux during pregnancy, leading to GERD.

3.    Hiatal hernia: Common in older adults, a hiatal hernia occurs when the top part of the stomach protrudes through an opening in the diaphragm, the muscle located below the lungs that aids in breathing. The bulging of the stomach can lead to dysfunction and less support of the sphincter muscle, causing heartburn and GERD.

4.    Dietary habits: Certain dietary habits can lead to repeated acid reflux, such as:

• Consuming large meals
• Drinking coffee, alcohol and other beverages that can relax the esophageal sphincter
• Eating meals close to bedtime
• Frequent consumption of fatty and fried foods

5.    Smoking: Smoking cigarettes has been shown to weaken the stomach sphincter, contributing to GERD. People who are exposed to secondhand smoke on a regular basis may also be more at risk for developing the condition.

6.    Medications: Certain prescription and over-the-counter drugs can cause GERD or make symptoms more severe. These include:

• Certain asthma and allergy medications
  
• Benzodiazepines
• Calcium channel blockers
• Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen
• Tricyclic antidepressants

Other medical conditions: Medical conditions that affect connective tissue, like scleroderma, can make a person more likely to suffer from GERD. Additionally, medical issues like nerve damage, which can cause delays in stomach emptying, can also raise the risk of developing GERD.

If you have risk factors for GERD or you’re experiencing bothersome symptoms, talk to your healthcare provider. They can recommend lifestyle and dietary changes that may lower the likelihood of you developing this condition in the future. For those who already have GERD, treatments like prescription medications and surgery are available. Your healthcare provider can explore treatment options with you and give you advice on how to manage symptoms.

Published December 2023