What are the main factors behind GERD disease?

Gastro-oEsophageal Reflux Disease (GERD) is a common medical disorder affecting millions of adult globally each year. It is commonly known by the public as “gastric” or “reflux disease” or simply by the major symptom is presented, that is, heartburn. GERD happens due to the sphincter muscle that prevents the backflow of stomach acid on the lower oesophagus becomes weakened.

A weakened sphincter enables the backflow of acid into the lower oesophagus causing the symptoms such as heartburn, chest pain, night cough and change in taste in the mouth. GERD is usually diagnosed clinically, which means, it is identified based on the patient’s symptoms history and physical examination. It is not known why GERD happens but there are several risk factors that may cause it such as:

  1. Smoking and Drinking Alcohol

Smoking is believed to be a significant risk factor based on the epidemiological (previous population control) data gathered for the past decades. It is postulated the nicotine content in cigarette smokes causes reduction in saliva which is important for acid clearance in the oesophagus.

Alcohol, on the other hand, is a natural irritant towards most surfaces either biological like the oesophagus sphincter or non-biological. Frequent consumption of alcohol or taking a large amount of alcohol weakens the sphincter and corroding the oesophageal wall.

  1. Increase intra-abdominal pressure (Pregnancy and Obesity)

The pathophysiology of this factor is simply a straightforward one as an increase in pressure in the abdominal space due to pregnancy or obesity, pushes the stomach and diaphragm upwards. This, in turn, causing more stomach acid to spill into the oesophagus and weakened the sphincter integrity. This is why it is advisable for pregnant or overweight people to sleep with more pillows to elevate the head and prevent frequent acid reflux.

  1. Hiatus Hernia

Hiatus hernia is an anatomical disorder where a part of the stomach bulging or pushes through the little space that separates the lower oesophagus and the stomach, called diaphragm. The resulting hernia causes an increase in pressure above the diaphragm thus enabling stomach acid to rise into the oesophagus tube.

  1. Medications

Certain medications can relax the sphincter such as drugs that belong to anti-muscarinic, calcium-channel blocker and nitrates group. Examples are like atropine, ipratropium bromide, amlodipine and glyceryl trinitrate (GTN).

  1. Having frequent large meals

Having large meals not only predisposes you to a higher chance of being overweight but also put stress to your lower oesophageal sphincter. The sphincter needs to work harder to prevent the stomach acid reflux when you eat a large meal and this is worsened if you are going straight to sleep your meal.

  1. Eating fried foods, caffeinated drinks and chocolates

All these have been shown to worsen GERD symptoms due to increase acidity level of the stomach acid which irritates the sphincter. Cutting back these foods/caffeine have been shown to improve the GERD symptoms for many patients.

GERD treatments in Malaysia involves the patient’s active involvement together with effective medication provided by the doctor. The condition can be a lifelong disorder if not tackled appropriately hence the need to know the causing factors as well as their proven management steps.