| Causes and Risk Factors* |
| Written by Thomas Gibson | |
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In people with GERD, the LES does not work properly. First of all, the contractions are too weak to prevent reflux. In other words, the door between the esophagus and the stomach is never completely closed, so the food leaks back in. Second of all, relaxations take place even when a person is not swallowing, and they last several minutes instead of a few seconds. The door opens by itself, and the esophagus doesn't close it in time. These "transient LES relaxations" tend to take place right after patients have eaten a large meal and have full stomachs. A third abnormality of the LES in patients with GERD is the tendency to open the door more widely than necessary, leaving a large hole rather than a small gap. This allows a lot more food to slip through in the wrong direction. When a malfunctioning LES leaves the stomach open too wide, for too long, or at the wrong time, its mixture of acid, food and liquid can leak into the esophagus, where it can cause heartburn and damage the esophageal lining Certain medical conditions tend to increase the chances of getting GERD. These conditions include pregnancy, hiatal hernia and scleroderma. In a hiatal hernia, the stomach gets out of whack and sits on top of a muscle called the diaphragm, whose normal location is between the chest and abdomen. Scleroderma is a disease of the connective tissues -- the fat cells, bone, cartilage, ligaments and tendons that give the body its shape. It causes collagens to accumulate in skin and other internal organs. As a result of both these diseases, the stomach digests more slowly than normal, and fills up more quickly, putting pressure on the LES. The valve weakens, opens slightly, and half-digested food gets backed up into the esophagus, causing heartburn. People who are obese or consume large amounts of cigarettes and alcohol are also particularly susceptible, as are users of any of the following medications: tricyclic antidepressants, sedatives, bronchodilators for asthma, Progestin for birth control and abnormal menstrual bleeding, Anticholinergics for motion sickness, calcium channel blockers for high blood pressure, and dopamine-active drugs for Parkinson's disease. Normally, the lower esophageal sphincter relaxes and opens the valve to the stomach for a few seconds at a time while a person is swallowing. Acid reflux only occurs if the LES opens at any other time, or stays open for longer than usual. A small number of people, however, develop a weak LES in which the valve doesn't close well, and although they are a tiny minority in the larger population, they constitute 25% of GERD sufferers. In addition to the diseases and disorders mentioned above, there are also foods that can relax the valve and increase the likelihood of reflux. Among them are mint, onions, chocolate, and any foods rich in sugar, fat, spices, or caffeine. If reflux has already inflamed the esophageal lining, sour foods like tomatoes or oranges, and spicy foods like curry or hot sauce, can give people a bad case of heartburn. Pregnant women are susceptible to GERD and heartburn because, first, the hormonal changes relax their muscles and slow their digestive system, and second, the weight of the baby they are carrying can put pressure on their abdomen. In healthy people, the esophagus contracts in response to leaky stomach juices, pushing them back into the stomach in an automatic muscle movement called peristalsis. The saliva (commonly known as spit) that we produce while chewing and swallowing also helps protect the esophageal lining because it contains bicarbonate, which neutralizes stomach acid. Cigarette smoking and some other habits increase the risk of GERD because they cause the body to produce less saliva and weaken our natural tendency to neutralize acid. To sum up, our body produces acid during normal digestion. Acid has the potential to damage internal organs, but our natural defenses, such as the LES, which blocks off the stomach from the esophagus, and our saliva, which neutralizes acid by turning it into salt, help to protect us. In GERD, these natural defenses are overwhelmed by the sheer quantity of stomach juices accumulating in the esophagus. Because the body cannot remove them quickly enough, they cause irritation and inflammation. The telltale symptom of this is heartburn -- pain, burning and unnatural warmth in the area behind the breastbone. * This article is based on the information at http://www.mayoclinic.com/health/gerd/, http://www.nlm.nih.gov/medlineplus/ency/article/000265.htm, http://www.webmd.com/heartburn-gerd/tc/gastroesophageal-reflux-disease-gerd-symptoms, http://www.gerd.com/, ttp://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/article.htm |
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