What causes heartburns, acid reflux and GERD? This must be a nagging question if you suffer from one of these medical conditions or know someone who does. Well, acid reflux occurs when one has a weakened or dysfunctional Lower Esophageal Sphincter (LES) valve. This is a band of muscles located at the lower end of the esophagus (gullet/food pipe) and it maintains a pressure barrier that prevents food contents from going the wrong way once swallowed and passed through your digestive tract.
Therefore, when the esophageal valve fails to shut tightly, stomach acid splashes up the gullet, causing a host of symptoms including the burning irritation and pain in the chest that we commonly call heartburn.
It’s not always clear what causes the LES to become weak or defective. However, there are still a number of factors that have been associated with the malfunction of the LES muscle. Some of the causes this can result in include acute acid reflux accompanied by occasional episodes of heartburn. Other causes can lead to the chronic form of acid reflux known as GERD.
Top Causes of Acid Reflux
- Underlying Medical Conditions
Certain medical conditions can weaken the LES and cause acid reflux. These include:
- Hiatal Hernia
The diaphragm usually has a small opening called a hiatus. It serves as an opening that allows the esophagus to pass through and connect with the stomach. Although the food pipe fits snugly around this hole, certain conditions can cause it to weaken or enlarge. This in turn forces a portion of the stomach to protrude into the chest area, resulting in a condition called hiatal hernia.
Since the diaphragm supports the lower end of the esophagus, this condition can impair LES muscle function. While studies have not been able to back up this claim with evidence, many people with GERD reportedly have hiatal hernia. If you’re suffering from acid reflux, you may have a hiatal hernia and not even know it.
The good news is that hiatal hernia doesn’t always cause acid reflux since heartburn and other acid reflux symptoms occur only when the lower esophageal sphincter muscle fails.
Much like pregnancy, obesity increases pressure in the abdominal cavity. This pressure may just be enough to throw the lower esophageal sphincter muscle out of its proper position, forcing food and stomach acid to come back up the food pipe. Obese individuals who suffer from acid reflux should be glad to know that losing weight often helps to stop the symptoms.
- Low Pressure LES
Some people simply have a Lower Esophageal Sphincter muscle that doesn’t put enough pressure to block stomach contents from sneaking up the gullet. It’s not clear why healthy individuals sometimes have a defective LES. However, patients suffering from this condition can seek treatment through a minimally invasive procedure called fundoplication.
Many expectant women report of heartburn during pregnancy. Health experts believe that hormonal changes during the first trimester tend to weaken and relax the LES. Add this to the increased abdominal pressure from a growing uterus, and you have two factors that predispose pregnant women to acid reflux. Fortunately, acid reflux symptoms tend to disappear after child birth.
- Slow Digestion/Gastroparesis
Scientific research has established that some patients who suffer from chronic GERD tend to have Gastroparesis or slow digestion. With this condition, the stomach suffers from impaired motility, which is basically a problem in spontaneous muscle action. When the stomach muscles are not able to contract the way they should, this causes delayed gastric emptying.
Under normal circumstances, HCL acid produced in the stomach flows into the small intestines. But if it stays in the stomach for too long, it will eventually flow back into the esophagus and cause heartburn.
While Gastroparesis is an unusual cause for heartburns, it mostly develops in diabetic patients. It’s also believed that diabetic patients tend to develop GERD because of high sugar that damages the nerves meant to guide food through the digestive tract.
- Esophagus or Gastrointestinal Disorders
Besides heartburns, GERD can instigate a number of symptoms such as difficulty in swallowing, the feeling of a lump in the throat, hoarseness, and chronic coughing. In some cases, the symptoms present themselves due to an underlying abnormality in the esophagus.
For instance, Adult-Ringed Esophagus is a condition that causes food pipe muscles to develop multiple rings, thus making peristalsis (or the involuntary muscle contractions that move food) along the gullet difficult. This condition often occurs in men and can contribute GERD symptoms.
The esophagus can also suffer from motility abnormalities, which is the inability of muscles to act spontaneously. This causes the LES to relax involuntary and result in acid reflux. It’s not known whether such abnormalities are as a result of long-term GERD effects or some other cause.
Other gastrointestinal disorders and illnesses that can bring about GERD symptoms include Crohn’s disease, Peptic Ulcers, Esophageal Cancer, Scleroderma and Sarcoidosis.
Studies indicate at least half of all asthma patients suffer from GERD symptoms. According to health experts, asthma patients are at risk because of violent episodes of coughing and sneezing. It’s also suspected that asthmatic attacks cause changes in pressure inside the chest cavity, thus triggering acid reflux.
- Food/Diet Triggers
If you suffer from frequent heartburns after eating, chances are you’ll need to start watching your diet. This is because certain foods and beverages can relax the LES and cause acid reflux. These include:
- Fried or high fat foods like fries, high fat cuts of meat etc
- Whole milk dairy products
- Caffeinated beverages such as coffee, tea, cocoa and soft drinks
Other heartburn trigger-foods do not necessarily relax the lower esophageal sphincter muscle. They instead stimulate increased acid secretion, which in turn sets the stage for heartburn. In case of carbonated drinks as the bubbles expand inside the stomach the increased pressure promotes reflux. If you frequently feel a burning sensation in your chest after eating, be sure to avoid the following types of foods:
- Acidic foods (e.g tomatoes or citrus fruits such as grapes, oranges and lemons)
- Spicy foods (e.g. meals cooked with black pepper)
- Acid beverages like pineapple and orange juice
- Carbonated drinks such as soda
- Acidic beers, liquors or wine
Since everyone is different, it may be a good idea to keep a food diary to determine which specific foods are problematic to you.
- Life Style Causes
Chronic acid reflux can develop as a result of certain lifestyle choices. For example, people who indulge in the following activities can suffer from recurring episodes of heartburn and other acid reflux symptoms.
- Overeating and Poor Meal Timings
It’s important for you to be aware that how much you eat and how often you do so play huge roles in determining the occurrence of heartburns. For instance, eating large meals doesn’t just leave you stuffed, but also puts undue pressure on the lower esophageal sphincter muscle. If the LES cannot hold up to a full belly, stomach acid will reflux into the gullet.
In addition, eating close to bedtime can cause bedtime heartburn. If you happen to be susceptible to acid reflux, allow food to digest 2 to 3 hours before going to bed. When lying down, stomach acid has a higher chance of seeping up into your throat, which makes nighttime heartburn more likely.
Studies indicate that tobacco from cigarette smoke tends to relax the lower esophageal sphincter muscle. Consequently, smoking causes acid to reflux into the esophagus.
Alcohol consumption may increase symptoms of acid reflux and cause damage to the esophagus. This can be attributed to the fact that beer, liquor, and wine tend to relax the LES, allowing reflux of stomach contents into the food pipe.
If any of the abovementioned factors form part of your lifestyle and you find the heartburns unbearable at times, you should make some lifestyle changes such as:
- Quitting smoking
- Avoiding alcohol consumption
- Manage your diet and lose weight
Certain drugs can cause acid reflux symptoms or lead to the development of GERD. For instance, certain medications relax the lower esophageal sphincter muscle, thus allowing it to leak stomach contents into the gullet. Such medications include:
- Nitrates – which help in the treatment of heart related chest pain/angina
- Calcium channel blockers – often administered to patients with high blood pressure
Some drugs may irritate the gullet and contribute to esophagitis (or inflammation of the esophagus). Examples include:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
There are numerous NSAIDs, some of which include ibuprofen, aspirin, and naproxen. These anti-inflammatory medications contain analgesic properties and help to relieve pain. However, NSAIDs not only increase the likelihood of developing GERD, but can also aggravate the severity of the condition in people who already have it.
- Selective Serotonin Reuptake Inhibitors (SSRIs)
These are medications that are used to treat depression.
Corticosteroids are a type of steroid based medication used for treatment of severe symptoms of inflammation.
Bisphosphonates are drugs used to treat osteoporosis.
A couple of other drugs can cause GERD too. These include antibiotics as well as potassium and iron pills. However, it’s important to note that people who take any of the mentioned drugs occasionally may not necessarily develop GERD.
5. Physical Factors
Certain physical factors can force food or stomach contents to wash back into the gullet. This happens mostly when the lower esophageal sphincter muscle experiences pressure. For instance, stomach acid may be forced up the food pipe and cause heartburns when you:
- Bendi over, especially when exercising
- Lie down on your back after meals
- Wear tight clothing
6. Stress and Anxiety
Do you find GERD acting up the most when you’re stressed? That shouldn’t be surprising given that studies have indicated that stress and anxiety can trigger heartburns. For example, in a 1993 study, researchers found that patients who suffer from chronic anxiety might experience mild esophageal stimuli, which manifests as painful acid reflux symptoms.
7. Genetic Factors
People who have a family history of GERD are genetically predisposed to this condition. Susceptibility also exists among individuals who have a history of Barrett’s esophagus, which is a precancerous condition caused by severe GERD. There’s evidence of inherited risk in many GERD cases and research indicates that 31 to 43% of cases might be hereditary. Researchers further speculate that offspring of GERD sufferers could inherit a gene associated with muscular or structural problems in the stomach and/or esophagus.While the symptoms of heartburn, acid reflux and GERD share many similarities, it should be noted that these medical conditions are not one and of the same. If you’re not sure what’s causing heartburns or other acid reflux symptoms, make sure to consult a doctor for proper diagnosis. Keep in mind that treatment options will largely depend on what is causing acid reflux to occur in the first place.