From the Guidelines
Gastroesophageal reflux disease (GERD) is primarily caused by a combination of factors including dysfunction of the lower esophageal sphincter (LES), obesity, dietary factors, and certain medications, as supported by recent clinical practice updates 1. The etiology of GERD is complex and multifactorial, involving various pathophysiological mechanisms. Key factors include:
- Transient LES relaxations, reduced LES pressure, and anatomical abnormalities like hiatal hernia, which compromise the normal barrier function of the LES
- Obesity, which increases intra-abdominal pressure and forces stomach contents upward into the esophagus
- Dietary factors such as fatty foods, chocolate, caffeine, alcohol, and acidic foods, which can trigger symptoms by relaxing the LES or directly irritating the esophageal mucosa
- Smoking, which damages the LES and reduces saliva production, impairing the body's natural ability to neutralize acid
- Certain medications, including calcium channel blockers, nitrates, anticholinergics, and NSAIDs, which can worsen GERD by relaxing the LES or directly damaging the esophageal lining
- Pregnancy, which commonly causes GERD due to hormonal changes that relax the LES and increased abdominal pressure from the growing fetus
- Connective tissue disorders like scleroderma, which can impair LES function
- Delayed gastric emptying, as seen in gastroparesis, which increases the risk of reflux by prolonging the time acid remains in the stomach Understanding these various causes is crucial for guiding appropriate lifestyle modifications and treatment approaches for GERD management, as emphasized in recent clinical guidelines 1.
From the Research
GERD Etiology
- Gastroesophageal reflux disease (GERD) is defined by recurrent and troublesome heartburn and regurgitation or GERD-specific complications and affects approximately 20% of the adult population in high-income countries 2
- The etiology of GERD is multifactorial, involving a decline in esophageal clearance and anti-reflux barrier mechanisms, as well as mucosal injury caused by gastric juice and immune and inflammatory mechanisms 3
- Risk factors for developing GERD include obesity, tobacco smoking, and genetic predisposition 2
Pathophysiology
- GERD is caused by the reflux of gastric contents into the esophagus, leading to mucosal injury and inflammation 3
- The pathophysiology of GERD involves a combination of gastric juice directly damaging the esophageal mucosa and the immune and inflammatory mechanism in which inflammatory cytokines released from the esophageal mucosal epithelium cause neutrophil migration, triggering inflammation 3
Treatment Options
- Gastric secretion inhibitors, such as proton pump inhibitors (PPIs), are the first-line treatment for GERD 2, 4, 5
- PPIs have been shown to be effective in healing GERD, with mean healing rates pooled from clinical trials ranging from 67% to 91% at 4-8 weeks 4
- Other treatment options for GERD include lifestyle modification, prokinetic agents, and surgery, as well as emerging endoscopic and less invasive surgical procedures 2, 3, 6