Is GERD triggered by more than just our eating habits?

Acid reflux is a normal process where acidic content of the stomach flows up the esophagus, causing a burning sensation in the upper stomach or chest. It is common for people —including myself— to experience acid reflux from time to time. However, frequent reflux can irritate the lining of the esophagus, giving rise to a condition known as gastroesophageal reflux disease (GERD).

What is GERD?

The lower end of the esophagus contains a circular ring of muscle that connects the gut to the stomach. If the muscle is working properly, it relaxes and opens normally when you swallow and tightens and closes after. GERD occurs when this ring of muscle is weak, causing digestive juices from your stomach to push up into your esophagus. This constant backwash of acid irritates the lining of the esophagus, causing it to become inflamed. 

GERD is one of the most common gastrointestinal disorders and affects about 20% of the population. It’s been found that obese individuals are more likely to develop GERD. This increased risk is thought to be due to excess belly fat that causes pressure on the stomach, resulting in the back flow of acid.

What are the symptoms of GERD?

Some common signs of GERD include: 

  • Heartburn especially after eating that may worsen at night
  • Chest pain
  • Difficulty swallowing
  • Regurgitation of food or liquid that tastes sour
  • Feeling of a lump in your throat

Additionally, I should add that if you experience constant acid reflux more than twice a week or take medication frequently for heartburn, it is in your best interest to see a doctor.

Other risk factors for GERD

Besides being obese, the following factors may increase your risk of getting GERD. I will explain why.

Ageing
As we age, our body goes through various changes and starts to wear out. The same goes for our stomach and esophagus. Naturally, degradation of the gastroesophageal junction and progressive impairment of clearance in the esophagus due to age will lead to reflux and eventually GERD.

Pregnancy
Most pregnant women experience symptoms of GERD or heartburn at some point during their pregnancy. This is due to hormones that cause the digestive system to slow down. As a result, the muscles that push food down the esophagus also move at a slower pace. Further into the pregnancy, as the uterus grows, symptoms of GERD might be more common due to the uterus pushing on the stomach, forcing stomach acid up the esophagus. If you were diagnosed with GERD before becoming conceiving, your symptoms might be worse during the pregnancy.

Smoking
Smoking relaxes smooth muscle inside the body, including the lower esophageal sphincter. When this sphincter is relaxed, the probability of acid flowing into the esophagus and damaging it increases. Research has linked smoking to some of the worst complications of GERD, including throat cancer. Many of my patients who smoke often find relief from their constant acid reflux once they quit smoking. 

Certain medication
Prolong use of certain medications —especially those related to aspirin therapy— such as ibuprofen, nifedipine and codeine have been found to stress the stomach lining and can lead to GERD. It does not matter even if the dosage is low — so long as long term use is there, the damage still exists. A 2018 study done on rats found that the group with constant aspirin doses had a 36.5% increase in GERD. 

Asthma
More than 75% of patients with asthma experience GERD. More research is needed to understand the relationship between asthma and GERD, but it’s believed that pressure changes inside the chest and abdomen during an asthma attack cause the esophageal sphincter muscles to relax, causing stomach acid to flow back up.

Does anxiety trigger GERD?

There is no scientific evidence that demonstrates the link between anxiety and increased stomach acid, and several tests conducted on individuals with anxiety show that they have normal esophageal acid levels. Yet, a 2015 study found that anxiety increases the symptoms associated with GERD, such as upper abdominal pain and heartburn. One reason is that anxiety makes you more sensitive to pain; the second being anxiety and psychological distress impacts esophageal mobility and the functioning of the lower esophageal sphincter. 

Further, the negative effects of GERD can affect quality of life, increasing feelings of anxiety. Unfortunately, this creates a vicious cycle between anxiety and GERD. If you suspect your anxiety might be causing you to experience symptoms of GERD or the other way around, I suggest you speak to a trained professional who can help you. And if you need treatment for GERD, I’ll be happy to prescribe treatment.

What can I do to prevent or reduce GERD?

To prevent the recurrence of GERD, you should cut back on the factors that trigger acid reflux as well as make some lifestyle changes. For example, if you are overweight, it would help for you to lose some weight. Similarly, if you smoke, it will make a big difference to quit smoking. If smoking cessation is not possible, then try to at least refrain from smoking immediately after meals. 

Avoid overeating and recognise trigger foods that cause you to have symptoms, and try not to lie down immediately after meals. If you need to take medication that tends to irritate your gut, make sure to drink plenty of water along with it.

References

  1. Masuda, T., Yano, F., Omura, N., Tsuboi, K., Hoshino, M., Yamamoto, S. R., Akimoto, S., Kashiwagi, H., & Yanaga, K. (2018). Effect of Low-Dose Aspirin on Chronic Acid Reflux Esophagitis in Rats. Digestive diseases and sciences, 63(1), 72–80. https://doi.org/10.1007/s10620-017-4840-3
  2. Chang, P., & Friedenberg, F. (2014). Obesity and GERD. Gastroenterology clinics of North America, 43(1), 161–173. https://doi.org/10.1016/j.gtc.2013.11.009
  3. Kessing, B. F., Bredenoord, A. J., Saleh, C. M., & Smout, A. J. (2015). Effects of anxiety and depression in patients with gastroesophageal reflux disease. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 13(6), 1089–95.e1. https://doi.org/10.1016/j.cgh.2014.11.034

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