Causes of GERD: Conditions, Medications, and Lifestyle
GERD typically results when your lower esophageal sphincter allows gastric acid from your stomach to flow into your esophagus. Certain conditions, medications, or habits may cause or contribute to this.
Gastroesophageal reflux disease (GERD) is a common condition in which stomach contents come back into your esophagus. This can lead to symptoms like heartburn and tasting food or stomach acid in your mouth.
Even though GERD is common, it can cause serious complications that might have long-term consequences for your health. Some people have trouble swallowing, experience tooth decay, or develop esophageal cancer.
Understanding what causes GERD can help you prevent and manage the condition. While you can’t prevent some risk factors for GERD, you might be able to make some lifestyle changes that reduce your chances of developing it.
How does GERD develop?
The lower esophageal sphincter (LES) is a muscle that helps prevent the backwash of stomach contents into your esophageal tract. The LES is located where your esophagus and stomach meet. The LES should relax to allow food to pass into your stomach, but then close tightly so stomach contents don’t escape.
GERD often results when the LES isn’t closing properly. It’s either weak or relaxes when it shouldn’t.
Several things can affect how the LES functions, including obesity, pregnancy, or smoking. Other conditions can increase your risk of GERD or make it worse, such as hiatal hernia or certain medications.
Hiatal hernia
A hiatal hernia is when the upper part of your stomach pushes through your diaphragm, which sits above it. This can cause the LES to become weak.
A hiatal hernia seldom causes symptoms. But when it does, gastroesophageal reflux is the most common symptom.
Hiatal hernias are often due to increased pressure around the abdominal muscles, such as from pregnancy, heavy lifting, or excessive coughing. A doctor can check for a hiatal hernia using a barium swallow or endoscopy.
Pregnancy
Many people experience GERD during pregnancy. LES pressure goes down as the pregnancy progresses because of an increase in the hormones estrogen and progesterone. As the uterus gets bigger, there’s also more pressure on the gastrointestinal system as a whole, and it can take more time for food to pass through the system.
About 30–50% of pregnant people experience acid reflux during their pregnancy, with increasing severity as the pregnancy progresses.
Obesity
Research links obesity to a higher prevalence of GERD. In a large global study, people with obesity were 35% more likely to develop GERD than people without obesity. They were also more likely to develop complications of GERD.
Obesity can contribute to GERD in the following ways:
- increased pressure within your stomach
- slower transit time of food through the esophagus
- higher exposure to esophageal acid
- higher incidence of problems with the LES
Smoking
Tobacco smoking is another risk factor for GERD. Smoking can lower the LES pressure, causing stomach contents to come back into the esophagus.
Smoking can also lead to less bicarbonate-rich saliva. This saliva is critical to clearing out acid from the esophagus. Smoking can, therefore, cause GERD and make symptoms worse by preventing the removal of acid.
Cannabis use may also contribute to GERD by relaxing the LES. While the link is controversial as research is mixed, experts still advise that doctors consider cannabis use a potential cause of GERD symptoms.
Medications
Certain medications can also cause GERD or make its symptoms worse. Depending on the medication, this might be because it lowers LES pressure, irritates the lining of the esophagus, or increases the time it takes for food to move through the esophagus.
Examples of medications that can cause or worsen GERD include:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- calcium channel blockers
- benzodiazepines
- tricyclic antidepressants
- some asthma medications
- opioids
- oral contraceptives
- GLP-1 agonists like semaglutide (Ozempic) and tirzepatide (Mounjaro)
If you’re taking any medications, you might want to speak with a doctor about your risk of GERD. A doctor might prescribe a different medication or recommend ways to help manage GERD.
Foods that cause acid reflux
Each person has their own trigger foods for GERD. To manage your symptoms, you might start a food diary to find which foods make your symptoms worse. You might also choose to avoid certain foods associated with acid reflux, such as:
- spicy food
- citrus fruits (oranges, lemons)
- tomatoes
- onions
- garlic
- chocolate
- mint
- caffeine
- alcohol
- carbonated beverages (soda, sparkling water)
Lying down within 3 hours of a meal can also contribute to acid reflux, as you no longer have gravity to help keep your stomach acid down.
When to contact a doctor
If you’re at risk of GERD or are experiencing GERD symptoms, a doctor might be able to help. It’s possible they can:
- support you in a program to quit smoking
- recommend strategies to manage obesity
- prescribe alternative prescription medications
- suggest ways to manage GERD during pregnancy
In the case of a hiatal hernia, a doctor might recommend surgery. This depends on how the hernia affects your gastrointestinal system, its severity, and your symptoms.
Frequently asked questions
What is the main cause of GERD?
Your risk of GERD depends on many factors, meaning there are many potential causes. The primary cause is a problem with your lower esophageal sphincter (LES), but many factors can contribute to its dysfunction.
Is GERD caused by a lifestyle?
Several risk factors for GERD are related to lifestyle, such as smoking. Stopping smoking might reduce your chances of developing GERD. Obesity management might also help reduce the risk, so lifestyle interventions like exercise and dietary changes can help.
Does stress cause GERD?
Daily stress doesn’t directly cause GERD. However, it can contribute to obesity and lifestyle habits that can lead to GERD. Stress can also cause you to sense gastrointestinal upset more easily, so you feel GERD symptoms more intensely.
A 2023 Sri Lankan study found that people with higher stress levels were more likely to experience GERD.
Takeaway
The main causes of GERD relate to LES dysfunction. The LES is a muscle that prevents stomach contents from coming back into your esophagus. When your LES is weak or relaxes when it shouldn’t, you can develop GERD.
Hiatal hernia, pregnancy, smoking, obesity, and certain medications can all increase GERD risk.
To reduce symptoms, consider avoiding common trigger foods for acid reflux, like spicy foods, citrus fruits, and carbonated beverages. Avoiding lying down within 3 hours of eating can also help reduce GERD symptoms or the incidence of nighttime acid reflux.
Great post! It’s really helpful to see a comprehensive breakdown of the various factors that can contribute to GERD, from medical conditions to certain medications and lifestyle habits. Understanding these causes can empower people to make informed decisions about their health. Thanks for sharing this valuable information!
Great comprehensive post! It’s essential to understand the various factors contributing to GERD, especially since so many people deal with it daily. The breakdown of conditions, medications, and lifestyle choices as potential causes offers a clear path to identifying and managing symptoms more effectively. Thanks for sharing!
This is a very informative post! Understanding the causes of GERD is crucial for managing it effectively. It’s interesting to see how various conditions, medications, and lifestyle choices can contribute to GERD. It’s a reminder of how interconnected our body systems are and how important it is to maintain a healthy lifestyle to prevent such issues. Thanks for sharing this valuable information!