Gastresophageal reflux disease (GERD) is a syndrome due to structural or functional incompetence of the lower esophageal sphincter, which permits retrograde flow of acidic gastric juice into the esophagus. The underlying abnormality in GERD is apparently inborn and irreversible and the incidence increases with age. In addition to reflux, most cases involve disordered gastric motility and prolonged gastric emptying time. Symptoms include recurring epigastric (area below the breastbone) and retrosternal (behind the sternum) distress, usually described as heartburn, along with varying degrees of belching, nausea, gagging, cough, or hoarseness. GERD is more common in men.

There are certain lifestyle factors that aggravate GERD. Most of these factors affect certain characteristics of the esophagus or the stomach. These factors may either reduce the lower esophageal sphincter (LES) pressure, directly irritate the esophageal mucosa, increase the intraabdominal pressure, promote reflux due to factors related to gravity, or affect the gastrointestinal tract in some mechanism that depends on a lot of factors and varies greatly from individual to individual. The latter, of course, pertains to emotional disturbances.

The LES is the musculature of the junction between the stomach and the esophagus which is tonically active except during swallowing and is responsible for preventing the reflux of food in the stomach towards the esophagus. Certain foods that lower the LES pressure include fats, sugar, chocolate, onions and coffee. Eating large meals also promote reflux. Smoking and alcoholism, the culprits of a wide array of diseases, also reduce the LES pressure. Medications that could lower the LES pressure include theophylline, anticholinergics, diazepam, nitrates, calcium channel blockers and even progesterone — a naturally occurring hormone that can be synthesized artificially for use as a contraceptive.

The esophageal mucosa is a mucus-secreting membrane lining the inner surface of the esophagus. Its mucous secretion helps lubricate the food just swallowed and hence allow easy and quick passage of food towards the stomach. Foods that directly irritate this layer include citrus products, tomato-based products, spicy foods, tea, cola drinks and (again) coffee. Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), tetracycline, quinidine, aldreonates, potassium tablets and iron salts are the medications that may directly irritate the esophageal mucosa.

Intraabdominal pressure, in a layman’s parlance, is the pressure within the belly. When this is increased as when you bend over, lift some weight, strain at your stool and even when you exercise, your GERD symptoms may occur or may even be exacerbated.

When you lie supine (lie face upward) or lie on the right side, gravity tends to pull your gastric contents downward, promoting reflux.

In addition, the likelihood of symptomatic reflux may be increased by obesity, pregnancy, diabetes mellitus, scleroderma, and other connective tissue diseases.

Acid reflux can cause peptic esophagitis, ulcer formation, or esophageal stricture. Metaplastic changes in esophageal squamous epithelium, called Barrett's esophagus, can progress to carcinoma. So you better read this article again and do what you have to do. What? You don’t think GERD can be fatal? Think again. If you still don’t believe it, just let others read this and you may become a hero — after you die of course.

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