The most common gut problem in our modern world: GERD (reflux)

You will see the details of an international study sharing the potential causes of GERD - study on PubMed.

7/16/20246 min read

GERD pain, painful belly - image by Engina Kurt (Pexels)

What is GERD?

GERD stands for Gastroesophageal Reflux Disease. It's a chronic digestive disorder where stomach acid or bile irritates the food pipe lining. This can lead to symptoms like heartburn, chest pain, and difficulty swallowing.

The prevalence of GERD can vary significantly across different countries and regions. However, as of the latest available data:

United States: About 18% to 28% of the population experiences GERD symptoms weekly.

Europe: Estimates suggest a prevalence ranging from 8% to 25%.

Asia: Generally lower prevalence compared to Western countries, with estimates around 5% to 8%.

However, many people don't take it seriously or think it comes with aging, or just don’t pay attention to it. Therefore they never go to doctors, and there is no data about it so I presume the actual numbers are higher.

What are the possible causes?

(GERD) or reflux can be a symptom of various underlying conditions.

These conditions and factors can either directly contribute to GERD by affecting the function of the lower esophageal sphincter or indirectly by altering gastric motility or increasing intra-abdominal pressure. Managing GERD often involves identifying and addressing these underlying factors in addition to symptomatic treatment.

Here are the possible, frequency-based (starting with the most common) conditions that can present with GERD or reflux symptoms (the list might go on but these are the most common ones)

Obesity: Excess body weight can increase abdominal pressure and cause or worsen GERD symptoms.
Certain Foods and Drinks: Spicy foods, fatty foods, citrus fruits, tomatoes, chocolate, caffeine, alcohol, and carbonated beverages can all trigger or worsen GERD symptoms in susceptible individuals.
Hiatal Hernia: When part of the stomach pushes through the diaphragm into the chest cavity, it can cause reflux symptoms.
Medications: Certain medications such as calcium channel blockers, nitrates, antihistamines, and some asthma medications can relax the LES or irritate the esophagus, contributing to GERD.
Pregnancy: Hormonal changes and increased abdominal pressure from the growing fetus can lead to GERD.
Smoking: Smoking weakens the LES and stimulates acid production, increasing the risk of GERD.
Stress: While not a direct medical condition, stress can exacerbate GERD symptoms by increasing acid production and affecting digestive processes.
Delayed Gastric Emptying (Gastroparesis): Delayed stomach emptying can increase the likelihood of reflux.
Esophageal Motility Disorders: Conditions like achalasia or esophageal spasms can disrupt normal swallowing and cause reflux.
Peptic Ulcer Disease: Ulcers in the stomach or small intestine can mimic or contribute to GERD symptoms.
Asthma: The relationship is bidirectional; GERD can exacerbate asthma, and asthma medications can worsen GERD.
Small Intestinal Bacterial Overgrowth (SIBO): Overgrowth of bacteria in the small intestine can lead to excess gas production and contribute to GERD symptoms.
Food intolerance (gluten, dairy, etc.): Intolerance to certain foods can trigger GERD symptoms in susceptible individuals.
Histamine Intolerance: Histamine intolerance can lead to symptoms similar to GERD due to its effects on stomach acid regulation.
Mast Cell Activation Syndrome (MCAS): MCAS can lead to gastrointestinal symptoms, including GERD, due to mast cell activation and release of inflammatory mediators.
Hypothyroidism: Thyroid hormone imbalance can affect gastrointestinal motility and sphincter function, potentially leading to GERD.
Sleep Apnea: Episodes of interrupted breathing during sleep can increase intra-abdominal pressure and worsen GERD symptoms.
Esophagitis: Inflammation of the esophagus, often caused by acid reflux, can lead to similar symptoms as GERD.
Connective Tissue Disorders (e.g., Scleroderma): These can affect the connective tissues of the esophagus, altering its function and leading to GERD symptoms.
Zollinger-Ellison Syndrome: This condition involves tumors that cause overproduction of stomach acid, leading to severe GERD symptoms.
Chronic Cough and Laryngitis: GERD can be an underlying cause of chronic cough or inflammation of the larynx.
Barrett's Esophagus: Chronic GERD can lead to changes in the cells of the lower esophagus, increasing the risk of esophageal cancer.
Dysphagia (Difficulty Swallowing): Conditions that cause difficulty swallowing, such as esophageal strictures, can lead to retention of food in the esophagus and subsequent reflux.
Chronic Kidney Disease: This condition can lead to electrolyte imbalances and metabolic disturbances that may contribute to GERD symptoms.
Medullary Sponge Kidney: A congenital disorder where cysts form on tiny tubes within the kidneys, sometimes causing kidney stones and indirectly contributing to GERD.
Chronic Pancreatitis: Inflammation of the pancreas can affect digestion and lead to abnormalities in the production of digestive enzymes, contributing to GERD.
Gastric Outlet Obstruction: Any condition that blocks the passage of food from the stomach into the small intestine, such as tumors or scar tissue, can cause reflux.
Post-Nissen Fundoplication Syndrome: This can occur as a complication of anti-reflux surgery (Nissen fundoplication), where patients may experience persistent or recurrent GERD symptoms.
Hypercalcemia: Elevated levels of calcium in the blood, often due to conditions like hyperparathyroidism, can lead to increased gastric acid secretion and worsen reflux.
Anorexia Nervosa: Severe weight loss and malnutrition associated with anorexia nervosa can lead to gastrointestinal dysmotility and reflux.
Bulimia: Recurrent episodes of binge eating followed by self-induced vomiting or excessive exercise can lead to GERD symptoms due to frequent exposure of the esophagus to stomach acid.
Gastric Cancer: Tumors in the stomach can obstruct the flow of food and gastric juices, leading to reflux symptoms.
Ehlers-Danlos Syndrome: Connective tissue disorders like Ehlers-Danlos Syndrome can affect the structural integrity of the esophagus and increase the risk of reflux.
Achalasia: A disorder of the esophagus where the lower esophageal sphincter fails to relax properly, leading to difficulty swallowing and reflux.
Zenker's Diverticulum: A pouch that forms at the back of the throat due to weakness in the area, which can trap food and cause regurgitation and reflux.
Dumping Syndrome: Typically occurs after gastric surgery, where food moves too quickly from the stomach into the small intestine, leading to reflux symptoms.
Cystic Fibrosis: A genetic disorder affecting the lungs and digestive system, including the pancreas, which can lead to malabsorption and GERD.
Gastrectomy: Surgical removal of part or all of the stomach can alter digestive processes and increase the risk of reflux.

STUDY - Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease

A comprehensive search of PubMed, EMBASE, CNKI, and CBM databases, 72 articles were identified, including studies from 10 Western countries (26 articles) and 9 Eastern countries (46 articles).

This systematic review examines the relationship between dietary and lifestyle factors and the onset of GERD. Through a

The review found significant associations between GERD and various dietary and lifestyle habits. Irregular habits such as midnight snacking, skipping breakfast, eating quickly, consuming very hot foods, and overeating increased GERD risk.

Vegetarian diets and limited meat intake were associated with a reduced risk of GERD.

A high-fat diet, short intervals between dinner and bedtime, smoking, alcohol consumption, and poor mental health tended to increase the risk of developing GERD.

Antioxidant intake, particularly vitamins C and E, showed a protective effect against reflux esophagitis (RE) and Barrett's esophagus (BE). These findings suggest that diet and lifestyle modifications are crucial in managing and preventing GERD, and further studies are necessary to confirm these associations.

Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal condition characterized by heartburn and regurgitation. It involves the invasion of stomach contents into the esophagus and dysfunction of the esophageal antireflux barrier. Factors such as age, sex, race, genetics, diet, and lifestyle influence GERD. The incidence of GERD is rising globally, with significant regional differences. The highest incidence is in Europe and the United States (up to 20%), and the lowest is in Asia (around 10%). Treatment includes lifestyle modifications, proton pump inhibitors (PPIs), and surgery. With concerns about the long-term use of PPIs, diet and lifestyle changes are increasingly important for managing GERD.

A comprehensive literature search was conducted in PubMed, EMBASE, CNKI, and CBM databases for articles related to diet and lifestyle factors affecting GERD, published before March 2020.

A total of 72 articles were included: 26 from Western countries and 46 from Eastern countries. Factors were classified into dietary (20 items) and lifestyle (11 items) categories. The results were synthesized based on disease types (GERD, NERD, RE, BE). Out of 72 articles, 42 discussed GERD-related factors, 6 NERD-related, 15 RE-related, and 18 BE-related.

Dietary and Lifestyle Factors:

GERD:

Tends to decrease with: Vegetarian diets, fruits, vegetables, vitamins (C and E), fiber.

Tends to rise with: Protein, fat, high-fat diets, snacking at night, overeating, strong tea, soft drinks, infrequent milk intake, smoking, alcohol, poor mental health, short intervals between dinner and bedtime.

NERD (Non-erosive reflux disease)

Tends to decrease with Vegetables, fruits, milk, tea.

Tends to rise with: Poor eating habits, raw/cold/spicy foods, high-fat/calorie diets, smoking, alcohol, poor mental health, insomnia, increased abdominal pressure.

RE ( Reflux Esophagitis)

Tends to decrease with: Vitamins and micronutrients.

Tends to rise with: Frequent consumption of liquids, coffee, strong tea, smoking, alcohol, poor mental health.

BE (Barrett's Esophagus)

Tends to decrease with: Vegetables, vitamins, micronutrients, fiber.

Tends to rise with: Coffee, tea, fruit, smoking, alcohol (except beer and wine), standing occupational activity.

Conclusion:

Dietary and lifestyle factors play a crucial role in the onset and management of GERD. While protein and fat intake, smoking, and alcohol consumption increase GERD risk, vegetarian diets and antioxidant intake offer protective benefits. These associations underscore the need for personalized dietary and lifestyle recommendations for GERD patients and further research to confirm these findings.

References: Zhang, M., Hou, Z.-K., Huang, Z.-B., Chen, X.-L., & Liu, F.-B. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055252/

Our thoughts

The human body is a complex system. GERD is most probably “just” a side effect of another underlying issue.

In one of our team's case the so called underling issue was SIBO and histamine intolerance. Once she started a low fodmap diet to treat SIBO and low histamine diet for histamine intolerance to decrease the inflammation in the body, the GERD went away.

Everybody is different so you need to search for the potential cause. I hope the above information about GUT HEALTH will help and facilitate you to reach health. Never give up until you get to the root cause of your condition.