Anyone who eats a lot of acidic foods can have mild and temporary heartburn. This is especially true when lifting, bending over, or lying down after eating a large meal high in fatty, acidic foods. Persistent GERD, however, may be due to various conditions, including biological or structural problems.
Malfunction of the Lower Esophageal Sphincter (LES) Muscles
The band of muscle tissue called the LES is responsible for closing and opening the lower end of the esophagus, and is essential for maintaining a pressure barrier against contents from the stomach. For it to function properly, there needs to be interaction between smooth muscles and various hormones. If it weakens and loses tone, the LES cannot close completely after food empties into the stomach. Acid from the stomach backs up into the esophagus. Dietary substances, drugs, and nervous system factors can weaken the LES and impair its function.
Impaired Stomach Function
Patients with GERD have abnormal nerve or muscle function in the stomach. These abnormalities prevent the stomach muscles from contracting normally, which causes delays in stomach emptying, increasing the risk for acid back-up.
Abnormalities in the Esophagus
Some studies suggest that most people with atypical GERD symptoms (such as hoarseness, chronic cough, or the feeling of having a lump in the throat) may have specific abnormalities in the esophagus.
Motility Abnormalities. Problems in spontaneous muscle action (peristalsis) in the esophagus commonly occur in GERD, although it is not clear whether such problems cause the condition, or are the result of long-term GERD.
Review Date: 07/11/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.