Causes of GERD

Gastro-oesophageal reflux disease (GERD) happens when stomach acid and contents flow back up into the food pipe (oesophagus) often enough to cause symptoms or damage. Occasional reflux is normal. GERD is reflux that is frequent or troublesome.

The main mechanism

A ring of muscle at the lower end of the food pipe, the lower oesophageal sphincter, normally acts as a valve. In GERD it relaxes at the wrong times or is weak, so acid escapes upwards.

Common causes and contributors

• Hiatal hernia: part of the stomach slides up through the diaphragm
• Obesity and weight gain, especially around the belly
• Pregnancy: hormones relax the valve and the womb presses on the stomach
• Large, late or oily meals, and lying down soon after eating
• Smoking and alcohol
• Delayed stomach emptying, including in diabetes
• Some medicines: certain painkillers (NSAIDs), calcium channel blockers, some sedatives and asthma drugs
• Tight clothing and bending after meals

Foods that trigger symptoms in some people

Fried and spicy food, chocolate, tea, coffee, fizzy drinks, citrus, tomato and mint. Triggers vary, and they worsen reflux rather than being the root cause.

Ayurvedic view

Ayurveda discusses these symptoms under Amlapitta, with aggravated Pitta and weak digestive fire. This is an interpretive framework with limited evidence.

Key point

Most causes can be improved with weight loss, meal timing and stopping smoking. Chest pain should never be assumed to be reflux without a medical check.