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Gastroesophageal reflux disease (GERD) is a disorder of the esophagus that causes frequent symptoms of heartburn. The esophagus is the tube connecting the mouth to the stomach. GERD occurs when a muscular ring called the lower esophageal sphincter (LES) is weakened, which permits irritating stomach contents to pass up into the esophagus, resulting in heartburn.
Sometimes regurgitation of acid and food as high as the mouth can occur. Chronic irritation of the esophagus by stomach acid can eventually cause ulceration and scarring and might lead to cancer of the esophagus, especially in people who smoke and/or consume large amounts of alcohol.1
People with GERD have heartburn, which usually feels like a burning pain that begins in the chest and may travel upward to the throat. Many people also feel a regurgitation of stomach contents into the mouth, leaving an acid or bitter taste. Some people with GERD may also have coughing while lying down, increased production of saliva, and difficulty sleeping after eating.
Smoking weakens the LES and is a strong risk factor for GERD.2, 3, 4 A study of infants with GERD found that exposure to cigarette smoke in the environment is associated with reflux, leading the authors conclude that secondhand smoke contributes directly to GERD in infants.5 No similar studies on environmental smoke have been done with adults. Psychological stress and alcohol have also been shown to be associated with the weakening of the LES and symptoms of GERD.6, 7, 8, 9
A number of studies have found that obesity increases the risk of GERD,10, 11 though one study found no association between severe obesity and GERD.12 Obese people tend to have weaker sphincters,13 and they more often develop a condition related to GERD called hiatal hernia, in which the upper part of the stomach protrudes above the diaphragm, resulting in a deformed LES.14 It has been suggested that obesity may contribute to GERD by increasing abdominal pressure, but this mechanism has not been proven.15 The benefit of weight loss for obese patients with GERD is controversial. Some researchers have found that symptoms of GERD are reduced with weight loss,16 while others have seen no change with weight loss and even increased symptoms in patients with massive weight loss.17
Lying down prevents gravity from keeping the stomach contents well below the opening from the esophagus. For this reason, many authorities recommend that people with GERD avoid lying down sooner than three hours after a meal, and suggest elevating the head of the bed to prevent symptoms during sleep.18, 19, 20
GERD occurs more frequently during exercise than at rest, and can be a cause of chest pain or abdominal pain during exertion.21 One study found that increased intensity of exercise resulted in increased reflux in both trained athletes and untrained people.22 In another study, running produced more reflux than less jarring activities, such as bicycling, while weight training produced few reflux symptoms.23 Eating just before exercise has been found to further aggravate GERD.24, 25 On the other hand, a recent survey found that people who participate in little recreational activity were more likely than active people to be hospitalized for GERD.26 It makes sense for people with GERD to use exercise as part of a healthy lifestyle, perhaps choosing activities that are less likely to cause reflux symptoms.
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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2014.