Internal factors of GERD

Gastroesophageal reflux disease(GERD) or acid reflux is a condition in which the liquid content of the stomach (acid) regurgitates into the esophagus.

  GERD is a chronic condition. It usually is life-long. In most patients, after the esophagus has healed with treatment the injury will return in a few months. The cause of GERD is complex.There are internal body's factors in addition to unhealthy food and habits that can help improve this condition:lower esophageal sphincter abnormalities, hiatal hernias, abnormal esophageal contractions, and slow or prolonged emptying of the stomach.
The lower esophageal sphincter (LES) is the most important mechanism that can prevent acid reflux. The LES is a specialized ring of muscle that surrounds the lower-most end of the esophagus and is in action most of the time, contracting and closing off the passage from the esophagus into the stomach. When LES doesn't working properly that might cause acid reflux or GERD. The patients with GERD have several different abnormalities of the LES. First of them and the most common is abnormally weak contraction of the LES. It reduces its ability to prevent reflux. Transient LES relaxations means abnormal relaxations of the LES.These prolonged relaxations are a great factor for acid reflux attack. Transient LES are infrequent in patients without GERD.

    Another abnormality in patients with GERD is laxity of the LES. When the LES is open helped by similar distending pressures that will allow an easier flow of acid into the esophagus.
Hiatal hernia might develop acid reflux attack. What means a hiatal hernia? Normally, the LES is located at the same level where the esophagus passes from the chest through the diaphragm ( a partition that separates the chest from the abdomen).
The diaphragm that surrounds the LES is important in preventing reflux.On a hiatal hernia, a small part of the upper stomach that attaches to the esophagus pushes up through the diaphragm. As a result, the LES is no longer at the level of the diaphragm.

   On this case, reflux occurs more easily because instead of a high-pressure barrier they are two barriers of lower pressure, one of the contributions of the hiatal hernia to GERD  is  to decrease the pressure barrier. But it can contribute also in another manner. The hernial sac ( a small pouch of stomach above the diaphragm) can trap acid that comes from the stomach, keeping it close from the esophagus and when the LES relaxes it's easy for acid reflux to attack.
Swallows are important in eliminating acid in the esophagus.   Swallowing causes a  wave of contraction of the esophageal muscles, that begin in the upper esophagus and travel to the lower esophagus. It pushes food, saliva, and whatever else is in the esophagus into the stomach. An abnormality of contraction will reduce the clearance of acid from the esophagus.
      The effects of abnormal esophageal contractions would be expected to be worse at night when gravity is not helping to return refluxed acid to the stomach. Smoking might contribute in a bad manner on improving this abnormality. The clearance of acid from the esophagus might continue for at least 6 hours after the last cigarette.
About 20% from patients with GERD have stomachs that empty abnormally slowly after a meal. The slower emptying prolongs the period of time during which reflux is more likely to occur.

      Medications can worse GERD in addiction to those internal factors. Here are some common ones: antihypertensives such as beta blockers or calcium channel blockers, bronchodilators, dopamine-active drugs, progestin, sedatives, and tricyclic antidepressants. If you have GERD, you will need a medical advice before using them.