Refluxordination Univ. Doz. Dr. Martin Riegler

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Gastroesophageal reflux disease (GERD): the cause

The only cause for the development of gastroesophageal reflux disease (GERD) is the failure of the lower esophageal sphincter (LES). Briefly, the oesophagus is ca. 25 cm long, passes from the neck to the stomach and serves the passage of the food. On it’s course it goes through a 3.0 cm wide hole within the diaphragm (our breathing muscle) and fuses with the stomach 6.0 cm below the diaphragm. The lower 6.0 cm of the esophagus harbour the anti reflux mechanism, the lower esophageal sphincter (LES). Normally the LES is closed and only opens for the passage of food or air during eating, drinking, belching and vomiting (migraine, eating disorder). Otherwise the LES is closed and prevents the return of acid gastric fluid into the esophagus (trumpet type A).

The following reasons favour the failure of the lower oesophageal sphincter (LES):
Heredity: genetically weak and soft tissue (connective tissue disease, Lupus, Scleroderma, Marfan Syndrome, Raynaud Syndrome);
Unhealthy eating and drinking habits (± obesity): repeated over-distension of the stomach after the consumption of large meals propagate into the lower end of the esophagus and over-stretch and weaken the LES; as a consequence the LES stays permanently open and reflux occurs. Initially the failure affects the segment of the esophagus below the level of the diaphragm (trumpet type A). Over time the dilatation and failure of the LES also affects the segment of the esophagus at and above the level of the diaphragm (trumpet type C): hiatal hernia develops;
Increased mechanical stress: pregnancy, vomiting (eating disorder; bulimia, anorexia, headache, migraine, obesity), lifting of heavy weights (street worker, fitness, gym), trauma (car accident, sport injury);
chemical compounds impairing the function of the lower esophageal sphincter (LES): psychopharmacological therapy, nicotine, drugs (heroin, LSD, cannabis);
A combination of the above listed causes.

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