Both genetic and environmental factors appear to influence the presence of GERD. Numerous studies have shown that obesity, weight gain, and increasing body mass index (BMI) are associated with GERD. Hiatal hernia is also a risk factor for GERD symptoms. Studies indicate that individuals with large hiatal hernias have shorter and weaker lower esophageal sphincters (LES), increased amount of reflux, less-efficient acid clearance, less-effective peristalsis, and increased severity of esophagitis compared with individuals with small or no hiatal hernia.3 Research also indicates that smoking, excess alcohol consumption, irritable bowel syndrome, and a family history of upper GI disease are risk factors. Pharmaceutical usage such as anticholinergics, antidepressants, and inhaled bronchodilators are also related to the disease. This study also associated lack of education and manual work with the presence of GERD.4 Additional studies have suggested that increased intake of table salt, sweets, or white bread is also a risk factor. Exercise and diets high in fruit and dietary fiber appear to be protective against the condition.5,6 However, high-intensity exercise has been shown to decrease LES pressure and induce GERD symptoms in otherwise asymptomatic individuals.7 Caffeine ingestion also decreases LES pressure and decreases distal esophageal mean amplitude of contractions and peristaltic velocity, which can increase reflux.8 Ingestion of carbonated beverages has also been observed in a study to decrease the resting pressure, overall length, and abdominal length of the LES in healthy individuals temporarily. This study showed that 62% of individuals who drank carbonated beverages had significant decreases in these parameters to meet the criteria for incompetence of the LES.9
GERD may present with atypical symptoms of esophageal and extraesophageal origin.
In addition, persistent wheezing, asthma, and airway hyper-responsiveness in childhood and adolescence have been shown to significantly increase risk for GERD symptoms at age 26 independent of BMI.10 A study with a Spanish population indicated that long-term GERD symptoms of 10 years or longer are associated with obesity and having a direct family member with GERD symptoms. GERD symptoms of 1 year or less were more closely correlated with having a spouse with GERD symptoms or taking 1-5 aspirins per week.11
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