GORD: What are the causes?

In the majority of people with gastro-oesophageal reflux disease (GORD), the primary cause is a sphincter that relaxes spontaneously more frequently than normal.

However, a weakened valve occurs in 20% of cases.

The following factors may contribute to aggravating reflux:

Food. The more the stomach is stretched by food, the higher the tendency to reflux. Eating fatty meals also increases this tendency, because fat delays the emptying of the stomach. Foods that prevent the oesophageal sphincter from working properly include chocolate and peppermint, while drinks such as coffee, fruit juices and alcohol have the same effect.

Hiatus hernia. Part of the stomach protrudes through the diaphragm (the layer separating the abdomen from the chest cavity), preventing the muscle fibres of the diaphragm from closing the lower end of the oesophagus. The oesophagus remains open, allowing stomach acid to enter it.

Overweight. When you are overweight, the fat in the abdominal cavity increases the pressure inside it. This can cause the contents of the stomach to move up into the gullet.

Pregnancy. Hormonal changes during pregnancy cause the oesophageal sphincter to relax. And because the uterus increases in size during pregnancy, it presses on the stomach, creating higher pressure inside it. Both of these factors increase the tendency to reflux.

Smoking. Tobacco prevents the oesophageal sphincter from working properly. It also increases stomach acid production and reduces the rate at which the stomach empties.

Medication. Drugs can cause reflux through sphincter relaxation, e.g. in asthma and cardiac conditions.

Position of the body. The tendency to reflux increases when you are lying down. A simple way to relieve this is to use a pillow under the mattress or to raise the head of your bed by 10cm. Bending over or bending and lifting can also cause reflux.