Acid Reflux and GERD
Acid reflux is a common occurrence among adults and is exacerbated by the increased incidence of excess weight and obesity over the past few decades. Acid reflux is the movement of gastric juices from the stomach into the esophagus, which can be occasional, typically after a fatty, spicy, or particularly large meal. Acid reflux can also be chronic, in other words, patients experience it regularly over an extended period. We classify this as gastroesophageal reflux disease or GERD.
Why Does Reflux Occur?
At the bottom of the esophagus, we all have a one-way valve known as the lower esophageal sphincter or LES. This muscle remains shut, only relaxing when food and drink are consumed or if we need to belch or vomit. If there is any laxity in the LES or it ceases to work correctly, it can loosen and open, allowing stomach juices to push back into the esophagus. The primary root cause of this upward movement of acid is excess weight and obesity, which puts additional pressure on the abdomen, thus moving fluid upward.
Some patients have what is known as a hiatal hernia or enlargement of the hiatus – a gap in the diaphragm that allows the esophagus to pass through. Hiatal hernias are typically asymptomatic, and most patients are not screened for them. They are usually found incidentally during other procedures, especially those involving the stomach or esophagus. Hiatal hernias are most commonly found in patients with obesity and excess weight.
That said, not all patients with chronic acid reflux are obese. Some of us are genetically predisposed to having a weaker LES and thus experience reflux even at a lower weight.