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GERD (Gastroesophageal Reflux Disease) Causes in the Elderly

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GERD Causes in the ElderlyAcid reflux is one of the most common acute upper gastrointestinal problems in adults of all ages. It often arises as an isolated incident after overeating, vigorous physical activity after a heavy meal and with excessive alcohol consumption. In most of these instances it is not a cause for concern and over-the-counter antacids are sufficient to ease the burning chest pain commonly referred to as heartburn. Sometimes this reflux may be recurrent, may occur spontaneously and trouble a person over months or years. In these instances it is is known as gastroesophageal reflux disease (GERD). While GERD also technically refers to acute episodes of acid reflux as well, the term GERD generally infers a more chronic state.

In order to understand GERD, it is important to have at least a basic knowledge of human anatomy. Food and drink pass from the mouth to the throat (pharynx), down the food pipe (esophagus) and into the stomach. At the junction of the esophagus and stomach is a muscular lower esophageal sphincter (LES) that controls the passage of food into the stomach. It is usually contracted and prevents the back flow of stomach acid up into the esophagus and opens momentarily when eating to allow food to enter the stomach. While the stomach is able to withstand the corrosive effects of acid, the esophagus is not and the esophageal lining is easily damaged with the entry of acid. Fortunately the esophagus has certain defense mechanisms to counteract the effect of acid should it enter. Strong and repeated esophageal contractions push the acid back into the stomach oran excessive secretion of the naturally alkaline saliva passes into the esophagus and neutralizes the acid.

Causes of Gastroesophageal Reflux Disease

The exact cause of gastroesophageal reflux disease cannot always be ascertained but it is known to be due to one of more of the following defective mechanisms :

  • Lower esophageal sphincter dysfunction which means that the sphincter cannot close tightly enough to prevent a back flow of acid into the esophagus.
  • Delayed gastric emptying which means that the stomach contents do not pass out fast enough into the small intestine and may then push up and out of the stomach into the esophagus.
  • Hiatal hernia where a portion of the stomach is pushed up through the diaphragmatic opening into the thoracic cavity and this hampers the normal mechanisms that prevent backflow of stomach acid into the esophagus.
  • Increased intra-abdominal pressure which may compress the stomach thereby pushing the stomach contents up into the esophagus.

Risk Factors

GERD is more likely to be aggravated with :

  • Overeating.
  • Exercising after meals.
  • Lying flat after meals.
  • Alcohol consumption.
  • Cigarette smoking.
  • Caffeinated beverages.

However, these risk factors do not actually cause one or more of the defective mechanisms mentioned above but instead make it worse.

Causes of Reflux in the Elderly

GERD becomes more common with age and the prevalence rises significant after the age of 40 years. Many of the mechanical defects that allow stomach acid to flow backwards into the esophagus are more likely to occur or be exacerbated in the elderly. This is due to several reasons such as :

  1. Muscle tonicity of the lower esophageal sphincter may decrease with age.
  2. Common chronic conditions in the elderly like diabetes mellitus may increase the risk of GERD.
  3. Many types of medication used for chronic conditions more so in the senior years may worsen GERD.
  4. Obesity, which is a risk factor for GERD, may be more likely in the elderly who are immobilized or sedentary.
  5. Hiatal hernias are more prevalent after the age of 40 and affects about 7 out of 10 people aged 70 years or older.

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