Doctors may not completely understand the relationship between asthma and heartburn, but most experts do agree there is an important connection. Some experts hypothesize that the coughing that accompanies asthmatic attacks can cause changes in pressure in the chest, which then can trigger reflux. Certain drugs for asthma that dilate the airways may also relax the LES and contribute to GERD. Likewise, GERD has been associated with a number of other upper respiratory problems and may be a cause of asthma, rather than a result.
Genetic Factors
Studies have suggested there is an inherited risk in many of the cases of GERD. This could be because of of inherited muscular or structural problems in esophagus or stomach. Genetic factors may also be an important aspect in a patient's susceptibility to Barrett's esophagus, a precancerous condition caused by very severe gastroesophageal reflux.
Overreactive Immune Response
An over-reaction of the immune systems to certain irritants in the esophagus may cause GERD symptoms even when the esophagus appears normal, and there is no evidence of acid reflux. When the immune system over-reacts to an irritant, it can trigger a change reaction that can end up causing inflammation and sometimes injury to the esophagus.
Drugs that Increase the Risk for GERD
NSAIDs.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are common causes of peptic ulcers. They may also cause GERD and increase the symptoms and severity of GERD in people who already have it. In one three-year study of 25,000 people, NSAID users were twice as likely to have GERD symptoms as nonusers. Symptoms did not become evident until after about six months of regular use. NSAIDs include:
- Aspirin
- Ibuprofen (Motrin, Advil, Nuprin, Rufen)
- Naproxen (Aleve)
A point of interest is that NSAIDs have properties that may help to prevent precancerous changes from Barrett's esophagus. The newer NSAIDs called COX-2 inhibitors may prove to be cancer protective in these patients without producing GERD. COX-2 inhibitors include: Celecoxib (Celebrex)Valdecoxib (Bextra).
Other Drugs.
Many other drugs can cause GERD, or increase the severity of symptoms in those who already have this condition. These include:
- Anticholinergic drugs (urinary tract disorders, antihistamines)
- Includes natural belladonna alkaloids (atropine, belladonna, hyoscyamine, and scopolamine) and related products.
- Beta-2 agonists (bronchodilators [Inhalation] -- asthma)
- Includes Alupent, Bronkaid Mist, Primatene Mist, Proventil, Ventolin, Ventolin Rotacaps.
- Calcium channel blockers (high blood pressure)
- Includes Cardizem, Dilacor-XR, Norvasc, Procardia, Vascor.
- Diazepam (anxiety disorders, seizures)
- Includes Librium, Paxipam, Valium, Xanax.
- Nitrates (angina)
- Includes Nitrogard, Nitrostat, Nitroglyn E-R, Sorbitrate.
- Opioid analgesics (prescription pain killers)
- Includes morphine, oxycodone, synthetic opioid narcotics.
- Theophylline (bronchodilators [oral] -- asthma)
- Bronchodilators. Includes Aerolate Sr, Choledyl, Respbid, Slo-Bid Gyrocaps, Theobid Duracaps, Theo-Dur.
- Tricyclic (psychotherapeutic agents, antidepressants)
- Includes Anafranil, Elavil, Norpramin, Pamelor.
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Part 1: Problems with the esophagus and stomach
Part 2: Other conditions that can cause GERD
