If you have GERD, you’ve probably asked, “What causes acid reflux?” While we can’t give an exact answer, there is one common culprit: stomach distension. Stomach distension occurs when the abdomen expands well beyond its normal resting state. Though infrequent stomach distension is not what causes acid reflux, it is the long period of sustained stomach distension that can be the underlying cause of GERD. The main connection between stomach distension and acid reflux is the harmful effect it has on the lower esophageal sphincter (LES). The LES is a valve-like muscle that exists at the junction of the stomach and the esophagus. The LES opens to let foods pass and closes to keep stomach contents from rising upward, except when vomiting or burping.
What causes acid reflux? A damaged lower esophageal sphincter
Any time the stomach expands, the LES stretches. The LES is durable and can withstand a considerable amount of stretching, but extreme prolonged and sustained abdomen expansion can gradually diminish LES function. A good way to describe the impact of stomach distension is to use a balloon as an example. Imagine a rubber balloon that is fifty percent inflated. The inflated section is your stomach and the neck of the balloon is your esophagus. The LES is at the junction of these two parts of the balloon. Imagine that you used a black marker to circle the LES on the balloon. What do you think will happen to that black circle when you blow more air into the balloon? Of course, the black circle will expand and be pulled toward the inflated part of the balloon.
This mirrors what happens to your LES when your stomach is distended. As in our balloon example, when the stomach is repeatedly distended, the muscle is stretched. Over time, the muscle begins to lose its barrier function. For example, the more frequently you overeat, the more likely it is that your LES muscle may lose strength over time and become shorter in length. Eventually, the LES could lose its effectiveness as a barrier completely. Years of excessive pulling and widening of the LES can severely weaken it, which can lead to chronic GERD. The main causes of stomach distension that cause damage to the LES are frequent overeating and large portion sizes, prolonged bloating and stomach pressure, and excessive belly weight.
Implications of overeating
Overeating is widespread in economically developed nations where food is readily available at reasonable prices. It should be no surprise that these same countries have the highest rates of GERD. The link between the two is clear: with affluence comes excessive behavior, including gluttony. Essentially, when an abundance of high-quality food is available, people tend to eat for enjoyment rather than consume food as needed. For many in economically developed nations, overindulgence is a prevalent temptation. Likewise, in less developed and poorer nations, where food is far less abundant, the incidence of GERD is substantially lower.
Eating a large meal that pushes your stomach beyond normal capacity stretches the LES and causes increased upward internal pressure. That pressure can force stomach contents to move upward, causing regurgitation. Anyone who has overeaten at a Thanksgiving dinner has most likely experienced an episode of regurgitation not long after finishing his or her meal. When people do this habitually at most meals over many years, damage and weakness to the LES can grow so bad that any meal, regardless of size, can regurgitate up into the esophagus and cause symptoms of acid reflux.
Overeating can also cause the stomach to produce more acid to fully digest the massive amount of food. Also, larger meals take longer to digest, which can significantly increase the amount of time that food and acid remain in the stomach. For those who regularly overeat, everyday actions such as bending over or lying down may result in regurgitation.
Limiting portion sizes may help to prevent regurgitation and the progression of GERD. Those who suffer from this disease should eat less at each meal and manage their portion sizes with diligence. The idea is to listen to your body and eat until you are comfortable, not stuffed. This requires planning for smaller meals by adding healthy snacks during the day to fend off hunger.
Here’s what you can do!
In addition to reducing your meal portion size, our medical advisors recommend the following action plan to attack the causes of acid reflux. First, work to reduce and maintain your body mass index (BMI) at 24 or less. Second, adopt a GERD-friendly diet and avoid all of your trigger foods. Third, adopt all the necessary lifestyle changes that trigger GERD symptoms and can lead to disease progression. Four, use the least powerful antireflux medications only when necessary to manage your symptoms to your satisfaction. Fifth, experiment with natural home remedies to reduce your GERD symptoms. Sixth, should those efforts fail, then consider antireflux surgery. This is a proven path to relief recommended by our GERD experts. You can do this!