GERD incidence rates for various countries?
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Question:
> Mark, everbody is completely well, right up until the day they get sick… > The mechanism behind TILESR’s is that the LES inappropriately get a signal > to relax. There are several things that can initiate this. Most frequent is > simply a full stomach. There are some foods/substances that can cause this > such as nicotine, alcohol, caffiene, and some spices. There is some > speculation that it can be induced by stress, but this link has not been > demonstrated. > The cause? It just happens. Some people are genetically prone to it. In your > case, I would suspect that GERD runs in the family. > HMc
Thanks again. It seems your suspicions could be correct… I just spoke with my father and found out that he has had GERD for a while. I always remembered him popping a lot of Antacids when I was a kid but I never made the connection. thanks for the insight. Mark
Response:
> It seems your suspicions could be correct… > I just spoke with my father and found out that he has had GERD for a > while. > I always remembered him popping a lot of Antacids when I was a kid but > I never made the connection.
Indeed, like a lot of medical conditions, people may have had problems in your family for years, but it was never diagnosed. While nobody in my family had ever had heard of "GERD", quite a few of my relatives have had chronic "heartburn." That, and sometimes people don’t talk about their medical problems, even to relatives. A friend of mine came down with Crohn’s disease, and only after the diagnosis and surgery did she discover that her father and grandfather both had the same disease (although neither of them had required surgery). And I didn’t find out that red-green colorblindness ran in my mother’s family (or that I had it myself) until I had my medical exam for the Naval Academy, which rather put a damper on things… (yes, you can get quite far in life before you realize that you are red-green colorblind). — Richard W Kaszeta http://www.kaszeta.org/rich
Response:
– Hide quoted text — Show quoted text -> Thanks for the reply. I had not considered the link between obesity > and Gerd as I am not overweight (probably closer to underweight) > So what originally causes the lower esophageal sphincter to not > function correctly? > It seems strange to me that all of a sudden one’s LES can stop working > correctly (as was the case with me…out of the blue one day a year > ago) > In my case, I am not overweight. I am realtively young(23). I do not > smoke or drink. I never eat fast food, or fatty foods. I dont eat > chocolate…or candy…etc The only meats that I eat are chicken and > fish. > but…I have had problems with stress in the past. > Is it possible for stress alone to cause the LES to not function > correctly?
Mark, everbody is completely well, right up until the day they get sick… The mechanism behind TILESR’s is that the LES inappropriately get a signal to relax. There are several things that can initiate this. Most frequent is simply a full stomach. There are some foods/substances that can cause this such as nicotine, alcohol, caffiene, and some spices. There is some speculation that it can be induced by stress, but this link has not been demonstrated. The cause? It just happens. Some people are genetically prone to it. In your case, I would suspect that GERD runs in the family. HMc
Response:
– Hide quoted text — Show quoted text ->The mechanism behind TILESR’s is that the LES inappropriately get a signal >to relax. There are several things that can initiate this. Most frequent is >simply a full stomach. There are some foods/substances that can cause this >such as nicotine, alcohol, caffiene, and some spices. There is some >speculation that it can be induced by stress, but this link has not been >demonstrated. >The cause? It just happens. Some people are genetically prone to it. In your >case, I would suspect that GERD runs in the family. > A hiatal hernia will exaggerate them, also.
Actually, a hiatus hernia would affect LES resting pressure, but usually wouldn’t contribute to inappropriate LES relaxation. The latter are neurally mediated. Here are the basics: The LES is the barrier between the stomach and esophagus. Reflux occurs when intragastric pressure exceeds intraesophageal pressure, and when that pressure gradient is greater than the pressure of the LES. Therefore, anything that increases that gradient might promote reflux. Also, anything that causes lower pressure in the LES would facilitate reflux (at lower pressure gradients). Obese people (and pregnant people) have higher intrabdominal pressure due to the intrabdominal fat (baby), so that gradient is greater, more likely to exceed the LES pressure and cause reflux. That intrabdominal pressure goes even higher when that person bends over. When lying down, gravity now has no contribution to the pressure gradient. So reflux is more common when lying down, or when bending over. Additionally, some people (fat or thin) have a low LES resting pressure, so that pressure gradient between stomach and esophagus needs to be less for reflux to occur. And, some people have more active transient LES relaxation in response to full stomach, nicotine, alcohol etc. So, you could be a thin person, but have a low LES resting pressure (such as with hiatus hernia), or very active TLESR’s and get bad reflux. It is more common in obese people because of their higher intrabdominal pressure. And, it’s also true that the intrabdominal fat can push upward and aggravate a tendency to hiatus hernia, which in turn can lead to lower LES pressure, which in turn can lead to reflux. So, how do we cure GERD? (CURE, not just treat the symptoms with prilosec). We either have to lower intrabdominal pressure, increase LES pressure, or stop the TLESR’s. Or any combination of the three. If an obese person with GERD loses a lot of weight, their intrabdominal pressure goes down and their GERD will very likely go away. This is one reason why obesity surgery cures GERD. If a person with GERD has a Nissen fundoplication, that will increase the resting LES pressure and splint its relaxations, and GERD is cured. If a person with GERD has a Stretta procedure, that will increase LES pressure, AND it will ablate afferent nerve fibers that contribute to TLESR’s, and the GERD is cured. Medical antisecretory treatment only decreases the amount of acid present in the stomach. It doesn’t stop the reflux. In fact, reflux still occurs, but the refluxate is highly alkaline. This alkaline reflux doesn’t cause symptoms, but still has the capacity to severely damage the esophagus over time (Barrett’s esophagus). Medical treatment may very well not do anything to lower the risk of esophageal cancer. As I have said before, symptom management with antisecretory medication may be entirely appropriate if it a) controls the symptoms to the patient’s satisfaction, and b) there is not evidence of Barrett’s esophagus. HMc
Response:
- Hide quoted text — Show quoted text – > Obesity is a very substantial contributing factor to GERD. Since obesity is > so rampantly epidemic here in the US, it’s not surprising that GERD is too. > Likewise, there is some correlation between lower incidence of GERD and > lower incidence of obesity in countries where the amount and type of food is > less obesity-inducing. > Diet does not cause GERD. GERD is caused by a dysfunctional lower esophageal > sphincter. That dysfunction causing reflux symptoms is exacerbated by the > increased intraabdominal pressure associated with obesity. > So, to the extent that diet contributes to obesity, GERD is indeed > diet -associated, and the classic American diet definitely makes it more > common in the US. > HMc
Thanks for the reply. I had not considered the link between obesity and Gerd as I am not overweight (probably closer to underweight) So what originally causes the lower esophageal sphincter to not function correctly? It seems strange to me that all of a sudden one’s LES can stop working correctly (as was the case with me…out of the blue one day a year ago) In my case, I am not overweight. I am realtively young(23). I do not smoke or drink. I never eat fast food, or fatty foods. I dont eat chocolate…or candy…etc The only meats that I eat are chicken and fish. but…I have had problems with stress in the past. Is it possible for stress alone to cause the LES to not function correctly? thanks, Mark
Response:
Does anyone have any info on what countries have what incidence rates for GERD (not sure if I am wording this correctly). I remember reading somewhere that in Africa for instance GERD is pretty rare… It would be interesting to take a look at countries where GERD is relatively rare, and see if the native diet has anything to do with it… Mark
Response:
> Does anyone have any info on what countries have what incidence rates > for GERD (not sure if I am wording this correctly). I remember reading > somewhere that in Africa for instance GERD is pretty rare… > It would be interesting to take a look at countries where GERD is > relatively rare, and see if the native diet has anything to do with > it…
Obesity is a very substantial contributing factor to GERD. Since obesity is so rampantly epidemic here in the US, it’s not surprising that GERD is too. Likewise, there is some correlation between lower incidence of GERD and lower incidence of obesity in countries where the amount and type of food is less obesity-inducing. Diet does not cause GERD. GERD is caused by a dysfunctional lower esophageal sphincter. That dysfunction causing reflux symptoms is exacerbated by the increased intraabdominal pressure associated with obesity. So, to the extent that diet contributes to obesity, GERD is indeed diet -associated, and the classic American diet definitely makes it more common in the US. HMc
