Some people have a physical distortion of the lower esophageal sphincter that prevents it from building up enough pressure to keep it closed. A hiatal hernia is a condition where the stomach protrudes up through an abnormally large opening in the diaphragm. The condition has been estimated to exist in 40% of Americans, and is usually of no significance in people who don’t have heartburn. While it does not always cause GERD, a hiatal hernia may cause LES incompetence in some individuals, especially when the hernia is severe. Over 90% of patients who present with severe esophagitis will have a hiatal hernia.
It is important to look for other causes of GERD like poor esophageal clearance, medical conditions such as scleroderma, certain medications, and prior radiation treatments to this area of the body. Finally, delayed gastric emptying will also produce GERD. This may due to a weakening of the stomach action due to diabetes or an obstruction at the outlet of the stomach.
Patients with long-standing GERD, may develop scarring of the lower esophagus making their GERD even worse.
For further information, you can ask Dr. Ferzli.