Why your stomach acid is migrating into your lungs
In short: Gastro-oesophageal reflux disease (GORD) is more than just a burning sensation in the chest. It is a complex physiological failure where gastric contents travel backward, potentially triggering asthma and chronic cough through mechanisms that scientists are still working to fully map out.
At its core, GORD occurs when the stomach's contents—including acid, bile, pepsin, and pancreatic enzymes—reflux into the oesophagus. This process is primarily driven by abnormalities in the lower oesophageal sphincter (LES). Specifically, transient relaxations of this sphincter allow for the upward movement of gastric contents, which can lead to mucosal injury and a significant decline in quality of life.
The pathophysiology is multifactorial rather than caused by a single defect. Key contributors include hiatal hernias, which promote LES dysfunction; delayed gastric emptying, which causes gastric distension and increases the frequency of sphincter relaxations; and impaired oesophageal clearance, which keeps acid in contact with the tissue for longer periods. Additionally, when mucosal defensive factors fail to neutralize hydrogen ion backdiffusion into the tissue, damage is more likely to occur.
One of the most intriguing aspects of GORD is its extra-oesophageal manifestations, such as laryngitis and asthma. While the causes of chest heartburn are well understood, the mechanisms behind these airway symptoms remain poorly understood. Two primary hypotheses exist: either gastric acid makes direct contact with the upper airway, or a vago-vagal reflex is triggered by the acidification of the distal oesophagus, resulting in bronchospasm.
Clinical management focuses on addressing these various pathways to mitigate damage and alleviate symptoms. Because GORD involves a complex interplay of mechanical, chemical, and neurological factors, understanding the specific drivers—whether it be a structural hernia or a functional clearance issue—is essential for effective treatment.
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Sources
- Summary by Intellect · source: GORD (GERD) Gastro Oesophageal Reflux Disease - Overview pathophysiology, treatment
- Also: Pathophysiology of gastro-oesophageal reflux disease
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