In addition, pregnancy or constipation may worsen GERD by increasing intra-abdominal pressure. Secondary causes of GERD include reflux caused by acid hypersecretory states, connective tissue disorders (scleroderma), gastric outlet obstruction as caused by ulceration and stricture, and delayed gastric emptying due to conditions such as gastric stasis, neuromuscular disease, idiopathic gastroparesis, pyloric dysfunction, duodenal dysmotility, or duodenogastroesophageal bile reflux.

Most patients with complicated GERD have a hiatus hernia, which, by displacing the ‘ LES segment of the distal oesophagus, both reduces LES pressure and impairs acid Clearance.