All three substances decrease LES tone. Alcohol and caffeine also stimulate gastric acid secretion, which, in combination with frequent TLESRs, increases the risk of esophageal mucosal injury from the gastric refluxate.
Stress
Obesity
Pregnancy
GERD is present in up to 80% of pregnancies. The underlying pathophysiology involves increased abdominal pressure, decreased LES tone (due to high estrogen and progesterone levels during pregnancy), and prolonged gastric emptying as a result of reduced gastric motility.