JOSE ERBELLA, M.D., FACS
General, Oncologic & Minimally Invasive Surgeries
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CAUSES OF GASTROESOPHAGEAL REFLUX DISEASE
At the junction where the esophagus and stomach meet is a small one-way valve called the lower esophageal sphincter. This valve, usually referred to as the LES, is responsible for preventing acidic stomach contents from flowing back from the stomach into the esophagus. When it is functioning normally, the LES opens to allow food to enter the stomach and then closes tightly to prevent backflow.
When the LES fails to close properly, the backflow of caustic stomach contents is called acid reflux or, more commonly, heartburn or indigestion.While occasional reflux is common and no reason for concern, frequent acid reflux exposes the esophagus to the digestive juices and acid normally confined to the stomach. The stomach contents are highly corrosive and cause irritation and inflammation of the esophagus. In addition to being quite painful, chronic exposure to stomach acid may lead to severe conditions such as esophagitis, ulceration, and narrowing of the esophagus from scar tissue formation. In rare instances, gastroesophageal reflux disease can also lead to a condition known as Barrett’s esophagus and may lead to cancer.
FACTORS AFFECTING REFLUX DISEASE
Located at the junction of the esophagus and the stomach, the lower esophageal sphincter (LES) is made from muscles of the esophagus and the diaphragm where it surrounds the esophagus. Because the LES relies on muscle strength to open and close, any factor that interferes with muscle activity can cause the LES to function poorly.
Nerve conduction, muscular abnormalities, medications, and higher than normal stomach pressure are some the factors that can result in acid reflux into the esophagus.
FACTORS AGGRAVATING ACID REFLUX
Heartburn sufferers report that several factors make their acid reflux symptoms worse:
Certain foods: While no specific food causes acid reflux in all people, the most frequently reported culprits for aggravating acid reflux are those that increase the acidity of stomach contents. Examples of these foods are tomato products, coffee, alcohol, peppermint, chocolate, and soda.
OTC and prescription medications: Medications can increase stomach acidity and affect the function of the lower esophageal sphincter (LES). The most frequently implicated medications are anticholinergics, Beta-2 agonists, calcium channel blockers, diazepam, nitrates, opioid analgesics, theophylline, and tricyclics.
Abnormal stomach pressure: If stomach pressure is too high, the muscular LES may not be strong enough to keep prevent stomach acid flowing back into the esophagus. Increased pressure can be caused by medications preventing stomach emptying, tight fitting apparel such as belts, or overeating.
Obesity: Obese individuals often experience chronic heartburn. This can result from increased abdominal pressures, presence of hiatal hernias, or overeating.
Hiatal hernia: The esophagus passes through the diaphragm as it leaves the chest cavity and enters the abdomen. A hiatal or diaphragmatic hernia results if the tunnel through the diaphragm enlarges and part of the stomach moves up into the chest cavity. This increases pressure on the LES and often leads to acid reflux.