Acid Reflux -- Esophageal Spasms
Gastroesophageal Reflux Disease (GERD, Acid Reflux)
Acid-Alkaline Balance by Karl Loren
Dr. Weston Price -- On Acid -- Alkaline Balance
Achalasia is a rare disease of the muscle of the esophagus
Mass Near The Esophagus -- Cancer? Benign?
Advice From Friends -- Esophagus Cancer
Treatments and Protocols BEYOND The Traditional
How about YOUR question here?
Read below or choose another question.
Medical Author:
Jay W.
Marks, M.D.
Medical Editor:
Leslie
J. Schoenfield, M.D., Ph.D.
What is GERD (acid
reflux)?
Gastroesophageal reflux disease, commonly referred to as GERD, or acid reflux,
is a condition in which the liquid content of the stomach regurgitates (backs
up, or refluxes) into the esophagus. The liquid can inflame and damage the
lining of the esophagus although this occurs in a minority of patients. The
regurgitated liquid usually contains acid and pepsin that are produced by the
stomach. (Pepsin is an enzyme that begins the digestion of proteins in the
stomach.) The refluxed liquid also may contain bile that has backed-up into the
stomach from the duodenum. (The duodenum is the first part of the small
intestine that attaches to the stomach.) Acid is believed to be the most
injurious component of the refluxed liquid. Pepsin and bile also may injure the
esophagus, but their role in the production of esophageal inflammation and
damage (esophagitis) is not as clear as the role of acid.
GERD is a chronic condition. Once it begins, it usually is life-long. If there is injury to the lining of the esophagus (esophagitis), this also is a chronic condition. Moreover, after the esophagus has healed with treatment and treatment is stopped, the injury will return in most patients within a few months. Once treatment for GERD is begun, therefore, it usually will need to be continued indefinitely.
Actually, the reflux of the stomach's liquid contents into the esophagus occurs in most normal individuals. In fact, one study found that reflux occurs as frequently in normal individuals as in patients with GERD. In patients with GERD, however, the refluxed liquid contains acid more often, and the acid remains in the esophagus longer.
As is often the case, the body has ways (mechanisms) to protect itself from the harmful effects of reflux and acid. For example, most reflux occurs during the day when individuals are upright. In the upright position, the refluxed liquid is more likely to flow back down into the stomach due to the effect of gravity. In addition, while individuals are awake, they repeatedly swallow, whether or not there is reflux. Each swallow carries any refluxed liquid back into the stomach. Finally, the salivary glands in the mouth produce saliva, which contains bicarbonate. With each swallow, bicarbonate-containing saliva travels down the esophagus. The bicarbonate neutralizes the small amount of acid that remains in the esophagus after gravity and swallowing have removed most of the liquid.
Gravity, swallowing, and saliva are important protective mechanisms for the esophagus, but they are effective only when individuals are in the upright position. At night while sleeping, gravity is not in effect, swallowing stops, and the secretion of saliva is reduced. Therefore, reflux that occurs at night is more likely to result in acid remaining in the esophagus longer and causing greater damage to the esophagus.
Certain conditions make a person susceptible to GERD. For
example, GERD can be a serious problem during pregnancy. The elevated hormone
levels of pregnancy probably cause reflux by lowering the pressure in the lower
esophageal sphincter (see below). At the same time, the growing fetus increases
the pressure in the abdomen. Both of these effects would be expected to increase
reflux. Also, patients with diseases that weaken the esophageal muscles (see
below), such as
scleroderma or mixed connective tissue diseases, are more prone to develop
GERD.
What causes GERD?
The cause of GERD is complex. There probably are multiple causes, and different
causes may be operative in different individuals or even in the same individual
at various times. A small number of patients with GERD produce abnormally large
amounts of acid, but this is uncommon and not a contributing factor in the vast
majority of patients. The factors that contribute to causing GERD are the lower
esophageal sphincter,
hiatal
hernias, esophageal contractions, and emptying of the stomach.
Lower esophageal sphincter
The action of the lower esophageal sphincter (LES) is perhaps the most important
factor (mechanism) for preventing reflux. The esophagus is a muscular tube that
extends from the lower throat to the stomach. The LES is a specialized ring of
muscle that surrounds the lower-most end of the esophagus where it joins the
stomach. The muscle that makes up the LES is active most of the time. This means
that it is contracting and closing off the passage from the esophagus into the
stomach. This closing of the passage prevents reflux. When food or saliva is
swallowed, the LES relaxes for a few seconds to allow the food or saliva to pass
from the esophagus into the stomach, and then it closes again.
Several different abnormalities of the LES have been found in patients with GERD. Two of them involve the function of the LES. The first is abnormally weak contraction of the LES, which reduces its ability to prevent reflux. The second is abnormal relaxations of the LES, called transient LES relaxations. They are abnormal in that do not accompany swallows and they last for a long time, up to several minutes. These prolonged relaxations allow reflux to occur more easily. The transient LES relaxations occur in patients with GERD most commonly after meals when the stomach is distended with food. Transient LES relaxations also occur in individuals without GERD, but they are infrequent.
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