Gastroesophageal Reflux Disease or GERD is an incredibly common disorder affecting Americans today. Many risk factors for GERD are common variables in the American population; obesity, Fast food diet, smoking, alcohol, eating late at night and large meals are all implicated in this process. The symptoms associated with GERD are typical ones such as “heartburn” and indigestion. There are also atypical symptoms such as chest pain and hoarseness. Chest pain can also be a sign of something more serious.
The esophagus is the food passage connecting the mouth to the stomach. There is an opening at lowest part of the esophagus which connects to the stomach. This opening has a circular muscular structure called the lower esophageal sphincter. This sphincter prevents the contents of the stomach from entering the esophagus. The stomach is very acidic with a very low pH. This acidity helps with food digestion as well protecting the body from infections. The lining of the stomach is equipped to handle the acidity. The lining of the esophagus is not meant to be in contact with the acid. The acid therefore irritates the esophagus and causes inflammation of the esophagus called esophagitis. This can cause symptoms of heartburn and chest pain. If the acid refluxes higher and reaches the vocal chords this can case hoarseness.
The sphincter needs to open to allow food to get into the stomach. The remainder of the time it needs to be closed to prevent the reflux of stomach contents. Many foods can loosen the sphincter. A loosening of the sphincter allows stomach contacts including acid to enter the esophagus. Stomach contents entering the esophagus is reflux or GERD. Foods associated with worsening reflux include caffeine, alcohol, and peppermint. Eating large meals increases the volume of the stomach allowing for the food to reflux. It is important not to eat several hours before bedtime allowing the stomach to empty into the small intestine before becoming horizontal. Since gravity is working against us when we are lying down, any food in the stomach can reflux into the esophagus.
Reflux has also been associated with visceral hypersensitivity in the same manner as IBS. Visceral hypersensitivity means that normal functions are perceived as painful. This has been particularly associated with GERD which has been considered refractory or difficult to treat medically. Visceral manipulation can be a useful technique to treat this discomfort (Harrow, M PDF)
I often hear from patients that they get heartburn symptoms or worsening of their already present reflux symptoms when they are involved in an emotionally stressful life event. This makes a lot of sense because of the vast neurological connections between the brain and digestive organs. Studies have shown that stress is intimately related with symptoms of reflux.
The standard therapy for reflux disease is to decrease acid secretion in the stomach. The standard medications decrease the acidity of the the refluxate which is subsequently less caustic to the esophagus. This standard approach treats the problem symptomatically rather than addressing the true cause. In my practice, I use visceral manipulation which is a gentle manipulative technique which addresses the motility of the esophagus and the tone of the sphincter allowing it to open and stay closed appropriately. As any digestive disorder it is very important to address the mind-body connection and dietary changes. Both are critical factors in maintaining health and prevention of disease.
- C. Prakash Gyawali, MD Esophageal Hypersensitivity. Gastroenterology and Hepatology (NY) 2010 Aug; 6(8) 497-500.
- Visceral Manipulation and Dyspepsia Study [PDF] - The Barral Institute - by M Harrow
- Eun Mi Song, Hye-Kyung Jung and Ji Min Jung. The Association Between Reflux Esophagitis and Psychological Stress. Dig Dis Sci. 2013 Feb, 58(2): 471-477.