By DR. VICTOR S. SIERPINA
Do you know what a sphincter is? This is a group of muscles that opens and closes to allow the passage of fluids, solids and gases in the body. We have more than 60 sphincters including those that control the muscles in the eye and in small blood vessels. If you have never heard of a sphincter, believe me that you depend on them every day. Some are voluntary and under our control and others work automatically. The most well known voluntary sphincters are those that control our bladder and bowel movements. Here, a sphincter that doesn’t work right leads to messy and embarrassing incontinence.
The lower esophageal sphincter is located at the bottom of our swallowing tube, the esophagus. It relaxes to release food and fluids into the stomach where they can be digested. It also is a two-way valve that can open to let air and liquids out the other way. This is necessary so we can burp to release gas pressure in our stomach and also so we can vomit bad food, toxins or to get rid of an infection. The cartoon character Garfield seems to have mastered control of this sphincter with the art of burping loudly at will, mainly to annoy others.
When the LES is out of whack, one of the consequences is that stomach contents, which include car battery acid strength stomach acids, back up into the esophagus. This condition is called Gastroesophageal Reflux Disease or commonly called heartburn. It can be severe enough to mimic a heart attack, give us hoarseness, cause pneumonia and with repeated episodes chronic esophagitis, scarring and the development of cancer.
What causes heartburn? A hiatal hernia is a bulge of the stomach into the chest cavity providing an open gate to reflux. Lying down after a heavy meal puts pressure on the LES and can cause reflux. Being overweight increases intra-abdominal pressure and I have had many patients who never experienced GERD until they gained 10 or 20 pounds or more. Certain things like tobacco, caffeine, alcohol and spicy foods can increase reflux to which many a Tex-Mex foodie can attest. GERD is sometimes associated with a bacteria that also causes stomach ulcers called Helicobacter pylori and treatment requires antibiotics. More serious esophageal problems like Barrett’s esophagus and eosinophilic esophagitis can develop and require close monitoring and upper GI endoscopy by a specialist.
Besides antacids, simple lifestyle measures can often reduce or even prevent GERD. We will cover some integrative treatment approaches in more detail next week as they are similar and overlap with the treatment of gastritis and ulcers.
In the meantime:
1. Eat smaller meals;
2. Lose weight;
3. Don’t go to bed witin two hours of a major meal;
4. Elevate the head of your bed 6 to 8 inches or use a wedge pillow;
5. Avoid offending foods and beverages including carbonated beverages, alcohol, chocolate, spicy foods like onions and peppers, fatty food;
6. Quit smoking; and
7. Avoid tight fitting garments.
Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.