The process of digesting your food starts with cooking and chewing! The food you chew goes into the stomach, mixes with acidic stomach juices and the digestion process speeds up. When the acidic contents of the stomach flows back (called re-flow or reflux) into the food pipe (called gullet or esophagus), it is called Acid Reflux.
If the reflux happens for more than 4% of the time in a 24 hour period, it is classified as a medical condition called Gastro Esophageal Reflux (gastro = stomach, esophagus = food pipe, reflux = flow back). If the incidence of GER is accompanied by symptoms of inflammation, then it is classified as GER Disease or GERD. GERD must be treated as it often leads to cancer of the esophagus.
Since the esophagus is sitting just behind the heart, the pain felt by the esophagus due to stomach acid flowing into it often presents itself like a heart attack. So, acid reflux or GERD is often called the Heart Burn.
The esophagus is a 25 cm (10 inches) long tube that runs from the mouth to the stomach. The food you swallow travels down the esophagus using peristaltic movement. On each end of esophagus has a sphincter valve that stops the swallowed food from traveling back. The valve at the beginning of the esophagus, between the throat and the esophagus, is called the Upper Esophageal Sphincter (UES). The valve at the end, between the esophagus and the stomach, is called the Lower Esophageal Sphincter (LES).
The amazing thing about these valves is that the esophagus at the location of these valves look identical to esophagus elsewhere. You cannot make out the difference even when you cut the esophagus open and look into it with a microscope.
Organs on either side of the LES valve, namely esophagus and the stomach, are the organs that are directly involved in acid reflux/GERD. Other organs like throat, mouth, wind pipe, etc., also get involved in severe cases.
Causes Acid Reflux, GERD, Heart Burn or LPR
Acid reflux (or GERD or Heart Burn) is a disease where the stomach contents, which are usually acidic in nature, flow back into the esophagus (food pipe) more than 4% of the time over a 24 hour period. This happens under one of the two conditions:
- When the pressure on the stomach, or the pressure in the stomach, is too high that the stomach content gets squeezed out of through the esophagus.
- When the sphincter valve (called the Lower Esophageal Sphincter, or LES) between the stomach and the esophagus becomes weak.
Let us take a look at each of the two cases a little bit more in detail.
Too much pressure on/in the stomach can cause Acid Reflux, GERD or Heart Burn
When there is too much pressure on/in the stomach, its contents tend to get squeezed out of the sphincter valve between the stomach and the esophagus. Here are some circumstances under which this can happen:
- An over weight or obese person carries too much visceral fat (fat inside the abdomen). It tries to squeeze out everything else in the abdomen, including the stomach.
- Certain type of hernias can increase the pressure on the stomach
- Wearing clothes that are tight around the abdomen (tight belts, corsets, tight trousers, etc.) can increase the pressure on the stomach
- Pregnancy can increase the abdominal pressure
- Eating foods that move slowly in the stomach, eating under-cooked food or not chewing your food adequately can fill up the stomach and the pressure.
- Eating food that ferments in the stomach (certain carbs) releases hydrogen gas. Hydrogen often finds it way out by forcing open the LES valve.
Working on any of the above causes will make your acid reflux symptom better.
Weak LES Valve can cause Acid Reflux, GERD or Heart Burn
The Lower Esophageal Sphincter valve is kept shut by several structures that are outside the esophagus:
- There is a muscular sheet between thorax (chest) and the abdomen called diaphragm.
The diaphragm moves up and down to increase or reduce the size of the chest cavity. When diaphragm moves down, size of the chest cavity increases, your lungs expand and you breathe in more air. When your diaphragm moves up, the size of the chest cavity reduces, air in your lungs gets squeezed out.
The diaphragm muscle also forms a sling around the esophagus, acting like a pinch cock
- Few fibers of the stomach muscle (yes, stomach has muscles; how else would it grind the food you eat) go around the junction between the stomach and the esophagus. They add to the pinch cock effect around the LES valve
- Two ligaments, called phrenico-gastric and phrenico-esophageal ligaments,
- The esophagus enters the stomach at an angle. This by itself reduces reflux of the food into the food pipe
Esophagus is a delicate pipe. The abdominal pressure is good enough to collapse it and close it.If the length of the esophagus inside the abdomen (intra-abdominal length) increases, there is more pressure acting on the esophagus from the outside to keep it closed.
- There is a rosette like structures on the inner wall, which seals up the LES valve. Fault in this structure can case acid reflux/GERD
<images showing the cross section of the food pipe in open and closed states>
- Certain food types can dilate the LES valve. Eating them will make it difficult to keep the value shut tight.
GERD/LPR Expertise at LIMA
- Our Chief Surgeon Dr. J. S. Rajkumar had authored a text book titled Modern Methods for Managing Acid Reflux/GERD. All the knowledge he used in writing this textbook are now incorporated in LIMA’s practice.
- LIMA has all the instrumentation needed to accurately investigate and assess how mild or severe your acid reflux is
- LIMA consultants offers the full range of Acid Reflux/GERD treatment, including
- Behavior modification experts to help you with lifestyle changes
- Registered dieticians to help you with a suitable diet selection
- Functional medicine doctors to help you with nutritional support
- Gastroenterologists to help you with medical protocol
- The surgical group that has handled more volume than anyone else in South India
If the nature of your GERD is such that it doesn’t respond satisfactorily for lifestyle, dietary or medical interventions, then a surgical solution is your best option. If you select surgery, LIMA can give you “unparalleled advantage”:
- Till date, we have carried out more than 2,000+ fundoplication surgeries. This is the largest volume handled by any single surgical team in South India.
- LIMA is the only center in the Chennai where you can get the surgery done through a Scarless procedure.
- LIMA subsidiary, MISTY, has trained largest number of surgeons in the country for
- Currently, Dr. J. S. Rajkumar is co-authoring the first and only manual for laparoscopic surgery (14 volumes)
Listen to some of our real patients who received acid reflux/GERD treatment at LIMA:
Even more Education
If you have read this far, we must congratulate you. You have taken your first step towards becoming an intelligent and informed patient. Very few patients have so much of dedication or put in the necessary efforts to empower themselves with the right kind of knowledge. Here are a few things you can do to further your knowledge:
- Enroll yourself in our free newsletter about Acid Reflux/GERD management
- Download our free ebook on Acid Reflux/GERD
- Download our free ebook on Indian diets for GERD
- LIKE our Facebook page on Acid Reflux/GERD to receive daily updates on this disease
- LIKE our LIMA Facebook page to updates on other cutting edge treatments available only at LIM