Acid Reflux or Gastroesophageal Reflux Disease (GERD) is a growing problem in the United States.
More people than ever before are being diagnosed with and treated for it than ever before. In the past, this condition affected only adults but over the past couple of decades the incidence of symptoms in children and infants has risen dramatically. The symptoms of this condition vary from person to person and there are many contributing factors to its development.
Symptoms of this condition may include: burning pain in the stomach that may move into the chest and/or throat, wheezing, dry cough, hoarseness, chronic sore throat, sour or bitter-tasting acid backing up into the mouth, bloating, burping, dysphagia -feeling as if there is food/lump stuck in the throat when swallowing, upper back and chest pain, and in some cases bloody/black stools or bloody vomiting.
In certain cases GERD can be caused by a condition known as a hiatal hernia. This is where part of the stomach moves above the diaphragm and allows acid to move past the lower esophageal sphincter and into the esophagus. More commonly though, there is a malfunctioning of the lower esophageal sphincter (LES), which is a ring of muscle that serves as a valve between the stomach and esophagus. Normally, when we swallow food the LES opens to allow the food to enter the stomach and then the valve immediately closes to prevent a backflow of food and/or stomach juices into the esophagus. We will discuss a potential cause of the dysfunction of the LES a little later.
Other common risk factors include: eating large meals or lying down after a meal; being overweight/obese; snacking close to bedtime; eating foods that tend to aggravate the stomach including, citrus, tomato, chocolate, mint, or fatty foods; drinking beverages such as alcohol, carbonated drinks, coffee, and tea; smoking, being pregnant, taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications.
There are several tests that may be performed to confirm the diagnosis of GERD before a treatment plan is decided upon. These tests include: Barium swallow – checks for ulcers or a narrowing of the esophagus, Esophageal manometry – to check the functioning of the esophagus and LES, Endoscopy – doctors use a small camera to inspect the throat and esophagus for abnormalities, Biopsy – samples of the esophagus can be taken during the endoscopy to be examined under a microscope for infection or abnormalities.
Depending on the outcome of the tests, treatments for acid reflux range from over-the-counter antacids (Alka-Seltzer, Mylanta, Maalox, Tums or Rolaids) to prescription medications (Zantac, Prevacid, Priolsec, Aciphex, Nexium, etc). Additional medications may include Reglan or Urecholine in an effort to help strengthen the LES and empty the stomach faster. Some of the side effects of these medications may constipation or diarrhea and if taken over long periods, the stomach will stop producing acid altogether and further digestive and mal-absorption symptoms may develop.
Surgery is only recommended in severe cases that cannot be controlled by diet modification and/or medication. Surgeons can perform a fundoplication procedure in which an artificial vavle is created using the top portion of the stomach. This strengthens the LES in an effort to prevent acid reflux and repair hiatal hernias when present.
It is important to note that prolonged acid erosion of the esophagus is serious and over time may lead to mutations in the cells which can lead to the development of esophageal cancer.
It is for this reason that the cause for the dysfunction of the LES needs to be determined. In a normal system, the swallowing of food or liquid causes a wave of propagation/movement of the esophagus that begins at the top and continues downward until it reaches the LES which is triggered by this movement to relax and open until the food passes through and then quickly close as the wave of propagation ceases. The muscles that are involved with this action are controlled through nerve impulses that have their roots/beginning from the first to the fourth thoracic vertebral area (T1-T4). Minimal nerve root compression or irritation at these levels can impair the transmission of this signal to the muscles involved and cause a “false signal” to the LES and allow it to open at inappropriate times, contributing to the acid regurgitating into the esophagus. In addition to improperly timed opening, the closing strength of the LES may also become impaired without receiving a clear signal from the brain and again allow a backflow of stomach juices into the esophagus. Chiropractors are highly trained in the evaluation of the spine and nervous system to locate and correct misalignments in the spine that can lead to the interference in the signal transmission between the brain and the LES.
It is important to find the source of dysfunction within the body that is causing the condition to occur for many reasons. Not only can this affect the quality and longevity of our lives but also that of our children. As was mentioned in the introduction to this discussion, the incidence of GERD in children and infants is on the rise. It was once believed that that the majority of children diagnosed with GERD would “out-grow” the condition. Over the past several years this view has changed. A study in 2006 from the American Journal of Gastroenterology evaluated a group of infants with GERD. The infants were split into two groups, one treated with medications and the other without. Esophageal tissue samples were obtained from infants at 2, 4, 6 and 12 months of age. Although both groups showed a decrease in symptoms over the testing period, none of the tissue samples taken at the 12 month point showed any improvement. The authors of the study point out that this “raises concern regarding sub-clinical persistence of ongoing esophageal insult, which might in the long-term, predispose the individual to GERD-related complications, such as strictures, Barrett’s esophagus, and/or esophageal adenocarcinoma”.
This study as well as other recent evidence shows that although medications can aid in symptom relief for infants, children and adults suffering from this condition, we need to focus more energy on identifying and treating the cause of the disease as early in life as possible in hope of preventing it from becoming a life-long illness.
If you or your child suffers from acid reflux/GERD, we urge you to call Total Health Systems of Macomb County today and schedule a chiropractic evaluation and/or nutritional assessment and get started on correcting the cause of this disease.
Gold, B.D., Is Gastroesophageal reflux disease really a life-long disease: do babies who regurgitate grow up to be adults with GERD complications? Am J Grastroenerol. 2006 Mar; 101(3):64 1-4