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Gastroenterology and Health

Lower esophageal sphincter, Gastroesophageal reflux disease

GERD and LES Are Not The Latest Pop Stars

By Dr. W. Gifford Jones

Have you heard about GERD and LES? No, they're not the latest pop stars. Nor are they brother and sister. But LES (lower esophageal sphincter) often determines whether you suffer from GERD (gastroesophageal reflux disease). And if you don't know anything about GERD you may think your pain is due to coronary disease.

Dr. Janhenk Voskuil, a Dutch gastroenterologist, recently addressed the World Congress of Gastroenterology in Los Angeles. He had disquieting news about cardiologists.

DR. Voskuil reported one would think that cardiologists should consider the stomach as a source of chest pain once they've ruled out heart disease. But they often fail to do so.

The result is that many patients remain undiagnosed for more than a year after studies show their heart is not causing chest pain.

Yet research studies done in the U.S. and Netherlands show that one-third of patients who are seen by physicians complaining of anginal-like chest pain are in fact suffering from GERD.

Dutch physicians are trying to change this neglect. Now patients with normal electrocardiograms, normal cardiac enzymes, exercise tests and continuing bouts of chest pain, are referred to a gastroenterologist to seek the source of the discomfort.

What causes gastroesophageal reflux disease (GERD)? The lower esophageal sphincter (LES) is the muscle at the bottom of the esophagus (foodpipe) which normally keeps irritating stomach juices from backing up into it.

Like muscles in other parts of the body the LES can become weakened and inefficient. If the stomach is overly distended it's ability to hold back the pressure of gas is also lessened. And as gas is expelled, gastric juices also shoot up into the esophagus causing inflammation of the lining of the esophagus.

Everyday heartburn is usually not difficult to pinpoint. It creates "a glowing fire" beneath the breastbone following a heavy meal. And it's often accompanied by belching and regurgitation of bitter fluid. Some families seem prone to developing this condition and spend a part of their lives gulping down bicarbonate of soda.

Can patients decrease the chance of recurring after-meal fires? I recall seeing a few years ago a T.V. ad that showed a man in considerable distress exclaiming, "I ate the whole thing!"

Don't forget the laws of physics also apply to the stomach. When too much food goes into it and a weak LES is present something has to give.

Remember too that all the jogging in the world won't make a weak LES stronger or tighten it up. The best solution is to leave something on the plate at mealtime and much of the fire will be dampened.

Gastric juices, like water, don't flow uphill. So remain upright following a meal and forget about after dinner naps. It's for this reason that doctors suggest raising the head of the bed as many attacks of heartburn occur during the night.

The common practice of loosening your belt following a heavy meal also makes sense. And avoid tight-fitting garments. This helps to take some of the strain off a weak LES.

There are a few more do's and dont's. Say no to onions, garlic, chocolate and tobacco. These decrease the stomach's motility as well as the tone of LES. Similarly avoid gas forming vegetables such as cabbage and beans.

Try to avoid tension at the dinner-table. Pent up emotions impede the normal workings of the stomach.

But suppose you limit your desires and the fires continue to burn? Doctors may suggest drugs that impede the secretion of acid. In general these drugs are reserved for proven peptic ulcers. But they can be used profitably in severe cases of heartburn.

Remember heartburn can mimic heart disease and heart problems can imitate heartburn. For example, substernal pain may radiate to the arms and jaw suggesting either GERD or angina. So if there's any doubt about the diagnosis be sure to consult your doctor. It's been aptly said that "he who treats himself has a fool for a patient."

Am I going to practice what I preach? You bet I am. I recently wondered if my chest pain was due to an impending coronary. Then I remembered that I'd rushed from surgery to my office, eating on the run all the things that trigger heartburn.

This year I'm going to change my lifestyle. I'll drive by the fast food chains and enjoy a leisurely lunch at my favourite Italian restaurant. Possibly order a glass of red wine to oil my cardiovascular system as well as ease the tension. Maybe even arrive a little late for the office.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod