GERD! (heartburn)

GERD – it sounds like growling, but it’s just the latest in a series of names for heartburn. It stands for gastroesophageal reflux disease, but has also been referred to as hiatal hernia and reflux esophagitis. Call it what you will, it’s all about where the tube to the stomach (the esophagus) meets the stomach. This happens at the left diaphragm (breathing) muscle, up under the ribs and near the heart, hence “heartburn.”

This is an important area to discuss, as treatment choices can have some far-reaching implications.

The stomach is very acidic in order to digest proteins, not just the proteins in meat, but in grains and vegetables as well. The acidity also is critical to absorbing B12, an essential nutrient to prevent anemia as well as to keep homocysteine low (homocysteine is a metabolite that damages arteries and can lead to heart and arterial disease). Stomach acid also helps kill ingested bacteria that could otherwise cause disease, damage intestinal mucosa, and lead to absorption of partially digested proteins (proteins that aren’t fully digested may be treated as foreign proteins in the bloodstream, resulting in food allergies and sensitivities).

So far, it sounds like having a nicely acidic stomach is a good idea. But what is the first response to heartburn and indigestion? Acid reducing or buffering medication, often taken on a long-term basis. Some of them are calcium-based, such as Tums, which can lead to hypercalcemia (high blood calcium).

So what is heartburn, really? It is the pain experienced when stomach acids splash back into the esophagus, which does not have the same protective mucosa as the stomach itself. This splashing is normally prevented by the gastroesophageal sphincter, a muscular thickening where the esophagus connects to the stomach, and the diaphragm muscle itself, which lies over the stomach and has a hole for the esophagus.

While a few people are born with trouble in this area, by far most of us have problems with splash-back because of the following sequence of events:

1. We overeat.

2. We sit and slouch after overeating, or lie down. Naturally we do this, because we’re tired from overeating.

3. This produces pressure on the sphincter, and acids escape to the esophagus as the stomach tries desperately to churn the food while overfull and all squished up.

Sadly, we may not normally overeat, but did so during a holiday, and started a problem that persisted. This can be a spasm and malfunction of the sphincter, or even a protrusion of the stomach up through the diaphragm (hiatal hernia). We’ve been warned that persistent heartburn can cause esophageal damage, even cancer, and besides, it hurts.

Conventional medical treatment is acid-reducing medications (see consequences above) or even surgery. Surgery itself can lead to scar tissue and constrictions, sometimes resulting in stenosis and inability to pass food through the esophagus. When that happens, the next step is a liquid diet, possibly poured through a stomach tube. Medical physicians, concerned with these kinds of results, keep working on gentler ways to do this surgery. Unfortunately, neither surgery nor medication address the basic mechanical problem: your sphincter is on the fritz!

So is there another way to deal with this? Absolutely. It isn’t comfortable, but it is simple and only takes 5 minutes. Once or twice usually does the job. It involves the practitioner treating reflex points, working out diaphragmatic spasm, and gently reaching under the ribs to traction the stomach.

I can’t think of the number of times I’ve been told by a patient, months or years later, that they have had no problems with heartburn since the procedure. Or they’ll be seeing me for something else, and say, “Oh, hey, can you do that thing with my stomach again? I overstuffed myself the other day and think I started the problem up again.” Success rate is ridiculously high. With no health harming antacids!

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