When you eat, food is propelled from the mouth to the stomach through a tube called the oesophagus with the aid of sweeping oesophageal muscle contractions. At the lower end of the oesophagus is a specialised ring of muscle called the lower oesophageal sphincter (LOS).
The LOS remains tightly contracted until food or liquid arrives from above. The LOS relaxes, allowing the food and liquid to pass into the stomach and then re-tightens again acting as a one-way valve. This action prevents stomach acid, bile salts, and enzymes from flowing up into the oesophagus, causing symptoms and tissue damage.
GORD occurs when the LOS relaxes abnormally or becomes weakened, stomach acid tends to back up, causing symptoms of heartburn. This can be exacerbated by the presence of a hiatal hernia.
- Heartburn, a burning sensation in the chest
- Sensation of food stuck in the throat and repeated attempts to clear it
- Regurgitation (backflow of stomach fluids into the mouth)
- Belching, specially belching that acidic or sour-tasting
- Chest or upper abdomen pain that disrupts sleep
- Chronic sour or bitter taste in the mouth
- Dysphagia (difficulty swallowing)
- Choking sensation at night time
- Chronic or morning hoarseness
- Excessive salivation
- Nausea or vomiting
- Chronic wheezing
- Chronic cough
- Sore throat
What Contributes to Gastro-Oesophageal Reflux?
Some people are born with a naturally weak lower oesophageal sphincter (LOS). For others, however, fatty, spicy and tomato-based foods, certain types of medication, tight clothing, smoking, drinking chocolate, caffeinated beverages, citrus drinks, peppermint and alcohol, vigorous exercise or changes in body position (bending over or lying down during the first 3 hours after meals) and obesity may stress the anti-reflux mechanisms or cause the LOS to relax, causing reflux.
This is when the intra-abdominal portion of the oesophagus and the upper stomach “slides” or “slips” up above the diaphragm (flat muscle that separates the chest from the abdomen) into the chest cavity due to widening of the crural hiatus. And in doing so, it compromises the anti-reflux mechanisms by losing the flap valve effect function of the Angle of His and the pinch like effect of the crural muscles. The condition causes the LOS to fail and leads to reflux.