Introduction to gastric reflux: what is it and how does it occur?

Gastric Reflux is really straightforward: it is the retrograde movement of gastric contents into the esophagus or throat. This simple definition belies the complicated reality of reflux for many patients. 


At the outset, it is important to recognize a simple fact: Reflux is a condition and not a disease. This means that Gastric Reflux is a lifelong problem that can be “managed” but not one that can be “cured” like a sinus infection. 


Reflux is a condition we ALL have, regardless of whether we have symptoms. We are considered normal if we have 40 or less reflux events per day. Although not everyone who refluxes reports discomfort, the prevalence is significant. 


In the United States alone, 1 in 5 Americans (that is about 60 million people) experience heartburn at least once a month and 15 million of us report daily symptoms.




To add to the confusion, there is no such thing as one type of reflux symptom. Patients who suffer from reflux can have the classic heartburn but may also complain of hoarseness, throat clearing, nasal discharge or just a weird feeling in the throat. 


This adds to the confusion of where the problem lies making medical diagnosis more protracted and making it difficult for patients who are seeking help to feel better sooner.


There are multiple ways that medical professionals, once they diagnose reflux, can help their patients to feel better. Over the course of the next several blogs we will discuss the differences between Laryngopharyngeal Reflux and Gastroesophageal Reflux, reflux treatments such as diet and behavior modifications, the use of over-the-counter medications and supplements, the use of FDA approved drugs, and procedures and surgeries to try to fix the anatomic problems that permit reflux to occur.


Our first discussion will concentrate on the GI anatomy and how reflux occurs.


The G.I. tract (gastrointestinal tract) is designed to work in both directions and based on the normative values that G.I. doctors use, it works this way most of the time. G.I. doctors consider 40 reflux events or less a day to be “within normal limits”. 


The difference between someone who has reflux and someone who does not complain of reflux symptoms is not necessarily the number of reflux events, but rather whether they feel it or not. 


In order to understand reflux we need to discuss some anatomy and how the system is ideally supposed to work.


When we eat, the food goes from the mouth to the throat, into the esophagus and empties into the stomach. Although we chew our food into smaller bits with our teeth, the stomach is responsible for grinding the solid food into a creamy material (chyme) that can pass into the small intestine where the nutrients are extracted. 


The stomach is a muscular “bag” that contracts to break the solid food apart, creating high pressures in the stomach as it does this. Like everywhere in nature, high pressures will always find a way out to areas of low pressure. In the case of the stomach, there are only 2 escape routes: into the esophagus or into the small intestine. 


The esophagus lives in the chest where there is low pressure to allow air to go into the lungs while the small intestine is in the abdomen where there is constant higher pressure. The esophagus comes with 2 areas that “pinch it off” and keep it closed under normal circumstances that we call sphincters. 


There is one sphincter located at the top of the esophagus where it meets the lower throat (upper esophageal sphincter – UES) and one at the lower end of the esophagus where it meets the stomach (lower esophageal sphincter – LES). 


The diaphragm (a large sheet of muscle that separates the chest from the abdomen and aids in creating the negative pressure to allow the lungs to fill) further reinforces the function and strength of the LES.


These sphincters should ideally only open when there is food coming down the esophagus into the stomach. 


Unfortunately, there are conditions that can impair the function of the sphincters. People who have hiatal hernias lose the advantage the diaphragm offers because the top part of the stomach and the LES are in the low-pressure environment of the chest, making reflux much more likely to happen. 


Anything that lowers the tone of the sphincters (such as alcohol, the methylxanthines in real chocolate, or caffeine in coffee or sodas) can increase the chances of refluxing, especially when combined with anything that increases the pressure in the abdomen (such as exercising or bending over).


Although Nature does provide a way to keep reflux in check, it isn’t always enough to keep us symptom-free. 



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