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The lower esophagus normally lies in the abdominal cavity below the diaphragm. Because there is a difference in pressure above and below the diaphragm, the higher pressure in the lower portion of the esophagus keeps the stomach juices in the abdomen. When one swallows, the lower esophagus opens to let food pass into the stomach and then it contracts again to prevent regurgitation. This is regulated by the autonomic (or automatic) nervous system and is also stimulated by conscious effort. If a person overrides this system by engorging his stomach with food added to the acid in the stomach, a small amount of reflux will take place and heartburn will occur.

When a person has reflux disease, a mechanical fault at the junction of the lower esophagus and stomach occurs and the esophagus becomes dilated. The esophagus then becomes shortened and the stomach can even push up into the chest cavity above the diaphragm - a situation called hiatal hernia. When this happens, the pressure in the lower esophagus is the same as in the stomach, and gastric secretions can move freely between the two. Gastroesophageal reflux disease follows.

The Diagnosis of Reflux Disease. It is not always simple to make the diagnosis of gastroesophageal reflux disease. It begins with the careful history and physical examination by your doctor. The symptoms previously described on this web-site are the most common. Their frequency is often associated with the severity of the disease; however, the severity of the discomfort is not always an indication of complications arising from the disease. Generally, anyone who experiences frequent heartburn or needs to use antacids or is awakened at night with stomach upset or regurgitant into the mouth should be evaluated by a physician. In addition, patients with frequent chest pain or asthma have often been found to have this disease. The diagnosis is often made after an extensive and costly work-up to rule out heart disease. Also, anyone having difficulty with swallowing needs to see a doctor for evaluation of their digestive function between the mouth and the stomach.

After a thorough physical examination, your doctor may first recommend a simple upper gastrointestinal x-ray series which entails swallowing a chalky substance called barium and watching it go down the esophagus and into the stomach. This often will diagnose a hiatal hernia and will sometimes actually demonstrate the reflux coming back the wrong way. Your doctor may also recommend endoscopy, which entails placing a small tube with a microscopic camera attached to the end into the esophagus. This helps visualize the damage done by the stomach juices to the lining of the esophagus. In order to firmly establish the diagnosis, however, it is necessary to measure the ability of the connection between the esophagus and stomach to function as a one-way valve. This is done with a special probe.

Relief From Gastroesophageal Reflux Disease. (Lifestyle Changes)

Initial treatment of reflux disease is to first distinguish normally occurring physiologic reflux from true gastroesophageal reflux disease, which can be done with diagnostic tests. Another way to rule out true reflux disease is to make significant lifestyle changes to see if the symptoms disappear. These include losing weight, smoking cessation, stopping alcohol intake and avoiding certain foods which can contribute to the problem. One can also raise the head of the bed at night to promote emptying of the lower esophagus with gravity. Avoidance of tight-fitting clothing and taking antacids may also help in some cases.

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Relief From Gastroesophageal Reflux Disease. (Lifestyle Changes)