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The Scenario:
Shawn had been studying very hard for his final exams. He had been staying up late, getting very little sleep, and was under a lot of pressure. His diet left a little to be desired. His essential nutrient intake for about a week consisted of Coke, Twisters, and potato chips. Nonetheless, he got through his first couple of exams feeling like he had done reasonably well.
As the week wore on, he began to notice increased acid indigestion and heartburn. He just figured it was due to the stress, and took some Tums. They helped for awhile, but the symptoms continued to worsen. By the end of the week, with exams all done, he was quite uncomfortable. He was popping ten or twenty Tums a day, and even tried some Tagamet from the grocery store, with only temporary relief. It got really bad at nighttime. Lying in bed, he could feel the acid reflux all the way up to the back of his throat. Finally, after a particularly bad night, he made an appointment to see the doctor.
The doctor gave him some pills to suppress acid production and ordered an upper GI x-ray.
Questions:
Answer:
There are several things you might see if you were to do an upper GI x-ray. Some people guessed ulcers, some a hiatus hernia, and others thought it would be normal. These are all reasonable possibilities, and it's hard to know without doing the test.
The interesting thing to focus on, and something that is commonly misunderstood, is the relationship between acid reflux into the esophagus --which is what Shawn had -- and what is called a hiatus hernia. Many people have heard of hiatus hernias but are unsure of what they are or what they mean.
In contrast to last week's puzzler which was about a hernia in the groin, a hiatus hernia is a condition where the stomach is pulled, or herniated, above the diaphragm. The diaphragm is a flat muscle that stretches across the chest, separating the contents of the chest and abdominal cavities. Normally, the esophagus, or food tube, passes through the diaphragm and immediately enters the stomach. The stomach normally resides below the diaphragm.
For many years it was believed that hiatus hernias caused acid reflux. There was a sense that just having a portion of the stomach herniated above the diaphragm must be a problem. But studies have shown that this is not true. Many people have hiatus hernias but are totally free of symptoms. Others have reflux symptoms but no hiatus hernia. As it turns out, the workings of a muscular sphincter at the lower end of the esophagus is more important. This sphincter must be coordinated and strong enough to let food pass easily, while preventing partially digested food and acid from refluxing back into the esophagus.
The drugs for this condition work great. But controlling your symptoms without medication is even better, and very do-able. Smoking, alcohol, chocolate, mint, and high fat meals will relax the esophageal sphincter and thereby cause acid reflux. Shawn should stay away from them. Lying down after a meal also promotes reflux. And some people benefit by putting the heads of their beds on six inch blocks to reduce nighttime reflux. Although not a problem for Shawn, heartburn is a common complaint of pregnant women. High levels of hormones cause excessive relaxation of the esophageal sphincter.
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