NEW - at the end of this discussion, we have added links to other web sites with additional information.
This article is a combination of several e-mails from Dan Cardin, a PAGER member and chemical engineer. Interesting ideas... Several parents have also reported that spinal issues were important factors in their child's reflux but we don't have any of the stories written up. Please send us stories that are about children. Meanwhile, here is some input from an adult.
Why is it that the medical community is forgetting their Anatomy 101 when investigating the cause of GERD? No one seems to consider how the esophagus and LES function together, and what is actually controlling them. The trigger signal that causes the LES to relax is a wave propagation that starts with the swallowing of food or liquid, and continues down the esophagus until reaching the LES, which responds by opening and then tightly closing. The muscles involved are controlled through nerve impulses having their roots at T1-T4. It would seem reasonable, then, that anything that impaired the transmission of this signal to the appropriate muscles could cause the mechanism to become faulty. Minor nerve root compression anywhere in T1-T4 could cause a "false signaling" to the LES which could cause it to briefly open and close. If the nerve directly controlling the LES is not sending a clear signal, then the LES may be only loosely contracting. In either case, stomach acid and chyme are being allowed to flow back into the esophagus.
So let's look at some of the facts. Over-weight people have a 3 times higher occurrence of GERD. Interestingly, they also have more back problems resulting in nerve root compression due to the extra weight they are carrying. Recently, it has also been shown that weightlifters and, to a lesser extent cyclist and joggers, have an increased occurrence of GERD. These exercises are also known to be hard on the spine, causing swelling and pressure to be exerted on nerve roots.
Theories are fine, but providing evidence is another thing. Here is an easy test to determine whether GERD is being caused by reduced nerve impulse transmission due to swelling or some other problem in the spine. If the sensation of GERD is alleviated almost instantly by icing down the upper back, then this is probably the source of the problem. Inflammation is not only decreased by cooling, nerve impulses are also known to improve (MS patients are warned to avoid heat because of this). This is an easy, painless test that should be quite conclusive. I have found, personally, that heartburn symptoms for me are rapidly eliminated when icing my upper back (T1-T4). I am normal weight, but I work out 5 times a week. When I lift for 2-3 days straight, my GERD gets worse. When I run for 2-3 days straight (4 miles in 30 minutes), the symptoms are very mild. Yes, proper diet and good probiotics have helped me, but probably not as much as taking a glucosamine/chondroitin supplement which is helping to keep my joints and spine properly hydrated and healthy to keep pressure from becoming excessive on nerve roots.
I like your logic. In fact, my acid reflux and ulcer-like stomach pain are due to a mid back injury. I used to think that my back started hurting because of standing very stiffly when my stomach hurt. It took me all through high school to discover that my back was going out first and THEN my stomach started hurting. Motrin and chiropractic treatments work better for my stomach pain than acid reducing meds.
I did see a very recent article on Medline about esophageal distention and stomach distention not resulting in the proper LES relaxation and tightening in patients with GERD.
I personally think you are onto something. We have a few people in our group who have found that chiropractic and craniosacral maipulation helped. We also have some kids in the group who have a mild birth defect called Arnold Chiari Malformation which puts the same type of pressure on the nerves.
One thing that readers might argue is that swimming. obesity and weightlifting are associated with GERD because of horizontal positioning and because of the high intra-abdominal pressure. This is the accepted theory.
Thank you for your reply.
I agree that there are other causes of GERD, including distention related stress that prevents proper functioning of the LES. However, these cases would not be consistent with symptoms that seem to quickly start and stop, which is very common with many GERD sufferers.
Weightlifters do not just lift in the horizontal position, and they would not be classified as having GERD if they only had symptoms while lifting horizontally. A large percentage of weightlifters develop symptoms that continue long past their workout, suggesting that acid is still getting past the LES. For the high abdominal pressure theory to be correct, then, it would suggest that high pressure itself is causing a lasting change which is affecting the operation of the LES. However, although some singers develop GERD, it is not nearly as common with accomplished singers although they equally exert large amounts of abdominal pressure, so much so that hernias are quite common with many opera singers. However, singing does not put as much stress on the spine as heavy physical exertion, which could easily explain why this activity does not lead to GERD as often.
I have heard reports of Xanax providing immediate relief for GERD patients. I was actually on it for 2 weeks with amazing results, although I did not want to acquire an addition so I discontinued its use. An improvement resulting from the use of Xanax cannot be explained by a weak LES. In fact, a muscle relaxant would cause the LES to close even less tightly. However, Xanax may reduce the amplitude of false trigger signals coming in through T1-T4, so the LES is not tricked into opening as often. Interestingly, Xanax is also stated to reduce anxiety, which may result in the reduction of nervous impulses in general that are being sent out to muscles that are not under our conscience control.
I feel saddened that most research focucuses on eliminating the symptoms rather than curing the illness. There just isn't as much money in a cure. There are obviously a lot of intelligent individuals such as yourself that operate on a higher ethical plane and really care about helping people. It's too bad that all of you can't be given a billion dollars to actually find the cure.
Personally, I have always been interested in medicine. I received a BS degree in Biochemistry from University of California in 1981 (Rhodes Scholar Nominee, Phi Beta Kappa) before going on the obtain advanced degrees in both Organic Chemistry and Engineering. I founded a company called Entech Instruments in 1989 which is now at the top of its field worldwide. We manufacture instruments that allow the analysis of trace chemicals in a number of gas phase matrices by GCMS (Gas Chromatography / Mass Spectrometry). Many of these trace chemicals are known to be toxic to humans, so this technology has been incorporated into both EPA and OSHA methods. Although I was premed before choosing a different course, I find myself making a full circle back towards medicine as our technology is starting to be used to analyze breath for the detection of endogenous chemicals that may indicate various disease states, such as lung cancer. I know that this doesn't make me an expert in GERD, but my engineering and design experience has taught me to perform systems analysis by looking at problems from all angles. The equation can become more complicated, but fewer assumptions have to be made.
Best of luck with the new section of your web site. The more information we share, that faster we are going to arrive at a more complete theory that makes sense.
Entech Instruments, Inc.
Thanks for the update. I actually have an update on my condition. This may be a good addition to your site.
After going to my 3rd Chiropractor, I was finally diagnosed as having an unusually straight spine. I later found out that sleeping on one's stomach with the head and shoulders elevated through the use of even a standard pillow can cause spine straightening to occur over time. Without a proper curvature of the spine throughout the thoracic region, nerve root compression can become more common, resulting in the improper functioning of the LES and digestive tract in general through compression occurring in the T1-T6 region. I found that my GERD symptoms completely went away within 4-5 weeks of sleeping on my back by using a rolled up towel placed under my neck and lower back, allowing much of the curvature to be restored to my thoracic region. During the first few weeks, I often awoke with some temporary soreness in my back, which I found to be comforting as I knew that the ligaments and tendons were starting to stretch to produce the proper curvature. This soreness did not persist at all after getting out of bed, and some nights I would remove the towels and sleep the rest of the night on my side if there was too much discomfort. Now I am in a maintenance mode, and I make sure that I give my lumbar region a lot of support when sitting at my office or in my car.
It's interesting how GERD sufferers have good days and bad days. That would be consistent with a nerve root compression theory, especially as related to how one slept the previous night. If they assumed a posture which increased the amount of nerve root compression, then their symptoms would increase the next day. If they slept, say, in a fetal position that promoted good curvature of the spine, then they might have a good day
I would sure like to see studies conducted with children with GERD to see if nerve root compression is the cause of the problem. To produce more room for nerves as they emerge from the spine, a simple curved plastic support could be made that is very flexible, but supplies some additional, gentle pressure to promote a more ideal shape to the spine. This could be worn during the day, but would be most helpful at night to make sure that the spine was being coaxed towards a position that promoted maximum nerve function. The type and thickness of the plastic could be adjusted to make the treatment more or less aggressive, and of course a variety of sizes would be needed to accommodate patients of all sizes and ages. I'm convinced that this could lead to an ultimate cure for some, or possibly most cases of GERD. Very few GERD causes are the result of a truly defective LES, and Hiatal Hernias may actually be the result of a poorly closing LES, not the cause. The data that I see still keeps pointing to the improper control of the LES through impaired nerve impulses. Interestingly, many other health related problems may also be the result of nerve root compression causing major organs to function at less than 100% efficiency, but these other symptoms will pale in comparison to the pain associated with acid reflux. Needless to say, more research really needs to be done here, as there are a lot of suffers out there that could find relief, as I have, by making sure that their nervous system was allowed to function as it was intended.
Your update sparked a connection. Several years ago we had a guest lecture by Peggy Eicher, MD. She is a pediatric gastroenterologist who has recognized a new ramification of GERD. She sees patients who develop a "guarding posture" (hunching from tummy ache) and this causes their upper torso muscles to develop unevenly. They end up developing a type of scoliosis where the upper back bends too much and the neck and chin jut forward too much. The forward neck posture is a reaction to hunching over and still trying to look up - you are forced to jut your chin out in order to see straight ahead.
A few parents report that Dr. Eicher spotted undiagnosed GERD in an older child based on posture and later tests proved her right. One school age child was just tagging along on his baby brother's GI visit. Dr. Eicher spotted the fact that older brother has bad posture, has such tight abs that he can't rotate his shoulders and neck far enough to look over his shoulder, he runs out of breath in the middle of sentences because his lungs are squashed from poor posture, etc. Turns out the kid has wicked GERD just like baby brother. Between GERD meds and deep massage to help release the overly tight abs, he is doing fine. And he is doing better at soccer because looking over your shoulder is a mandatory skill in that game.
So you have to wonder if this is a bad spiral with pressure causing GERD that causes pain that causes bad posture that causes additional pressure on the nerves.
BTW, a friend of mine is an OT. At one of her jobs, she used to make soft hand spints that slowly retrain the hand muscles to go back to their intended positions after an injury or surgery. They are made of a plastic that is a bit like the stuff hockey mouth gards are made of. It has a low melting point but when it returns to room temp it is hard enough to apply light pressure. OT's cut, heat and shape the splints for each person. This technology might be less intrusive than the old scoliosis braces.
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