The Lower Esophageal Sphincter

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Lower Esophageal Sphincter Overview

Mother Nature demonstrated an incredible piece of biotechnology when she designed this valve.

This mechanism performs a number of breathtakingly elegant roles. In fact, the LES is the single most important organ we have when it comes to preventing heartburn and GERD...

Mother Nature also did an awesome job when she designed the stomach and the digestive system.

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How the LES and Stomach Work

Here’s how it all comes together:

After chewing and swallowing, the food travels down a muscular pipe called the esophagus. During this process, our digestive system performs a number of complex reflexive actions:

• Firstly, the esophagus instigates a series of contractions causing a ripple effect. This movement pumps the masticated food/saliva mixture downwards with the help of gravity.
• Secondly, when the food reaches the stomach entrance, a nerve impulse fires, announcing the arrival of the nourishment.

At the entrance to the stomach, Mother Nature installed the lower esophageal sphincter - a device to prevent acid from backing up into the food pipe and injuring it.

This valve consists of a ring of muscle that forms a powerful sphincter called the lower esophageal sphincter (LES).

The LES is assisted by the opening or 'hiatus' in the diaphragm - a dome of muscle separating the chest cavity from the stomach.

The hiatus works in harmony with the LES, thereby increasing its clenching action.

This makes the LES capable of withstanding the onslaught of pressurized stomach acid, yet delicate enough to allow the regurgitation of digestive gasses via the action we call "burping".

When the sphincter senses the presence of food, it relaxes, opens briefly and then closes. This allows the food to pass safely into the stomach, while at the same time preventing acid from escaping upwards... and then the digestive process begins.

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The Digestive Process

In order to break the food down into nutrients the body can absorb, the chemical factory we call the stomach must first treat the nourishment with a corrosive digestive fluid.

This is a mixture of hydrochloric acid, an enzyme called pepsin (starts the process of digesting proteins), and a trace of liver bile.

To prevent us from digesting our own stomach, the gut is lined with a complex mucous membrane that is impervious to acids and digestive enzymes...

However, this protective layer does not extend past the lower esophageal sphincter.

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The Onset of Heartburn

Occasionally after swallowing, the LES doesn't quite close all the way. Sometimes it even opens spontaneously or stays open too long.

When this happens, digestive acid backs up into the tube and attacks the inside wall of the unprotected esophagus.

This causes the discomfort we call 'heartburn' or 'acid reflux'.

The feeling is unmistakable.

There's a burning sensation behind the breastbone (or sternum), which can also radiate to the upper chest, throat and around to the back.

In addition to the pain, every now and then a person will burp and taste a mixture of food an acid in the back of the throat.

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Causes

In the case of the GERD sufferer, the LES itself is defective or malfunctioning.

This could be caused by a number of factors:

• A hiatus hernia, which reduces the clenching action of the LES.
• A relaxed lower esophageal sphincter caused by some drugs (illegal or otherwise).
• Food allergies that also cause relaxation.
• Physical anomalies.

As a result, the frequency of attacks could escalate to dangerous levels. This in turn, could lead to a painful disease known as 'esophagitis' and ultimately, a life-threatening malady called Barrett's esophagus.

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Remedies

There are a number of ways to alleviate this condition, including:

• The short-term use of a proton pump inhibitor (PPI) or an H2 blocker.
• Various natural remedies.
• Lifestyle changes.
• Diet adjustments.
• Avoiding certain medication and drugs.
• And as a last resort, surgery.

It should be noted that any drug such as a PPI, an antacid or H2 blocker, would simply treat the symptoms of acid reflux without correcting the malfunctioning LES - and whichever way you look at it, that is the root cause of GERD.

With regard to surgery: The most successful technique for correcting a hiatus hernia and reinforcing the LES used so far, is called the Nissen fundoplication procedure, developed by the Swiss surgeon, Rudolph Nissen.

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References

Barrett's Esophagus Info: Lower esophageal sphincter (LES) function

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