The diaphragm serves as a strong external support to the internal lower esophageal sphincter. If the diaphragm opening is weak, part of the stomach may protrude through the opening and create a condition called a hiatal hernia. Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen, resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people aged 50 and over have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages.

How many people have it?
Studies have shown that from 20% to 40% of the population have some symptoms of gastric reflux. This translates to 60 million people having symptoms of GERD at least once a month. Approximately 10%, or 25 million people have symptoms daily. What are contributing factors to this condition?

First, the ability of the diaphragm to contract properly is one of the most commonly overlooked factors. When you inhale, the diaphragm must contract properly so that you take air deeply into your lungs. Contraction of the diaphragm exercises the muscle, and the strength of the muscle is directly related to its ability to aid the lower esophageal sphincter. There are many simple tests that can be done in the office to test your diaphragm function.

Treating the cause of the failure of proper functioning will allow you to gain strength in the diaphragm and aid in the suppression of the regurgitation process.

“Studies have shown that from 20% to 40% of the
population have some symptoms of gastric reflux.”

Other factors that can effect regurgitation include some foods, coffee and alcohol, smoking, medications like calcium channel blockers, nitrates and beta-blockers. Hormones like progesterone can decrease lower esophageal sphincter pressure. Obesity is a contributing factor, probably because of the increased intra-abdominal pressure. Most pregnant women will experience symptoms of gastric regurgitation.

What are the symptoms?
Heartburn, also called acid indigestion, is the most common symptom of GERD. It usually feels like a burning chest pain, beginning behind the breastbone and moving upward to the neck and throat. Many people say it feels like food is coming back into the mouth, leaving an acid or bitter taste.

The burning, pressure, or pain of heartburn can last as long as two hours and is often worse after eating. Lying down or bending over can also result in heartburn. Many people obtain relief by standing upright or by taking an antacid, clearing acid out of the esophagus.

Heartburn pain can be mistaken for the pain associated with heart disease or a heart attack. However, there are differences.

Exercise may aggravate pain resulting from heart disease, and rest may relieve the pain. Heartburn pain is less likely to be associated with physical activity. Heartburn can also be caused by a lack of sufficient stomach acid, a condition known as hypochlorhydria. If you
have any symptoms of heartburn, talk to your doctor. She may be able to help determine exactly why you have the symptom.

What can I do to help the problem?
1. Avoid foods and beverages that affect lower esophageal sphincter pressure or irritate the
    esophagus lining:

        • fried and fatty foods

        • peppermint

        • chocolate

        • alcohol

        • coffee

        • citrus fruit and juices

        • tomato products

2. Lose weight if overweight.

3. Stop smoking.

4. Elevate the head of the bed 6 inches.

5. Avoid lying down 2 to 3 hours after eating.

6. Have your diaphragm tested for proper functioning. If it is weak, have it treated. Do breathing
    exercises to help it regain strength. 

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