Do symptoms of acid reflux, esophageal spasms and hiatal hernia really overlap that much?
“There is a continuum of disorders that can affect the esophagus,” says gastroenterologist Larry Good, MD, who’s been in practice for 40+ years; has a private practice in Lynbrook, NY; and is affiliated with Concierge Choice Physicians, a leading provider of personalized care in the U.S.
Dr. Good continues, “Patients often equate the presence of a hiatal hernia, the herniation of the stomach above the diaphragm, with GERD. This is not true.
“About a third of adults have a hiatal hernia and the vast majority of these patients do not have symptomatic heartburn.
“Adding obesity, diabetes mellitus and delayed gastric emptying to the presence of a hiatal hernia is a good recipe for heartburn.
“Symptomatic acid reflux occurs when the esophageal lining or mucosa becomes inflamed.
“The esophagus is lined with stratified squamous epithelium, so it is exactly like the skin. Imagine how your skin would react to being exposed continuously to hydrochloride acid!”
What really causes heartburn?
Dr. Gordon says, “Physicians have always believed that heartburn was primarily caused by acid injury to the esophagus. Medication [such as with PPI pills] is extremely effective in treating heartburn and in allowing inflamed esophageal mucosa to heal.
“There is, however, some recent evidence that this simple explanation for heartburn may not be entirely accurate.
“An allergic response to certain foods (unrelated to the typical food triggers for heartburn) may generate an inflammatory reaction in the esophagus called eosinophilic esophagitis, and that may presage many episodes of reflux esophagitis.
“Gastroenterologists are now seeing many patients with eosinophilic esophagitis and are studying the links between these conditions.”
Dr. Good has additional expertise in the diagnosis/treatment of IBS and inflammatory bowel disease, and is extremely proactive in genetic testing, individualization of pharmacologic treatment, and risk mitigation in cancer screening/prevention. Concierge Choice Physicians
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.