Domain

Explanation

Gastroesophageal? … my tongue seems tied up …

• Gastroesophageal refers to the stomach 胃 and esophagus 食道 à Guts
• The stomach stores, dissolves, and partially digests the contents of a meal, then delivers this partially digested food to the small intestine in amounts optimal for maximal digestion and absorption. Parietal cells within gastric glands in the folds of the stomach lumen secrete hydrochloric acid (HCl), which makes gastric juice acidic 胃酸, with a pH less than 2.
• Esophagus is a muscular tube that extends from the pharynx through the esophageal hiatus of the diaphragm à it propels food toward the stomach by peristalsis, prevents acid-reflux by minimizing the retrograde movement of gastric contents
• Gross Overview

Reflux?

• Reflux 倒流 means to flow back or return.

Then, Gastroesophageal reflux is?

• Gastroesophageal reflux 胃酸倒流 is the return of the stomach's contents back up into the esophagus & sometimes into the mouth
• The stomach digestion products & contents à a solution of hydrochloric acid, enzymes, and food particles that is called chyme
• Are forced up into the esophagus through the following forces:

1. Faulty LES 食道下端括約肌不正常操作: haphazard opening when foods are still inside stomach; LES tissue damage – either genetic flaws or injuries or harmful physiological interactions or attack by other infectious diseases
2. Agitated stomach 胃不適: stomach as an organ for pre-processing foods for digestion before absorption by intestines, is agitated à either by other bodily contacts or physiological influences or by bodily posture or by emotions (stomach is considered the centre of emotions in TCM – a tender, flexible, elastic stomach is a reflection of high spirits, relaxation & even happiness)
3. Induced suction 反向抽壓: just like air is drawn into the lungs by the pulling down action or contractions of the diaphragm (the powerful muscle in between the lungs-thorax & the stomach) in the abdominal cavity à diaphragmatic contraction during straining or deep breathing (when abdominal pressure exceeds intraesophageal pressure) augments lower esophageal sphincter pressure to prevent reflux à ineffective or weak or injured diaphragm cannot reflux, hence GERD & might induce suction to suck the stomach contents into esophagus, just like it is doing to the lungs

GERD?

• GERD stand for Gastroesophageal reflux disease
• It is a digestive disorder that is induced by the lower esophageal sphincter (LES)--the muscle connecting the esophagus with the stomach
• Evidence indicates that up to 44% of otherwise healthy adult Americans suffer from heartburn at least once a month
• Affects atleast an estimated 5% to 7% of the global population—men, women, and children
• To laymen, the occasional stomach disorder or "grumbling" may not seem much; the occasional burp is a mischievous distraction; the daily bad breath is just another bad day, perhaps
• Perhaps, perhaps not
• However,
• The severity of the consequences & ailments that GERD causes (like cancer) are simply too life-threatening to joke about
• GERD is a disease, not a symptom à it has been identified as one of the leading causes of serious diseases à remember, all serious things have not-so-serious starts
• GERD is also chronic 長期疾病 à it takes a long time to ignite & develop à & it takes a long time to handle & keep under control, if it is still controllable à & it takes even longer for people to observe & admit to themselves the presence of GERD

The causes?

• Hiatal hernia may weaken the LES and cause reflux
• Dietary and lifestyle choices may contribute to GERD
• Lower emotional well-being 失落感: people with unresolved GERD often report worse scores than those with other chronic diseases, like diabetes, high blood pressure, peptic ulcer, or angina à people with GERD are more depressive & disturbed
• Certain foods and beverages, including chocolate, peppermint, fried or fatty foods, coffee, or alcoholic beverages, may weaken the LES causing reflux and heartburn.
• Smoking relaxes the LES
• Obesity
• Pregnancy!

The effects?

• GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach.
• The disease of GERD is formed by:

1. Erratic LES: either emotional or physiological or both (in closed-loop structure)
2. Tissue damage 細胞被嚴重灼傷 & mutation 病變 due to acidic vomit from stomach: consistent damage leads increased risks of malignant mutations, leading to unimaginable complications
3. Complications: as a direct or indirect result or accompaniment of GERD à may mask GERD presence & the patient seeks treatment for the complicated, instead of the its cause, GERD à hence, GERD survives to continue its damage to the body & subsequently, the mind through bodymind interactions

• The severity of GERD depends on:

1. LES dysfunction: the more abnormal LES, the more it allows stomach contents to spill backwards into the esophagus
2. Type and amount of fluid brought up from the stomach: the more acidic, the lower the pH, the more corrosive, the more tissue damage, the higher risks of complications
3. Neutralizing effect of saliva: the more saliva the better

• Mild symptoms like:

1. Burping 嘔胃气!
2. Hoarseness in the morning
3. A sour taste
4. Bad breath! 口臭!

• Further symptoms like:

1. Difficulty or pain when swallowing
2. Waterbrash (sudden excess of saliva)
3. Dysphagia (the sensation of food sticking in the esophagus)
4. Chronic sore throat
5. Laryngitis
6. Inflammation of the gums
7. Erosion of the enamel of the teeth
8. Chronic irritation in the throat: known to cause damage to vocal cords (the late Leslie Cheung also had GERD & his vocal cords were once so damaged that he had to retire & rest temporarily)

• More severe symptoms like:

1. Chronic heartburn 胸口赤痛
2. Regurgitation of acid 胃酸倒流: as in hydrochloric acid (every chemistry student knows how reactive & corrosive HCl is à in fact, it is one of the most corrosive acids in nature)
3. Barrett's Esophagus: a pre-cancerous condition when a transformation takes place in the normal tissue lining the esophagus

• Complications à only a minority of patients develop complications of GERD. These complications include breaks in the lining of the esophagus (esophageal erosions), esophageal ulcer, and narrowing of the esophagus (esophageal stricture). In some patients, the normal esophageal lining or epithelium may be replaced with abnormal (Barrett's) epithelium. This condition (Barrett's esophagus) has been linked to cancer of the esophagus and must be carefully watched. Lung (pulmonary) aspiration, asthma and inflammation of the vocal cords or throat may also be caused by GERD
• The consequences could be dire:

1. Direct complications: esophagus-related diseases
2. Indirect complications: non-esophagus-related diseases where there is spreading & complex manifestations resulting in different diseases at other parts of the body

Treatments?

• Treatments like repairs must address the following 2 aspects:

1. Symptoms: relieve, reduce &/or manage the above symptoms
2. Causes: eliminate or reduce by managing the causes of GERD that the patient is suffering from

• Work closely with your doctor & family
• Medications, lifestyle changes & surgery

Prevention?

• Daily living
• As GERD is chronic, we have to realise steady changes of diet, lifestyle, attitude, emotion, surrounding people & environment
• Use consistent, qualitative monitoring of our bodily symptoms & feelings as the criteria to judge whether what we are doing helps against GERD
• Things to note:

1. Never sleep within two hours after a heavy meal
2. Lower living tension
3. Have regular, balanced diets
4. Less late dinner or too much supper
5. Sleep with a tilt: raise the head with a bigger pillow or raise the bed front
6. Eliminate heartburn, stomach discomfort & aches
7. Less alcohol, smoking & coffee, fatty, oily foods

Advice …

• The body is the root of our existence, the fundamental for life
• People can always argue, think, work, compete, race & go for their dreams, goals & what not
• But,
• In the end, the body is still the root à no body, no life
• That's why the Chinese saying: health is wealth 健康就是福
• Take care of our bodies – be giving to the body what it has given us
• Further readings:
• Human biology - Figures, Biology Project
• FAQ
• http://page.search.sohu.com/cgi-bin/pagesearch.cgi?tn=sohu&si=gi&word=?áµÁ÷,%20&ct=0&cl=2&lm=0_????