Esophageal Reflux – Symptoms and Causes

The esophagus is the muscular tube leading from the throat to the stomach. It directs and food and drink into the stomach for digestion and absorption which continues through the small intestine. Esophageal motility ensures that peristaltic waves that start in the throat during swallowing continues to propel the bolus (ball of food formed after chewing and pharyngeal swallowing) into the stomach.

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The direction of movement is from the throat to the stomach and retrograde flow (backward flow) is prevented by the direction of the peristaltic waves. In addition, the lower esophageal sphincter (LES) at the bottom of the esophagus ensures that the stomach contents do not travel up into the esophagus.

Esophageal reflux may be related to regurgitation or vomiting. Regurgitation is a more passive process than vomiting and can propel food in the esophagus, stomach or even first part of the small intestine back into the throat or mouth. Gastroesophageal reflux disease (GERD) is chronic acid reflux usually associated with lower esophageal sphincter dysfunction (LES). This is one of the more common causes of esophageal reflux. Other causes may be due to problems in the esophagus like a tumor, constriction, failure of the LES to function properly or dysmotility.

Signs and Symptoms of Esophageal Reflux

  • Water brash – a sudden secretion of large amounts of saliva to neutralize the acidic stomach contents in the esophagus
  • Nausea, sometimes leading to vomiting
  • Heartburn – burning chest pain
  • Indigestion – stomach bloating, excessive belching
  • Throat irritation
  • Projectile vomiting due to obstruction in the lower part of the esophagus, stomach or duodenum

Chronic reflux may lead to a host of symptoms in the upper airway, including coughing, hoarse voice and a lump in the throat feeling.

Causes of Esophageal Reflux

  • Gastroesophageal Reflux Disease (GERD)
  • Stomach contents, and sometimes duodenal contents, pass up into the esophagus.
  • Occurs due to a failure of the lower esophageal sphincter to prevent the backward flow of stomach contents, hiatal hernia or increased intra-abdominal pressure.
  • Achalasia
  • Food cannot enter the stomach at a rate that allows for complete clearing of the esophagus.
  • Occurs due to a failure of the lower esophageal sphincter to open fully.
  • Esophageal Stricture
  • An esophageal stricture is an abnormal narrowing of the esophagus.
  • Occurs for various reasons including an obstruction like a tumor, inflammation of the esophageal wall, compression from an external structure or constriction due to scarring of the esophageal wall.
  • Stomach or Small Intestine Obstruction
  • An obstruction in the distal end of the esophagus (pylorus) or proximal parts of the small intestine may cause regurgitation and reflux.
  • This may arise due to pyloric stenosis, tumors, foreign bodies, gallstones or other causes as outlined under blocked bowel.

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