Posted 25 September 2011 - 01:15 PM
Just wondering if anyone knows if it is the gut that is the initial problem with the Esophagus (in CREST). For example, is it the gut not digesting foods that causes the food/acid reflux to back up into the esophagus or does it happen because the esophagus does not allow the food to get into the stomach to begin with? Any ideas? Thanks.
Posted 25 September 2011 - 03:48 PM
I am no sort of medical person but I think I do understand how the esophagus works.
There are involuntary muscles called sphincters at various places in your digestive system, Their job is to keep the contents of your stomach and small and large intestines where they should be. So (I think) there is one at the top of your esophagus which lets food down but not back up. Then peristalsis carries the food to the stomach where the next sphincter lets it into the stomach - and not back. Except in many people's case this sphincter is damaged by various things like scleroderma in our case. This is called a Hiatal Hernia when the sphincter gets damaged and doesn't work so well. When you lie down (or stand on your head) there is nothing to stop the contents of your stomach coming back. Because the stomach fluids are acidic to digest your food then this backflow burns the lining of your esophagus because it is not supposed to be be there.
The action of the antacid preparations we take neutralises the acid so when the reflux comes up it doesn't burn and therefore does less damage.
I hope that answers your question, the food does get to your stomach but doesn't always stay there.
I am not sure what gets damaged first, but I think it is the esophagus becoming rigid from the collagen which get laid down in an inappropriate place, then peristalsis becomes less effective then gravity is the only thing which carries your food down, that is why you need to chew well and drink with your food to get it to a state where it will flow more easily. My first problems occurred with eating bread - it would get stuck and I couldn't understand why. Then I was sent for a dilation where my esophagus was gently stretched. Now that the years have gone by it is floppy and saggy I believe!!
Hope that helps.
Posted 26 September 2011 - 01:43 AM
I'm afraid I can't really add anything to Judy's excellent explanation, but I've included a link to GERD which I hope you'll find interesting.
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Posted 26 September 2011 - 05:29 PM
Thanks to you too for the link, Jo.
Posted 29 September 2011 - 06:26 AM
It is my understanding that drugs like Nexium control the production of acid while tablets such as Tums neutralize the acid. I had severe acid reflux and I could not get it under control with any of the medication. I basically have little/no esophogus motility. My flap separating the esophogus and stomach was completely gone as a result of the acid having eaten it away. Ultimately, I had fundoplication surgery which helped dramatically. The surgery is such that the esophogus is stretched and wrapped around the stomach to make it difficult for the acid to come up into the esophogus. All the sclero doctors that I saw recommended that I NOT have this surgery done. The best I got was that even if it worked that it would only last 2 years as my esophogus would continue to deteriorate due to the sclero disease. In any event, I took the leap of faith and had the surgery done. It has been the best thing for me. My acid reflux is not bad at all and I pretty much eat everything. I just need to drink alot of liquid when I eat items such as bread in order to push the bread down.
If this is something that people want to consider, my only advice is to have it done by a surgeon that does lots of them and one who is very familiar with sclero patients. The surgeon who did my procedure was great and I appreciate the fact that he was willing to adjust the surgery he performed based on how flexible he found my esophogus as he was aware that with sclero patients you don't really know how rigid the esophogus will be. If you reach the point that you can't manage the acid reflux no matter how many Nexiums you take, then this might be an option for you.