Heathy Esophagus and Stomach

Healthy Esophagus & Stomach

The stomach begins the process of food digestion through the production of acid. The stomach is designed to handle acid but the esophagus is not. There is a sphincter between the esophagus and stomach that usually prevents the acid from backing up into the esophagus. Irritation of the esophagus can be painful. Chronic irritation places a person a risk for developing a condition called Barrett’s Esophagus, which is a precursor to esophageal cancer. So what causes excessive sphincter relaxation and acid reflux?

First, abdominal obesity or tight fitting clothing can increase stomach pressure and push acid backward into the esophagus. Weight loss can decrease this problem. Esophageal sphincter relaxation can also be caused by smoking, alcohol, caffeine, spicy foods, acidic foods, fatty foods, chocolate, and mints. If reflux is a problem you can take the following measures to prevent esophageal irritation: lose weight, avoid tight-fitting clothes or betls, avoid excessive consumption of foods that relax the sphincter or increase acid production, elevated the head of your bed to use gravity from refluxing all the way up, and the Mayo Clinic has found that relaxation techniques can help as well. Those who have had bariatric surgery and have a smaller stomach are at a higher risk for reflux and have to be more careful about these foods that relax the sphincter. Fortunately, as they loose weight the pressure on the stomach will decrease somewhat.

The stomach can also also get irritated by excessive acid production and cause heartburn (gastritis) or even ulcers. Heartburn can be increased by the following: Helicobacter pylori (bacteria in stomach- see last week's blog), overeating, eating in a hurry, fatty foods (they linger in the stomach longer), acidic foods (vinegar in salad dressing, tomatoes, citrus, etc), caffeinated beverages, carbonated drinks (soda pop), Chocolate, spicy foods, and alcohol. Stress and anxiety can also contribute to heartburn and gastric ulcers.

The stomach should be nice and pink like the muscosa in your mouth. Imagine how your mouth would hurt if it looked like this.

Aspirin and Non-steroidal anti-inflammatories (ibuprofen, aleve, etc) also increase the risk of gastritis and gastric bleeding. Some carry a higher risk than others. If you must take any of these medications long-term you should discuss with your physician how to minimize your risk. You may need to take a proton-pump inhibitor (prilosec, nexium, etc) to decrease acid production. You may be able to switch to a less risky NSAID (sulindac, celebrex).

All of the above foods can increase the risk for stomach cancer because they cause irritation. However, smoked foods, salted fish and meat, pickeled vegetables, and smoking have all been found to be even greater risk factors. The reason for this is because they contain nitrates and nitrites that can be converted by bacteria in the stomach into dangerous compounds that increased the risk for cancer. Many believe that the Japanese and Chinese carry a much higher risk for stomach cancer because of their diets.

Healthy Small Intestine

The small intestine is an often neglected organ despite its average size (16 feet long). The surface area of the small intestine mucosa could cover a tennis court if stretched out. The small intestine has three parts: duodenum, jejunum, ileum. Why is it neglected? Because it never really has too many problems. If there were common diseases associated with it we would talk about it more. For example, it is very rare to develop cancer of the small intestine. It is much more common to develop oral, esophageal, stomach, colon, or rectal cancer. So how do you keep a healthy small intestine? Is there much you need to do?

In reality, there is not much that needs to be done to maintain a healthy small intestine. However, you need to pay attention to this organ and catch the signs that something may be wrong. The small intestine performs the important role of absorbing your nutrients once they have been digested. You need to maintain a healthy mucosa to perform this role.

What can cause the mucosa to be unhealthy?

Helicobacter pylori is a bacteria that causes 90% of the ulcers in the duodenum. Duodenal ulcers can be life-threatening as they can bleed profusely and even perforate. This organism was discovered a little over 10 years ago and was found to cause a significant number of ulcers primarily in the duodenum. Duodenal ulcers cause epigastric pain that radiates to the back. A bleeding ulcer can cause you to have black tarry stools. This ulcer can be caught through a upper GI series (barium swallow), esophagealgastroduodenoscopy (EGD), or a blood test for the bacteria. The treatment is a long course of antibiotics to eradicated the organism.

Celiac disease (celiac sprue) is an autoimmune disorder where the body reacts to the wheat protein gluten. This reaction results in inflammation and the loss of healthy intestinal mucosa. The loss of intestinal mucosa leads to poor absorption of nutrients. The symptoms may include diarrhea, weight loss, poor growth (in children), fatigue, abdominal pain, bloating, irritable bowel syndrome, aphthous ulcers (canker sores), or no symptoms at all. This disorder is becoming more and more common. The diagnosis can be made by a blood test, biopsy, or by elimination diet. Elimination diet is where you cut out all gluten. If your symptoms improve then it is a good possibility that you have the disorder.

Lactose intolerance can be caused by a genetic deficiency of the enzyme (lactase) needed to digest lactose. It can also be caused by damage of the cells that produce the enzyme such as celiac disease. Very rare that it is caused by a true allergy to lactose. It is estimated that 75% of adults have some form of lactose intolerance. It varies by your genetics (5% of northern europeans to 90% of some asians and africans).

Green indicates a low percentage. Red indicates a high percentage. There is a test for this diagnosis but again an elimination diet where you cut out all lactose may be all you need. You don't have to go overboard to do this. There is milk with the enzyme added (lactaid), yogurt has bacterial enzymes that helps digest lactose, cheeses have very little lactose (the harder the cheese the less the lactose).

Dairy product	Lactose Content
Yogurt, plain, low-fat, 240 mL	5 g
Milk, reduced fat, 240 mL	11 g
Swiss cheese, 28 g	1 g
Ice cream, 120 mL	6 g
Cottage cheese, 120 mL	2–3 g

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Small Bowel Obstruction is usually caused by another problem. It can be caused by the bowels twisting on themselves, by scar tissue from prior surgeries, by masses, or severe infections. People with SBO often present with intractable nausea and vomiting. The treatment is to avoid eating until it either resolves on its own or the problem is repaired.

The key with all of these problems is to listen to your body and to catch the problem early before it becomes a severe problem. Do not ignore nagging symptoms. The second hint is to find a doctor that is willing to listen and work with you as many of these symptoms can be vague and the diagnosis can be difficult. Physicians, like patients, get frustrated when they cannot put a diagnosis to a symptoms. Sometimes the best course is to experiment with an elimination diet to see if it helps before you even go to the doctor. Just don't go overboard and eliminate all nutrition.

Remember don't neglect those "small" bowels and keep em' healthy.