Hiatal hernias also contribute to the gastroesophageal reflux disease. As a result of the hiatal hernia, small part of the stomach and the lower esophageal sphincter come to lie in the chest. Normally, the lower esophageal sphincter is at the level of the diaphragm. The diaphragm that surrounds the lower esophageal sphincter seems to be important in preventing reflux. Effects of the diaphragm and lower esophageal sphincter appear at the same location in patients without hiatal hernia. The sum of the pressures generated by them prevent the reflux. In people with hiatal hernia, the diaphragm and lower esophageal sphincter continue to generate pressure, but at different levels, and in this way, the pressure barrier is decreasing. In hiatal hernia disease, there exist a sac, which is a small pouch of stomach above the diaphragm .It is full of acid, and when it is pinched off from the esophagus above by the lower esophageal sphincter and from the stomach below by the diaphragm, it can reflux easier during a swallow or a relaxation. It is known that the esophagus connects the stomach obliquely, and due to this, a flap of tissue is formed between the stomach and esophagus. It is believed that this tissue is acting like a valve and preventing reflux. When hiatal hernia is present, the valve-like flap disappears, or is distorted and will not help to prevent the reflux.

 

Esophageal contractions are very important, they are caused by the act of swallowing. During this, food, saliva or whatever there is in the esophagus is pushed into the stomach, and if there is a abnormality with this contraction, refluxed acid is not pushed back into the stomach. Some abnormalies that can appear: the waves of contraction may die out before they reach the stomach, or waves of contraction do not begin after each swallow, or the pressure generated by the contractions is too slow to push the acid back into the stomach. These are frequent in patients that have gastroesophageal reflux disease.

Usually, in most cases reflux during day appears after meals, and this probably happens because of the transient lower esophageal sphincter relaxations. There were seen patients that are having an extremely slowly digestion, and it is known that during this period the reflux has greater chances to appear. total3page: Pre [1] 2 Next