Ken DeVault

Article / Updated 11-25-2019

Digestion is the process of changing food into a form that the body can absorb and use as energy or as the raw materials to repair and build new tissue. Digesting food is a two-part process that's half mechanical, half chemical. Mechanical digestion begins in your mouth as your teeth tear and grind food into small bits and pieces you can swallow without choking. The muscular walls of your esophagus, stomach, and intestines continue mechanical digestion, pushing the food along, churning and breaking it into smaller particles. Chemical digestion occurs at every point in the digestive system, beginning when you see or smell food. These sensory events set off nerve impulses from your eyes and nose that trigger the release of enzymes and other substances that will eventually break down food to release the nutrients inside. The body then burns these nutrients for energy or uses them to build new tissues and body parts. How sight and smell relate to digestion At first glance — or sniff — the digestive link between your eyes, nose, and stomach sounds a tad weird. But think about it: How many times has the sight or scent of something yummy like a simmering stew or baking bread set your tummy rumbling? The sight of an appetizing dish or the aroma (actually scent molecules bouncing against the nasal tissues) sends signals to your brain: "Good stuff on the way." As a result, your brain — the quintessential message center — shoots out impulses that Make your mouth water. Make your stomach contract (hunger pangs). Make intestinal glands start leaking digestive chemicals. All that from a little look and sniff. Imagine what happens when you actually take a bite! Tasting and chewing in the digestion process You know that small bag of potato chips you have stashed way at the back of your desk drawer? Well, dig it out and take a chip. As the chip hits your tongue, your mouth acts as though someone had thrown the "on" switch in a fun house. Your teeth chew, breaking the chip into small manageable pieces. Your salivary glands release a watery liquid (saliva) to compact the chip into a mushy bundle (a bolus in digestive-geek speak) that can slide easily down your throat on a stream of saliva. Enzymes (which you can think of as digestive catalysts in this case) in the saliva begin to digest carbohydrates in the chip. Your tongue lifts to push the whole ball of wax . . . no, bolus, back toward the pharynx, the opening from your mouth to your esophagus, and then through a muscular valve called the upper esophageal sphincter, which opens to allow the food through. In other words, you're about to swallow. Swallowing food: The slide from esophagus to stomach If you think about it, the human digestive system is a wonder. As food enters the esophagus, your salivary glands release a rush of saliva to help food slide more easily down the tube. Then your esophageal muscles swing into action. Like the rest of your digestive tract, your esophagus is ringed with muscles that contract to produce wavelike motions — which you can refer to as peristalsis or (no surprise here) peristaltic contractions, if you're so inclined — pushing food down toward your stomach. At the bottom of the esophagus — an area known as the gastroesophageal junction — a muscular valve called the lower esophageal sphincter (LES) opens to allow food through. Then the LES closes to prevent reflux, the flow of stomach contents back into the esophagus. A malfunctioning LES is public enemy No. 1 in the reflux world. Digesting food in the stomach Point to your stomach. Go ahead. Don't be shy. Odds are your finger is aimed somewhere around your belly button, an interesting site to be sure, but definitely not your stomach. Your stomach, a wide, pouchy part of the digestive tube, is located on the left side of your body above your waist and behind your ribs. Like the walls of your esophagus, the walls of your stomach are strong and muscular. They contract with enough force to break food into ever smaller pieces as glands in the stomach walls release stomach juices — a highly technical term for a highly acidic blend of enzymes, hydrochloric acid (HCl), and mucus. The stomach juices begin the digestion of proteins and fats into their respective bodily building blocks — amino acids and fatty acids. Churned by the stomach walls and degraded by the stomach juices, what started as food — apples, pears, potato chips, steak, cake, you name it — is now a thick, soupy mass called chyme (from chymos, the Greek word for juice). The stomach's wavelike contractions push this messy but still intact substance along to the small intestine where your body begins to pull out the nutrients it needs. Pulling out nutrients in the small intestine Here's an easy anatomy lesson to find your small intestine: Open your hand and put it flat slightly below your belly button, with your thumb pointing up and your pinky pointing down. Your hand is now covering most of the relatively small space into which your 20-foot-long small intestine is neatly coiled. Just like your esophagus and stomach, contracting muscles line your small intestines to push food along. But your small intestine is nobody's copycat. This part of your digestive system has its own set of digestive juices including Alkaline goop from the pancreas that powers special enzymes (called amylases) to digest carbs Bile from the liver and gallbladder that acts as an emulsifier (a compound that enables fats to mix with water) Pancreatic and intestinal enzymes that complete the separation of proteins into amino acids More contractions shove the chyme along the intestines while specialized cells in the intestinal walls grab onto sugars, amino acids, fatty acids, vitamins, and minerals, which are then sent off into your body for energy or as building blocks for new tissue. Then, after your small intestine has squeezed every last little bit of useful material (other than water) out of the food, the indigestible remainder (think dietary fiber) moves toward its inevitable end in your large intestine. The end of the digestive line: Poo-poo Your large intestine is also sometimes called the colon. Think of this area as a giant sponge and press whose only jobs are to absorb water from the mass you deliver to it and then squeeze the dry leftovers into compact bundles of waste — which you may know as feces and any 2-year-old as poo-poo (or poop, caca, whatever). After resident colonies of friendly bacteria digest any amino acids remaining in the waste and excrete smelly nitrogen — in a process scientists call passing gas — muscular contractions in the rectum push the feces out of your body, and digestion is finally done.

Cheat Sheet / Updated 03-27-2016

Knowing the common signs of GERD (Gastroesophageal Reflux Disease) is your first step to recognizing if you may have a problem. To prevent heartburn and reflux, keep away from certain seasonings, foods, and other risk factors that trigger reflux. Learn key terms related to heartburn and reflux, and maintain a healthy weight and BMI to further reduce your risk.

Article / Updated 03-26-2016

Heartburn is common. Esophageal cancer isn't. According to the American Cancer Society, less than 1 percent (0.4 percent to 0.5 percent) of the people with Barrett's esophagus progress to esophageal cancer in a given year. The lifetime risk is related to how many years you live with the condition, but most experts say that a Barrett's patient's risk of getting cancer in his or her lifetime is less than 5 percent. There are actually two types of esophageal cancer. One is a complication of long-term acid reflux (adenocarcinoma), and the other probably isn't related to reflux, but is related to excess use of tobacco and alcohol (squamous cancer).Adenocarcinoma is more common in the United States.Squamous cancer is more common in other parts of the world (for example, the incidence in northern China, India, and southern Africa). As Table 1 demonstrates, the number of cases of both kinds of esophageal cancer and, sadly, the number of deaths, have been rising steadily in the United States over the past 30 years. Table 1 Esophageal Cancer in the United States Year New Cases Deaths 1973 5,500 6,488 1980 8,020 7,985 1990 10,380 9,719 2000 11,770 12,232 2004 14,250 (estimate) 13,300 (estimate) Source: American Cancer Society Identifying people at risk According to the American Cancer Society and the National Cancer Institute (NIC), in the United States, the people with the highest risk of esophageal cancer are Men: The National Cancer Institute says both types of esophageal cancer are three to five times more common among men than among women. African Americans: Squamous cell esophageal cancer is three times more common among American black men than among American white men. NCI says African American women are also at higher risk than Hispanic and non-Hispanic white women. Middle-aged and senior citizens: Both types of esophageal cancer are most common among people ages 45 to 70. Smokers and drinkers: Both alcohol and tobacco smoke irritate the esophagus, but neither one alone is as potent a risk factor as the two together. Why? Scientists theorize that alcohol acts as a solvent for carcinogens in burning tobacco, carrying them into the esophageal lining. This may be more of an issue in squamous cell esophageal cancer, but it's likely true in both types. People who eat their food very hot: Foods and beverages consumed very hot irritate the esophagus; theoretically they may raise the risk of repeated injury leading to cell changes leading (mainly) to squamous cell cancer. Predicting outcomes Esophageal cancer isn't a walk in the park. Forty years ago, only 1 to 4 percent of Americans diagnosed with this disease lived for at least five years. Today, while the five-year survival rate has risen to 9 to 13 percent, and many patients live much longer, this cancer is still highly lethal.

Article / Updated 03-26-2016

When you're talking about tests, this section is the Big Time for your esophagus. To reach this level of testing, you must exhibit symptoms of GERD which suggest esophageal damage that requires your doctor take a closer look with one or more of the three following tests: A barium swallow, a noninvasive radiological examination of your esophageal lining An upper GI (gastrointestinal) series, a noninvasive radiological examination of your esophagus, stomach, and small intestine An esophageal endoscopy, an invasive examination of the esophagus that permits the doctor to take a tissue sample for a biopsy These tests are listed in order of complexity. Which one (or more) your doctor orders is up to him. Barium swallow The barium swallow is most often done for people who have frequent reflux or difficulty swallowing. The test requires you to sip a solution of the metallic element barium in water. When you drink the liquid, the barium coats all the teensy little folds and crevices of your esophageal lining, making them visible to a fluoroscope, a device that shows a real-time image created by X-rays passing through the body. Preparing for this test Don't consume any food or liquids for at least 12 hours before the test. Taking this test To take this test, you 1. Stand behind a fluoroscopic screen. 2. Take swallows of a barium liquid. 3. Have pictures taken to show how the liquid moves from your mouth to your pharynx (the opening at the back of your mouth) and your esophagus, and how it flows down the esophagus. Sometimes you may be asked to swallow a soft barium "marshmallow" (white bread soaked in barium liquid), which shows up as solid material passing through your gut. This is more often done when a patient has trouble with swallowing. Evaluating the result Pictures showing smooth, even distribution of the barium liquid over the lining of the pharynx and the esophagus say your esophagus is healthy. Abnormalities in the distribution of the barium liquid may show the following GERD-related problems: Esophageal muscle weakness, a known risk factor for GERD Esophageal stricture, narrowing of the esophagus due to repeated exposure to acid reflux Esophageal tumors, which may (or may not) be malignant Esophageal ulcers, reflux-related erosion of the surface of the esophagus Hiatal hernia Upper GI series The upper GI series is a fluoroscopic examination of the esophagus, stomach, and small intestine. This test looks for the same kinds of problems as a barium swallow, but the upper GI — for gastrointestinal — series covers more intestinal acreage. This test is usually recommended for people who have Difficulty moving food down the esophagus or pain while swallowing Frequent reflux and heartburn, plus such symptoms of stomach or small bowel disease such as nausea, vomiting, diarrhea, weight loss, or bleeding Preparing for this test Eat a low residue (dietary fiber) diet for two to three days before the test. Don't consume any food or liquids for 12 hours before the test. Taking this test You swallow a barium solution. Then you lie on a tilting table that is first positioned to enable a technician to do a fluoroscopic exam while you're in standing position. Then the technician turns the table to different angles and positions in order to make different parts of your upper digestive system visible to the fluoroscopic camera. Evaluating the results A smooth distribution of the barium solution over the lining of the esophagus, stomach, and small intestine shows a healthy upper GI tract, meaning you may have GERD but don't have any visible reflux-related damage to your gastrointestinal tract. Unusual or uneven distribution of the barium solution may show Esophageal muscle weakness Esophageal strictures Esophageal tumors, which may (or may not) be malignant Esophageal ulcers Hiatal hernia Upper endoscopy If the barium swallow or the upper GI series shows abnormalities on the surface of the esophagus, your doctor may recommend an upper endoscopy.This test has the advantage of enabling the doctor to look directly at the esophageal tissue and to obtain tissue samples for biopsy so as to determine whether cells in the tissue are malignant (cancerous). In fact, many guideline statements (including the official guideline statement of the American College of Gastroenterology, written by the contributing author of this very book) suggest that upper endoscopy is actually the first test to do if the patient is at risk for reflux complications. Its big advantage over radiology is that tissue samples (biopsies) can be performed with endoscopy. Preparing for this test Don't consume food or liquids for 12 hours prior to the test. Certain blood thinners may also need to be stopped prior to the test. Taking this test The person performing the endoscopy sprays your throat to numb it and then, slides a thin, flexible plastic tube called an endoscope down your mouth into your esophagus. The endoscope has a tiny camera that transmits an image to a television screen where the doctor can visualize the esophageal lining. If he sees something unusual, such as a growth on the tissue, the doctor may also use small tweezerlike forceps in the endoscope to take a sample for a biopsy. No, you don't feel a thing — you don't have any nerve endings in your esophagus that say "ouch" when the doctor takes the sample. If the endoscopy shows a narrowing of the esophagus, the doctor may insert a balloon or other stretching device through the endoscope and inflate it inside your esophagus to dilate (stretch) the tube right on the spot. Afterwards, your esophagus will stay stretched, making it easier for you to swallow. Evaluating the results Smooth, undisturbed tissue shows a healthy esophageal lining. In other words, you may have GERD, but it hasn't damaged your esophagus. A biopsy of esophageal tissue can diagnose conditions such as Bacterial or viral infection Damage cause by acid reflux Precancerous or malignant changes in esophageal cells With diagnosis in hand, your doctor can begin to treat these problems.

Article / Updated 03-26-2016

Carrying extra body weight, especially around your middle, raises your risk for heartburn. So how do you know if you’re at risk? A BMI (body mass index) higher than 24 is considered overweight. BMI is a gender-free measurement that relates height to weight. To find out your BMI: BMI = (W/H2) × 705 Translation: Your weight (in pounds) Divided by your height (in inches, squared) Multiplied by 705

Article / Updated 03-26-2016

To better understand things related to heartburn and reflux, recognize the following key terms that describe treatment, symptoms, and basic information about the two conditions: GERD: Gastroesophageal reflux disease Reflux: Stomach contents that slosh back from the stomach to the esophagus through the LES LES: Lower esophageal sphincter; the “trapdoor” between esophagus and stomach Heartburn: Pain caused by reflux Gastroenterologist: Physician specializing in diseases of the digestive tract Antacid: Medicine that neutralizes stomach acid H2 blocker: Histamine 2 blocker; a class of drugs that slows the production of stomach acid PPI: Proton pump inhibitor; a class of drugs that reduces the production of stomach acid and appears to heal reflux damage to the esophagus

Article / Updated 03-26-2016

GERD is a tricky condition to identify. Its symptoms mimic those of other common medical conditions. The following list represents the primary symptoms of GERD: Bad breath Bad taste in mouth Chronic cough Chronic laryngitis Frequent hoarseness Frequent throat clearing Frequent wheezing

Article / Updated 03-26-2016

One way to avoid reflux is to keep away from foods that may trigger it. According to the NBHA (National Heartburn Alliance), the following spices are more likely to cause heartburn than others: Chili powder Cloves Curry powder Garlic, fresh Mint Mustard seed Nutmeg Pepper — black, red (hot), white

Article / Updated 03-26-2016

What you eat and drink may raise your risk of heartburn. This list shows you some foods that are more likely to cause reflux and heartburn, so stay away from these: Alcohol beverages Carbonated soft drinks Chocolate Citrus fruits Coffee (regular and decaffeinated) High-fat foods

Article / Updated 03-26-2016

Risk factors make it more likely you’ll get reflux, but it’s not a certainty. As a basic rule, the risk factors for heartburn and reflux fit neatly into one of three basic categories: Risk Factors You Can’t Change Your sex Your body shape Your family history Risk Factors You Can Make Less Risky Medical conditions (such as asthma) that may trigger reflux Medicines that upset your stomach Risk Factors You Can Eliminate Bedtime snacking Being stressed Being overweight Irritating foods and beverages Lack of moderate exercise Smoking Very large meals