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Reflux Esophagitis, Hiatal Hernia, Heartburn

The terms Reflux Esophagitis, Hiatal Hernia, and Heartburn have all come to be associated with the same condition. The valve located at the very bottom of the esophagus just above the stomach is called the lower esophageal sphincter. It generally remains closed unless a person swallows. With swallowing, the valve opens, allowing liquids and food to pass into the stomach, and then the valve closes again. In some patients, for reasons we do not understand, the valve is incompetent and does not close properly. When the valve is not closed, acid is allowed to reflux (flow back up) from the stomach into the esophagus. This occurs more often when a person is lying down because gravity does not keep the food in his stomach as easily as when sitting or standing. It also occurs after meals when the stomach is full, and this is a time when the stomach makes large amounts of acid to begin the process of digestion. Certain foods and other substances make this condition worse by further interfering with the valve function. Included are alcohol, peppermint, tobacco, caffeine and particularly fatty foods (fried or greasy foods). These all lower the pressure of the valve making it even more incompetent.