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Question for those of you with a weak LES (esophogeal sphincter)....
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Question for those of you with a weak LES (esophogeal sphincter)....

Logically, the only 'cure' for GERD caused by LES is medication or surgery; reason being the acid will always be there b/c the LES is weak and won't close. Am I wrong here? Are there any of you who have gotten off the meds and not had surgery and the acid problem actually went away, even with a weak LES?
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Avatar_m_tn
What affects with your LES depends on a number of factors. The LES isn't something that just goes "weak". Usually there's something that makes it so, and it could be a large number of things:

1) having too much bellyfat or being overweight puts pressure in the stomach area and essentually pushes the LES open.

2) Slowed digestion, for whatever reason, can cause acid to sit in your stomach too long and head up to your esophagus. The more acid irritates the LES, the weaker it can get. (Eating lots of fat will slow digestion)

3) Over eating, especially when mixed with #1 and #2 can cause a weaker LES.

4) Problems with your Vagus nerve could cause the LES (as well as other areas, eventually) to weaken.

5) Foods you eat -- like onions, chocolate, coffee, caffeine, peppermint, and garlic -- will weaken the LES.

The key is trying to find out what is causing your heartburn in the first place. When that's found, THEN can you begin to affective treatment of the condition instead of the symptoms.

Drugs like Nexium and Prevacid, maligned as they are, will actually help strengthen the LES. It's part of what they do. Losing belly fat will usually help, if for no other reason than there's less pressure on the area. Wearing loser clothing helps, especially after eating. Ceasing eating foods which trigger reflux will usually help. (These includes the ones mentioned above as well as, in some cases, gluten.) Relaxation techniques are usually VERY helpful. Raising the head of your bed 6 to 12 inches is very beneficial for your long term recovery, as is sleeping on your left side. Eating protein has been proven to help strengthen the LES, so have at it, but only lean meats like fish and chicken breast.

I was diagnosed with GERD. The underlying reasons were (are?) my weight, stress, and slowed digestion due to viral damage to my vagus nerve. (I'm also looking into the possibility of non-celiac gluten intolerance.) Once my weight went down things started to get better. Once my stress went down -- via spending more time with friends, making it a point to laugh a lot every day (at least 10 minutes of hearty, belly shaking laughter), Yoga and Kung Fu -- they improved even then, and my digestion's been increasingly better. Doctor has told me to cut my meds in half at the end of the month, and within 2 months after to cut them out altogether.

Note that I HIGHLY reciommend you find a good acupuncturist, as my treatment with one improved my situation immensely. Additionally, I recommend taking an herb called Shatavari, which is helpful with dyspepsia, and probiotics.

That's a start. The point is find the root cause of your issue and you'll be one HUGE step on the road towards recoverly.
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Avatar_f_tn
Wow. Thank you soo much for that response!
Well, I am not overweight; I'm 5'4.5" and weight about 120. I have some 'cosmetic' fat around my lower belly (I've been told no one else notices) and have been seeing a personal trainer and had a session w/a dietitian.
I have had depression/panic since I was about 14 (I am 31); however, both have significantly decreased since then, though I am still on meds (mainly b/c I'm scared to go off them totally) - 20 mg Prozac, .125 of Xanax. I have heard these meds can cause weak LES...is that correct?
I do have IBS, which acts up a few times a year.
I try to stay away from trigger foods; I never have caffiene, my chocolate has gone down; I never have peppermint; onions only on burgers (which is maybe once/week); never have coffee. Never have garlic. (Before I was diagnosed w/gerd, I only had coffee a couple times a month, and mint gum)
I take marshmallow root every day; I have dgl licorice but I rarely take it, mainly b/c its a pain (I cannot take it w/in 2 hrs of taking Prozac, AND I have to take it 20 min before i eat).
My bed is about 6 in off the ground at the head.
I certainly get enough protein and eat mostly lean chicken; red meat once/week. I eat lots of fruits, some veggies. Whole grains.
The gastro's I've been to have looked in my throat- one said I had gerd, the other thought it may be bile. He wanted to do surgery but I refused. You must have a good doc b/c I have no idea what caused this. I originally went to a ENT b/c I felt like vomiting all the time in my throat (not that there was stuff there, just the gaggy like feeling) and he put me on Prevacid, which seemed to help, usually.
Any other suggestions?
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Avatar_m_tn
"I have had depression/panic since I was about 14 (I am 31); however, both have significantly decreased since then, though I am still on meds (mainly b/c I'm scared to go off them totally) - 20 mg Prozac, .125 of Xanax. I have heard these meds can cause weak LES...is that correct? "

DING! Yes! First, anxiety and depression will BOTH have massive negative effects on your Vagus nerve, and along with it any autonomic functions it controls (which is to say, the digestive process; watch out also for the heart, since it controls that, too). Meditation, acupuncture (with a doc that knows herbs) and relaxation techniques, as well as a visit to a holistic physician will do wonders, I think, for you. Your IBS may not be the root cause, but I'll put money on whatever's causing it being a major contributing factor. (FYI, I was diagnosed with panic disorder & depression. Had psychological counseling, never took drugs for it. I highly recommend you read up on the works of the psychologist Dabrowski.)

Yes, the drugs CAN (and usually will) weaken the LES. Work with your docs on getting off of them, and start -- IMMEDIATELY -- working with a psychologist. Your braind and body will both thank you.

As for having good docs, yes, I can't say they're bad. But I'm a research nerd and won't let go of a topic until I get answers. I don't rely on just my docs: I rely on my own observations, write stuff down, bring them print outs... In fact, one of my docs literally calls me her "little nerd." (Even though I'm about 100 lbs heavier than her and about a foot taller.)

Have you had an upper endoscopy yet? If not, I recommend you get one. You might also want to see about a HIDA/CCK, since with all this going on, I'm willing to bet you might have biliary dyskinesia (it's generally symptomless, and shows up for a lot of people with anxiety; can also cause heartburn issues). It can also rule out anything else (like H.Pylori, which I think is somewhat unlikely based on what you described, but still a very real possibility), and if there is some sort of surgery needed, then you can begin thinking about it.

BTW, I have biliary dyskinesia myself. By sticking to a low-fat (mostly from Olive oil), mostly organic foods diet I've been able to keep it for a while. It'll probably have to go some time, but by golly, I'm getting all the use out of it I can.

Good luck
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603946_tn?1333945439
Have you tried enzyme with meals? I take one for at least two of my meals and I have even had the loose toupet wrap- mostly successful- but I was vomiting- my hiatal hernia was high up in my chest- BTW if you are scared of the surgery- from experience I can tell you it was a walk in the park/ easy easy easy
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Avatar_m_tn
While enzymes are good (I use them regularly myself, and they generally help), I'm not sure that based on the descriptions that would help cure the problem, simply bandage it. Still, I suppose a bandage is better than nothing, and if PPI's are being taken (or even H2-inhibitors) then enzymatic therapy can be very useful.

Regarding surgery, I'm going to recommend holding off on that. While surgery can be helpful, it should be a last resort solution. Ceasing the anti-anxiety meds, along with psychological therapy, meditative help (particularly biofeedback, but also Yoga and Qigong), and a holistic approach (acupuncture, eastern herbs) may offer a better solution. (Better in that it might be just as effective without many of the possible side effects.) After those lifestyle changes have been made, if the issue still persists, then surgical intervention should be seriously considered.

A determination of the root cause is by far the best course of action at the moment. Research is key, and getting multiple opinions from various medical disciplines may be helpful. (My favorite has always been integrative medicine because it deals both with mainstream western and "alternative" approaches.) Attempting to solve a problem without first understanding its root cause(s) can lead to an ultimately more costly (and unnecessarily risky) course of action.
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603946_tn?1333945439
Right well, as a cure would have been awesome without surgery- for me it was not feasible to do acupuncture, meditation, or psychological therapy....
I will also admit I wasn't about to change my diet drastically- and eat only oatmeal and crackers for the rest of my life.
I had the surgery and I still need the bandaids (enzymes and Tagamet, and Gaviscon) and I am happy as pie just to not be vomiting my entire stomach contents nightly although the weight gain is not so desirable- I used to be 99 pounds but I even looked ill- I can now eat without knowing it will just have to come up in a few hours..... food is enjoyable now- but like I said- my case was bizarre- my surgeon never heard of anyone vomiting nightly- just regurgitating undigested food was what his patients usually had- I could have live with that---
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Avatar_f_tn
I have had 2 endoscopies, one in 91 and one in 99, but both were before I had any GERD stuff. Would they notice anything that may contribute or cause GERD by doing an endoscopy BEFORE I had any symptoms? I just don't want to do it a damn 3rd time. 2nd experience I was awake b/c the doc was a moron and was pulling up the tube from my stomach...it's kinda like torture.
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Avatar_f_tn
Ok guys, I went to my gastro and brought up some of the things you were saying.
Firstly, he said anxiety could make one more sensitive to what's going on in the espohogus (I'm guessing that means not necissarily GERD).
Re: the accupuncture and relaxation etc, he said that could help w/anxiety, and thus, sensitivity.
Re: vagus nerve...said something like if that nerve is cut during some sort of surgery, then that can cause reflux (and I've not had any surgeries).
Re: endoscopy helping identify LES...said that an endoscopy could not indicate whether the LES is weak b/c they don't measure it or something. Then he said there was a test they could do (and it sounded like that 24 hr test) by sticking a tube down your nose into the stomach that could gauge that, but that even if an LES was the problem (which he said that that in most cases IS the problem), the ONLY things they could do to fix it is medication or surgery.
Re: meds causing the weak LES... he said maybe but that the meds they have (eg Prevacid) are so reliable that there's no sense going off my anxiety meds (esp if they're helping).

So it doesn't sound like he is into any other kind of treatment. Also re: the cause of the possible LES: said something to the effect of if the meds treat it why bother?

Do you recommend a holistic doctor then? Is my doc completely closed-minded here?? And where do I look to find one?
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