Your stomach pain and heartburn can be treated without surgery or antacids! Improve digestion, resolve stomach pain and heartburn, relieve pressure on the lower esophageal sphincter, and resolve hiatal hernia through Acupuncture, Tui Na, and Abdominal Massage. Make an appointment to treat the roots of the problem. Don’t just mask the symptoms.

Anatomy and physiology

When we swallow food, it passes through a tube called the esophagus. The esophagus normally passes through the diaphragm (the muscle primarily responsible for expanding the lungs), before it enters the stomach.

The hole in the diaphragm that the esophagus passes through is known as the esophageal hiatus.

The esophagus and the stomach are separated by a round band of muscle known as the lower esophageal sphincter. This muscle is responsible for opening to allow the passage of food, and normally closing to prevent stomach contents from moving in the opposite direction. The exception to this rule is in the case of vomiting, when the lower esophageal sphincter relaxes to allow food to be expelled from the stomach, through the esophagus and out of the mouth (and, unfortunately, sometimes the nose).

GERD stands for gastroesophageal reflux disease. Gastro means stomach, esophageal means esophagus, reflux means flowing backwards, and disease denotes a particular ill-at-ease pattern or category. So for simplicities sake, GERD means ill-at-ease because the stomach contents are flowing backwards into the esophagus.

What contents are flowing backwards? Stomach acid. The esophageal lining isn’t designed to cope with the acidity of stomach acid the way the stomach is (which partially accounts for the reason it is not called esophageal acid), so its presence in the esophagus causes pain.

One of the problems with naming a condition is it automatically influences (and often limits) the treatments available. If it were up to me this disease would be called gastroesophagealenteric reflux disease, which while harder to say, provides a more complete picture. Enteric means relating to the intestines, and contrary to popular belief this disease does indeed relate to the intestines. But more on this later.

So back to the western explanation for things: The reason for heartburn (which is experienced as chest pain), and the sour taste of acid that sometimes creeps into the back of the mouth for sufferers of GERD is two-fold.

1) Over-production of stomach acid by the stomach: If there is too much stomach acid to be contained, it has to go somewhere, so what better place than up the esophagus where it causes burning pain and discomfort?

2) Weakness of the lower esophageal sphincter: As I said before, the lower esophageal sphincter functions to separate stomach contents from the esophagus, so it stands to reason that if it is weak, stomach contents are more likely to meander back up into the esophagus where they don’t belong.

Hiatal hernia

A hiatal hernia is when a portion of the stomach protrudes upwards through the hole in the diaphragm; the esophageal hiatus (hiatal and hiatus, this is no coincidence). It can happen in three ways.

1) Sliding hiatal hernia: A sliding hiatal hernia is when the lower esophageal sphincter slides above the esophageal hiatus.

2) Paraesophageal hernia: The lower esophageal sphincter is still inferior or level with the diaphragm, but part of the stomach protrudes above the esophageal hiatus next to the esophagus.

A mixed hiatal hernia is a combination of the above two hiatal hernias.

Emergency:

3) Strangulated hiatal hernia: In the case of a paraesophageal hiatal hernia, part of the blood supply to the stomach can be cut off. This is an emergency scenario; say what I will about Western Medicine and its treatment of chronic disease, it is a phenomenal tool for dealing with emergencies.

If you have or suspect a hiatal hernia and experience severe chest pain, bloating, and difficulty swallowing, this is a possible strangulated hiatal hernia. Call 911, you need immediate medical assistance. Do it now. Do not finish this article. You can read it tomorrow. Stop reading. Why are you still here?

Western Explanation for Hiatal Hernia

So hopefully everyone with a strangulated hiatal hernia has had the sense to get to the hospital and we can continue.

A few explanations for why a hiatal hernia can happen are as follows:

1) Excess or undue pressure on the stomach lining can force the stomach upwards through the esophageal hiatus. This can be due to overeating, obesity, coughing, vomiting, a nephew using your stomach as a trampoline, or anything else that puts undue pressure on the stomach.

2) If the esophageal hiatus (hole in the diaphragm) is too big, part of the stomach can slip through. This explanation is similar to the theory that a loose attachment of the esophagus to the diaphragm will allow it to slip through. If the attachment is tight, but the hiatus is large, then the esophagus is held in place but the stomach can slip through, leading to paraesophageal hernia.

3) Shortening of the esophagus can pull the stomach upwards. Scarring of the esophagus due to GERD can pull the stomach upwards.

Of all these explanations the excess pressure explanation is typically the most popular.

How GERD and hiatal hernia go together

There is currently no evidence that a hiatal hernia causes acid reflux disease (GERD). You can have a hiatal hernia with no symptoms of heartburn. This is because a hiatal hernia does not cause looseness of the lower esophageal sphincter, or excess stomach acid production (the two western medicine explanations for GERD).

One explanation I listed above reasons that acid reflux causes a hiatal hernia. Excess acid reflux causes scarring of the esophagus, which causes the esophagus to shorten and pull upwards on the stomach through the diaphragm.

This explanation is poor however, because people often have a hiatal hernia with no scarring of the esophagus (and thus no shortening).

So how can we account for the fact that hiatal hernias and GERD being found together so often (they are found together often), if hiatal hernias don’t cause GERD, and GERD doesn’t cause hiatal hernias?

Third variables

The issue at hand here is a known as a third variable. In statistical analysis, when events or phenomena have a temporal relationship (go together in time), it is important to establish why.

Sometimes this is simple. If Bob hits Billy and Billy falls down, most people would say Bob hitting Billy caused Billy to fall down, not that Billy falling down caused Bob to hit him (although Bob may make this claim when Billy takes him to court).

But sometimes it is harder to establish a causal relationship. One study compared ice cream consumption and muggings. Low and behold, the more ice cream people ate, the more likely they were to get mugged.

So does eating ice cream cause you to get mugged? Are people who just got mugged more likely to cheer themselves up with two scoops of frozen goodness despite the recent blow to their pocket finances?

The third variable in this case turned out to be summer time. The summer caused people to go outside because it was nice and hot. The heat led people to want to eat ice cream, and the fact that they were outside instead of safe in their homes meant they were more likely to get mugged.

Sometimes a third variable is to blame even when cause and effect seem obvious at first hand. In the Billy and Bob example, Bob was actually hitting a bee that was dangerously close to Billy. He knew his friend was allergic to bee stings and wanted to help him, but the bee got there first and stung Billy, causing him to pass out.

Hiatal hernias may seem at first glance to cause acid reflux, but it helps to look closer at their relationship.

Link between hiatal hernia and GERD

The current western medicine explanation for hiatal hernia is very good; most say it’s due to excess pressure, which is why most hernias happen. Lifting or bending the wrong way can put excess pressure on the disks of the spine and cause them to herniate, and excess pressure can cause the organs of the stomach to push through the abdominal wall leading to an abdominal hernia.

Similarly, excess pressure on the stomach can cause it to press through the diaphragm.

But the western medicine explanation for GERD is painfully inadequate. It is primarily due to the name of the disorder, which as I said earlier only implicates the stomach and the esophagus. If you look at these organs as independent from the rest of the digestive system, you are bound to fall short.

Any one who would look at a sink as independent from the drain that leads to the sewer will fail as a plumber, and any one that sees the stomach as independent from the intestines that lead waste out of the body will inevitably make a very mediocre gastroenterologist.

It is helpful to consider the esophagus, stomach, and intestines as a group of hollow organs that act as a drain for food to pass into the body, and back out again. A blockage anywhere in this drainage system will create a backup and pressure above the blockage much as water backs up when the pipes in a toilet are plugged.

Excess pressure causes GERD and hiatal hernias

We established that large excess pressure, such as a cough or vomiting can put pressure on the stomach walls and produce a hiatal hernia. It stands to reason that large excess pressure can also force stomach contents (namely acid) up into the esophagus.

In basic physics, one large force will produce a large reaction (every action has an equal and opposite reaction).

Mathematically many small forces over time can add up and lead to an equally large reaction. Certain habits and lifestyles produce chronic pressure in the digestive system, and overtime this pressure can add up and lead to both GERD and hiatal hernias, so that both can happen with out any obvious traumatic pressure on the stomach.

Anything that slows or stops the passage of digestive contents in the stomach or intestines will inevitably lead to a back up. This pressure can lead to heartburn, bloating, constipation, and/or diarrhea, depending on the patient’s constitution and lifestyle.

Pressure build up can force stomach acid past the lower esophageal sphincter into the esophagus and cause heartburn. It can put pressure on the stomach lining and push part of the stomach past the diaphragm. Food will spend a longer time in the stomach, stimulating excess acid production which can lead to ulcers.

What can slow the passage of digestive contents?

1) Diet:

Insufficient fiber intake, as well as excess fiber intake can lead to a backup of digestive contents and possible constipation. Foods that produce a lot of intestinal gas will lead to a pressure back up.

Eating timing can also be an issue. People who eat according to a schedule instead of when they are hungry are packing food on top of undigested food, inevitably causing pressure to build up.

Lying down after you eat, (often the case for those who eat too late at night) means gravity doesn’t aid digestion, and will lead to pressure build up.

Simply overeating puts excess pressure on the stomach overtime.

2) Peristalsis:

Peristalsis is the rhythmic contractions of the digestive organs to propel food through the digestive system. Anything that interrupts peristalsis can cause pressure to backup.

Peristalsis is controlled by the sympathetic/parasympathetic nervous systems. This is the fight or flight/rest and repose nervous system. Basically here, when we are stressed or emotionally upset, digestive function is reduced, peristalsis decreases. So emotional disorders can slow digestion and lead to a backup.

The spinal nerves interact with the internal organs, and regulate them. Any interference with these nerves will impact peristalsis, and can lead to a backup of pressure. What started off as a back problem can turn into a digestive problem.

3) Fatigue:

Fatigue doesn’t only mean our skeletal muscles are tired, it means our internal organs are tired as well. Intestinal fatigue will slow the passage of digestive materials.

There are of course more issues that can affect the rate of digestion, and overtime these things can lead to a backup of pressure leading to GERD or hiatal hernia. The main reason standard medicine doesn’t treat these issues this way is not because they have not thought of it; it is because it is too complicated.

The only method Western medicine has for dealing with these issues is fiber supplements (which are hard to make money on), and the prokinetics. The prokinetics are medicine to increase the movement of the digestive organs, but they have far too many side effects to be used regularly.

Taking into account an individual’s emotions, their diet, their timing when eating, their energy level, their posture, etc, leads to too many variables and takes too much time to be considered ‘cost-effective medicine’. It’s easier, faster, and cheaper to label this disease GERD and/or hiatal hernia and do the standard therapy that accompanies that label.

But Chinese Medicine provides excellent diagnostic methods to discover the cause of your GERD and hiatal hernia. The treatment is very flexible, based on individual patient differences. When the cause or roots of the problem are discovered treatment is simple and straightforward. Effective relief of symptoms can be provided with minimal side effects.

Standard Western Medicine therapy

Medicine:

The medicine rationale is to reduce the acid which the stomach supposedly overproduces.

Simple antacids neutralize acid already in the stomach. These have the least side effects, but need to be taken every time heartburn/indigestion comes about. Some are a good source of calcium.

Stronger antacids fall into two categories, and they reduce acid before it is produced.

1) H2 blockers block histamine, which is one of the chemicals that stimulate the parietal cells (stomach acid producing cells) to produce stomach acid. This can decrease acid production moderately, but as there are other chemicals that can stimulate acid production (acetylcholine and gastrin), it doesn’t stop acid production entirely.

2) Proton pump inhibitors stop the parietal cells from pumping out hydrogen ions, which is the final stage of acid production. This produces a much larger drop in stomach acid because it stops the parietal cells altogether.

Antacid critique

One of the problems with antacids is that there is no investigation into why there is more stomach acid in the first place. If there actually is more stomach acid, it is typically because food is spending a longer time in the stomach due to slowness or blockages deeper in the intestines. Antacids do not address this issue.

The other problem is that they don’t actually solve any problems, they provide only temporary relief. If they are discontinued, stomach pain and heartburn often returns. And if the H2 blockers or Proton pump inhibitors are taken long term they decrease calcium absorption, which increases the likelihood of osteoporosis.

Surgery:

Surgical rational is to strengthen the barrier between the stomach and the esophagus. The technique in both surgeries is to make a hole smaller so things don’t slip through.

Nissen Fundoplication wraps the upper part of the stomach around the bottom of the esophagus, to reinforce the lower esophageal sphincter. Surgeons will also repair a hiatal hernia if they find one during this surgery.

Hiatal hernia repair: This surgery is typically done in addition to Nissen Fundoplication. The stomach and esophagus are pulled into the correct position, after which the surgeon puts some stitches into the esophageal hiatus to make it smaller, so less likely for the stomach to pass through it again.

After these surgeries people typically have to keep taking their antacids, although possibly at a lesser dose, with less severe symptoms.

Surgery critique

These surgeries do not reduce the pressure that caused the problem; they just block its effects. They provide a barrier to abnormal movement, but do not address the force behind the abnormal movement.

They are akin to a driver who attempts to stop his car while his foot is still on the accelerator. So surgery, while it leads to a reduction in necessary medication, it does not eliminate the need for it entirely.

Blocking pressure creates more pressure. Even if you put a cork in a geyser the build up of pressure will eventually break through.

What can we do?

Providing a vent for pressure to escape is the best way to relieve it. The intestinal tract provides a natural vent to pass digestive materials and eliminate body waste. Only when the entire digestive tract is functioning normally can excess pressure build up in the stomach be eliminated. Through acupuncture, tui na medical massage, abdominal massage, and herbs we can optimize the functioning of the intestinal tract and thus vent the pressure.

Chinese medicine offers diagnostic methods to uncover why the acid reflux and hiatal hernias are happening, and utilizes tools to make a fundamental change rather than just endlessly managing the symptoms. Make an appointment to treat the root of this disorder; don’t just cover up the symptoms.