Gastro Oesophageal Reflux Disease

June 9, 2012 by
Filed under: Case of the month, Cases, Spinewave Bulletin, Symptoms 

“My sternum no longer troubles me; my reflux and indigestion has subsided and my general health has improved.”

Gastro Oesophageal Reflux Disease (GERD) is when reflux is frequent enough to cause symptoms that reduce well being. It occurs when the lower oesophageal sphincter allows the acid stomach contents back up towards the throat. The pressure of this sphincter needs to be greater than the pressure in the stomach. There are two distinctions in lower oesophageal sphincter tone when considering whether you have GERD or not – and they make a difference: 1. Myogenic tone, and 2. Neurogenic tone.

Myogenic tone refers to the condition of the smooth muscle of the sphincter itself. A person should be able to stand upside down after a large, hearty meal and have no food back up into the oesophagus or mouth. Sometimes this muscle is damaged through acidic damage or when the intraabdominal pressure overcomes the natural reflex of the sphincter to close. Long term damage to the muscle may result in an impasse to a solution, besides surgery perhaps.

The contraction or relaxation of the sphincter muscle is also due to a multitude of chemicals and hormones. Some chemicals are harmful. To name a few that play a role in opening or closing the lower oesophageal sphincter: Dopamine (feeling good or bad, basal ganglia damage), histamine (allergy drugs, sensitivity problems), pain killers, progesterone (oral contraceptives), serotonin (antidepressants), glucagon (blood sugar problems), substance P (pain). It’s not as straight forward as simply taking Losec for the rest of your life.

Neurogenic tone refers to the neuromuscular mechanisms that maintain tonic or reflex contraction of the sphincter, essential for its antireflux behaviour. Impairment of these mechanisms promotes gastro oesophageal reflux and – like so many conditions when considering function as opposed to disease – is often overlooked when considering the person as a whole.

Specific upper cervical chiropractic care addresses changes to the brainstem you are unaware of. The brainstem contains the central control mechanism for the lower oesophageal sphincter, which is closely integrated with the “swallow pattern generator”, i.e. when you swallow, a cascade of automatic events occur that open and close the sphincter. There is a topographical representation of neurons representing the lower oesophageal sphincter in the dorsal motor nucleus of the vagus nerve. It is also intimately linked to one’s breathing through the crural diaphragm and inspiratory centre of the brainstem.

What this all means is that if stress has altered your neck, and stress has altered your breathing, and poor posture crushes the diaphragm, the entire feedback loop between brainstem and lower oesophageal sphincter is not going to work properly, resulting in reflux. And it is far more likely for this disruption in function to occur first, before physiologic damage to the myogenic tone of the lower oesophageal sphincter, due to the nature of our stressful lifestyles nowadays.

Naturally diet, avoidance of acidic or fatty foods, weight loss, and reducing alcohol consumption is also an important consideration in the management of GERD, but the purpose of this case is to consider the functional aspect of reflux and how imperative looking after one’s nervous system is to the overall control and health of the body.

Neil visited my daughter’s place of work explaining the benefits of Spinewave. My daughter was aware that I had been suffering from severe indigestion and reflux for many years – the last 3-4 years in particular. She suggested I go and see them.

I had been for numerous tests: endoscopy (actual image below), chest X-ray etc. They concluded that I had an ulcerated oesophagus and I was given medication to control and heal this problem, but the indigestion and reflux never seemed to improve. Gradually it got to the stage that my sternum was very tender to touch causing me continual discomfort.

My consultation with Neil found that my spine was problematic in many areas and this might be causing a lot of the problems that I was suffering from. Once I started my treatment, within a few weeks I was starting to feel much better.

After a few months, my sternum no longer troubles me; my reflux and indigestion has subsided and my general health has improved. Neil now keeps my spine in check regularly. It has been a pleasure consulting with Pip and Neil at Spinewave.


© Dr Neil Bossenger 2012

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