Lower Oesophageal Sphincter Impairment

If you scored high in the ‘Lower Oesophageal Sphincter Impairment’ section of the health quiz, then please read this article as it contains some useful resources to help you.

What is Lower Oesophageal Sphincter Impairment?

Between the mouth and the stomach, we have the oesophagus. This tube helps to move things from the mouth to the stomach. Most food, especially food that has been well-chewed will pass down the oesophagus in about 6 seconds, however dry food can take up to a minute, perhaps longer.

Between the stomach and the oesophagus there is a sphincter. The role of this sphincter is to prevent stomach acid and food from coming back up. The majority of the time this sphincter remains closed, except for when food is entering the stomach.

When the sphincter does not work properly this can lead to heartburn and reflux, hence we will focus a lot of our attention on the underlying causes of LOS dysfunction, reflux & heartburn. There are a number of things that can lead to impairment in this area and in the content below I provide some insight that may help you to reduce your symptoms and perhaps discover what the underlying cause/causes might be.

In many cases, improvements can be made in this area by simply improving one’s foundational areas, so if you scored high in any of your nutrition and lifestyle sections, then we strongly recommend focusing on improving those areas first. Equally you may also want to see if there is an overlap with your scores in multiple digestive health related sections, as one area may be impacting another.

As well as the recommendations below you can also get in contact to work with one of our recommended nutrition and functional medicine practitioners to support you with your overall health and specifically digestive health goals.

Common symptoms of LOS impairment and what you can do about it

The sphincter when functioning well, helps to prevent the acid in the stomach from backing up into the oesophagus. If the sphincter relaxes or if there is perhaps a structure issue affecting the function of the sphincter, acid can move upwards into the oesophagus.

Probably the most common symptom is heartburn. In America around 50% of the total spend on prescriptions for digestive diseases is from proton pump inhibitors (PPIs), such as omeprazole. This class of medications are designed to lower levels of stomach acid to help relieve the symptoms of heartburn. In many cases this is not a treatment for the underlying cause, in fact it is extremely rare that excessive acid is the cause of heartburn, instead it is more likely to be a sphincter dysfunction, hiatus hernia, infection, excessive intra-abdominal pressure or perhaps even low stomach acid.

This is not to say that these medications are not needed, in fact if the underlying cause of the heartburn persists and the reflux is not treated then this can lead to Barrett’s oesophagus, a disease where the reflux leads to scarring, perhaps difficulty in swallowing, and constriction of the oesophagus. Untreated this can significantly increase oesophageal cancer risk; in fact, the risk is said to be 30-125 x higher in those with Barrett’s. Also, it should be noted that PPI use over time has been linked with slight increases in all-cause mortality risk and a number of other side effects, so the optimal approach is to determine the true underlying cause of the symptoms in the first place.

Underlying causes of Lower Oesophageal Sphincter Impairment

Let’s go through some of these underlying causes to help you narrow down areas of consideration.

Hiatus Hernia

This occurs when a small portion of the stomach pushes up through the diaphragm into the chest region. This condition is more common in those over 50 years old. The most common symptom of this is heartburn. Causes of this vary, from a weakening or damage to muscle tissue, through to coughing, vomiting, straining, lifting heavy objects etc. Other potential risk factors also include obesity, smoking and as mentioned above simply getting older.

You may also experience a lot of belching and some chest pain or difficulty swallowing as well.

To help determine if this is an issue for you then it is recommended that you work with your gastroenterologist and perhaps look at an endoscopy or barium X-ray to help diagnose Hiatus Hernia.

In some cases, this can be helped with osteopathic care, specific adjustments and exercise therapy.

Medication Side Effects

Certain medications are also common contributors to heartburn because of their relaxing effect on the LOS or their direct irritating effect on the oesophagus. Some medication examples include:

• NSAIDs like ibuprofen
• Aspirin
• Nicotine
• Birth control
• Diazepam
• Progesterone
• Provera
• Theophylline
• Nitroglycerine

Of course, this does not mean you should stop taking your medications but may be a worthwhile point of discussion with your GP.

Intra-abdominal pressure

Reflux is most commonly caused by the flow of gastric juices up the oesophagus leading to the discomfort. If you scored high in the small intestine section as well, it is certainly possible that excessive fermentation of food products by bacteria within the small intestine may lead to this additional pressure and backflow of acids and gases.

Carbohydrate malabsorption has the potential to lead to bacterial overgrowth in the small intestine. Thus, if you scored high in the digestion and absorption section there may be a link here to why you are experiencing symptoms associated to LOS impairment and intra-abdominal pressure.

Pregnancy is another significant cause of intra-abdominal pressure, this reflux/heartburn is a common symptom whilst pregnant, especially in the later stages of pregnancy where there is a lot of pressure on the stomach.

Helicobacter Pylori Infection

Certain infections have been linked with these types of symptoms, in particular H.Pylori. Whilst H.Pylori can be present in healthy individuals and cause no symptoms at all, chronic infections may lead to atrophic gastritis which can cause a lot of inflammation in the stomach, lowering the levels of acidity in the stomach.

Stool testing and antigen testing for H.Pylori is important to help rule a problematic infection out. Whilst it may also be seen during an endoscopy, this is not a conclusive assessment of H.Pylori, likewise H.Pylori blood testing is not conclusive. Anyone I see with chronic gastritis, I like to rule in or out the presence of a problematic strain of H.Pylori through appropriate stool testing.

Low stomach acid

The production of stomach acid decreases with age. Therefore, if high stomach acid were the underlying cause of heartburn and reflux then you would expect to see it mostly in young individuals, but the opposite is true.

As mentioned before, high acid is actually very rare, whilst reduced acidity, small intestine bacterial overgrowth, infections, dysfunctional LOS etc are much more common.

The trouble with low stomach acid is that it is a primary cause of bacterial overgrowth in the small intestine, infection/food poisoning or maldigestion of foods, all of which can lead to reflux/heartburn.

When you consider the factors that may lead to low stomach acid, such as stress or the use of anti-acid medications, you then start to see why so many people are at risk of developing symptoms in this area.

Low stomach acid has also been linked with reducing the tone of the LOS, hence another reason it may lead to the symptoms you might be experiencing.

Foods that relax the LOS or might cause reflux issues

As mentioned previously, if the sphincter becomes relaxed it can contribute to reflux as the sphincter helps to prevent backflow of the acid. Below are a list of foods that have been shown to impact the functioning of the LOS.

• Coffee – Top of the list, caffeinated or non-caffeinated. Coffee relaxes the lower oesophageal sphincter (LOS)
• Peppermint, onions & garlic – relax the LOS
• Spicy, fatty or fried foods – relax the LOS
• Chocolate – contains a chemical called methylxanthine from the cocoa tree which is similar to caffeine. It relaxes the LOS
• Tomatoes, citrus fruits – high acid content can sometimes cause issues, however, are not relaxers of the LOS
• Carbonated beverages, whipped foods containing lots of air do not relax the LOS, but the gases can cause pressure so they might exacerbate symptoms if there is an underlying issue already

8 steps to take if you scored high in the LOS impairment section

1. If you have not done so already, speak with your GP and see if you can make an appointment with your gastro for further assessment and analysis
2. Review your diet and look for common triggers for you in terms of the development of pains around the stomach, reflux, heartburn etc. I often get clients to complete a food and symptom diary before considering the elimination of any foods. This allows us to be more targeted in our approach. Refer to the foods that I listed above that are common causes of LOS dysfunction. Also look for how you respond to high fibre or high carb foods in general as well.
3. Avoid eating close to laying down or any type of exercise. Lying down will result in a loss of gravity that helps to move things down through your digestive system. Likewise, jumping around with a stomach full of food is not going to aid your chances of proper digestion.
4. Consider an assessment by your osteopath to review any musculoskeletal factors that might be impacting the proper function of your digestive tract. Certain massage techniques can be very useful to help with relieving tension in the digestive system.
5. Consider running a comprehensive stool analysis to review the microbiome, rule out infections, review pancreatic function for enzyme product that assists with digestion, inflammation and more. We can assist with appropriate testing in this area as a way of giving you a more in depth and functional analysis of the gut beyond more standard assessments and tests offered by your Gastro.
6. Try the following to help with the symptoms of reflux:
• Cabbage Juice – Old folk remedy for heartburn, probably helps because of the high glutamine content of cabbage juice
• Slippery Elm Bark – Gentle and soothing for the mucous membrane. Can be drank as a tea or can chew on the bark. There are also slippery elm supplements that can be useful as well
• Ginger Root – Can provide temporary relief. Add a few slices of fresh ginger to a cup of boiling water and leave for 10 mins before drinking
7. Review levels of stress in your life. If you feel you are under a lot of stress, then this may be your starting point. Assuming you scored high in one of our multiple sections relating to stress on the quiz, please review the recommendations there or get in contact so we can find a practitioner for you to work with in this area.
8. Practice mindful eating practices as outlined in the ‘How You Eat’ section. Chewing food thoroughly, breakdown the surface area as much as possible and being present with your food is a major factor in improving ones digestive health.

Additional Resources

Books / Audiobooks

• Digestive Wellness – Elizabeth Lipski
• Fast Tract Digestion: Heartburn & Heartburn Cured – Microbiologist, Dr Norman Robillard PhD
• Why stomach acid is good for you – Jonathan Wright

Articles

• 5R approach to restoring gut health
• Foods that support a healthy digestive system
• Pre & Probiotic foods