Gastritis Support Group
Gastritis is a medical term for inflammation of the lining of the stomach. It means that white blood cells move into the wall of the stomach as a response to some type of injury. Gastritis has many underlying causes, from infection with the bacterium H. pylori, bile reflux, or excessive consumption of alcohol or certain foods or drugs like aspirin.
Does anyone know what this means?
Hypotensive lower esophageal sphincter
Normal esophageal peristalsis
Thanks
Hypotensive lower esophageal sphincter
Normal esophageal peristalsis
Thanks
But the muscles that push food down your esophagus are good.
Hypotensive lower esophageal sphincter
The LES is a 3-4 cm long segment of tonically contracted smooth muscle at the distal end of the esophagus. Resting tone of the LES normally varies from 10 to 30 mmHg relative to intragastric pressure. Lower esophageal sphincter pressure is lowest in the postprandial period and highest at night [1]. Intra-abdominal pressure, gastric distension, peptides, hormones, various foods, and many drugs affect the LES pressure. The mechanism of LES tonic contraction seems to be a property of the muscle itself rather than of nerves affecting the sphincter. Pressure within the
sphincter is minimally affected following the elimination of neural activity by close intra-arterial injection of tetrodotoxin [12]. Furthermore, biochemical evidence suggests that the properties of the sphincter are defined by properties of the circular muscle. Nonetheless, 50-70% of LES tone of humans can be inhibited by atropine [13]. Such influences may be especially important in modification of closure force in response to stimuli such as feeding and fasting.
Diminished LES pressure can be associated with gastroesophageal reflux by two mechanisms, stress reflux and free reflux. Stress reflux results when a relatively hypotensive LES is overcome and "blown open" by an abrupt increase of intra-abdominal pressure. Substantial data have accumulated suggesting that stress reflux is unlikely when the LES pressure is greater than 10 mmHg [2,4,6]. However, it should be noted that these studies were not controlled for the potential effect of a hiatal hernia and a recent investigation suggests that for a given LES pressure, the susceptibility to stress reflux is directly related to the presence and size of hiatal hernia [14]. The other mechanism by which diminished LES pressure is associated with gastroesophageal reflux is free reflux. Free reflux is characterized by a fall in intraesophageal pH, without an identifiable change in either intragastric or LES pressure observed when the resting LES pressure is within 0-4 mmHg of intragastric pressure [2,4],
A puzzling clinical observation supporting the importance of tLESRs is that only a minority of individuals with GERD have a hypotensive LES when determined by isolated fasting measurements [15,16]. This observation can be somewhat reconciled when one considers the dynamic nature of LES pressure. The isolated fasting measurement is probably useful only in identifying patients with a grossly hypotensive LES who are constantly susceptible to stress reflux. However, there is probably a larger group of patients with mild or moderate GERD susceptible to stress reflux when their LES pressure has been temporarily diminished as a result of specific foods, drugs, or habits [2,6].
and this to explain where it is:
http://www.webmd.com/digestive-disorders/picture-of-the-esophagus
A quick read seems to indicate your sphincter at the end of your esophagus, just at the top of your stomach, is too loose. It is tighter when your stomach is empty and looser just after you eat, essentially once you put food past it, it gaps open for a while and your food can come back up for quite some time. I remember a friend with gastroparesis mentioning this kind of thing at one point. He was told it could be fixed with surgery, by wrapping some of the stomach around it to tighten it and I've heard that myself as well.
Also I found something saying it could involve the vagus nerve having damage, which sounds logical.
Barring surgery, the other options are to eat tiny meals and nothing that will cause it to relax more than it already does at least after lunchtime.
Not finding much on the recommended diet, but when do we ever?
I did find that following the same type diet as hiatal hernia is helpful. Here is a page on that:
http://www.webmd.com/digestive-disorders/hiatal-hernia-diet-tips
You'll note that this diet is essentially the same as the plain old gastritis type diet. Small meals, low fat, no caffeine. Now for most of the folks in the US anyway that would be good news because we need to lose weight...but you are already by your own account too thin. It would seem to me that a visit to a nutritionist would be helpful at this point. She might have some RX high calorie low fat meal replacement drinks for you as liquids are always good with this type of thing since they don't stretch the sphincter so much as solid food. I'm thinking if they are RX then you can maybe get ins to pay for them as well...
Sorry about the book, I raised a daughter who is a librarian and I guess I should have been one too.
Stress reflux results when a relatively hypotensive LES is overcome and "blown open" by an abrupt increase of intra-abdominal pressure. I'm wondering if this is what makes me feel like something is taking my breath away. I get a kind of sudden catch in my chest... almost like air rushing upwards in my esophagus. Have had all the heart tests... no answers there. I guess I will have to haunt my doctor tomorrow and try to get a better explanation. Thanks for looking this up. You go way beyond to help!
Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism.
Eastwood GL, Braverman LE, White EM, Vander Salm TJ.
Abstract
A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with 131I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism.
I am absolutely so confused now that I'm not sure what to do about the gastritis anymore. I assume it plays a part in all this.
I have been pain free for 10 days now after 9 months of suffering.