Originally posted by Karen Morrone, DAc, DPT, MS on Advance for Physical Therapy & Rehab Medicine, June 19, 2012
Acid reflux is a common and chronic problem which is prevalent in society today. It is characterized by the reflux of gastric contents across an incompetent gastro-oesophageal junction, resulting in damage and inflammation of the lining of the oesophagus. It is quite difficult to study the epidemiology of acid reflux due to the lack of consensus regarding the basic definition of the disease. Dent et al reported that a large percentage of the general population experience occasional symptoms.
The frequency of one to two times per week seems to be a common denominator for determining the diagnosis of gastro-esophageal reflux. They concluded that the prevalence of at least once weekly episodes of heartburn and/or reflux in the Western world ranges from 10 to 20 percent, while in Asia the prevalence is less than 5 percent. They also concluded that the prevalence is higher in North America than in Europe. Structurally, the junction between the stomach and the esophagus is a highly specialized area which is composed of the lower esophageal sphincter and its adjacent structures which include the crural portion of the diaphragm. The authors reiterate that together these structures allow ingested food into the stomach while preventing reflux of contents back up into the esophagus.
As we look at the anatomical structure of the respiratory diaphragm, it has been shown that the crural portion of the diaphragm acts as an external sphincter. The lower esophageal sphincter and the crural diaphragm are fastened to each other by the phreno-esophageal ligament. This musculo-visceral junction is the basis of this article. What happens when dysfunction of the respiratory diaphragm causes an insufficiency of the gastro-esophageal junction? This article hypothesizes that the function of the crural portion of the diaphragm plays a significant role as a gastro-esophageal sphincter and, if inhibited can be a possible etiology of acid reflux.
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