When we swallow food, it passes through the esophagus into the stomach, where natural acids help break down the food particles so they can easily be absorbed when passing through the digestive tract.
- Between the esophagus and the stomach there is a valve called the lower esophageal sphincter (LES) that stops this potent stomach acid from backing up (reflux) into the esophagus, where it can cause serious damage. Coughing is only one of the symptoms and effects of acid reflux.
- Normally, the LES opens to allow food to pass into the stomach, and then closes so that there is no reflux. Certain conditions can alter the stomach-LES pressure gradient (most patients with reflux have lower than normal LES pressure) and relax or lower the esophageal sphincter pressure, resulting in reflux.
- Smoking, drinking too much coffee, and some medications including beta-blockers, Calcium channel blockers, nitrates, and estrogen can lower the pressure gradient and contribute to reflux.
- Damage from surgeries (balloon dilation of the esophagus, gastric resection), Esophagitis, diseases such as Scleroderma, and conditions that force the LES to open when it is not supposed to (e.g., Bloating, obesity, pregnancy, Ascites, tight clothes, etc.) can all lead to reflux.
As the acid moves upward, it can cause heartburn, pain in the middle of the chest, nausea, belching, coughing, sore throat, and increased risk for dental caries.
- If not treated, reflux can lead to inflammation and erosion of the esophageal surface (Esophagitis), and eventually to scarring and narrowing of the esophagus, making it difficult for food to pass through with ease.
- For further details, please see GERD (Gastro Esophageal Reflux Disease).