Food and fluid move from the mouth to the rectum. These movements are in one direction. Muscles in the wall of the gut contract and relax in a rhythmic manner to ensure that there is unidirectional movement through the tract, which is known as peristalsis. Sometimes the movement of food and fluid may actively or passively occur in the reverse direction and lead to vomiting, regurgitation or reflux.
Regurgitation and Reflux
The terms regurgitation and reflux are often used interchangeably to describe the backward flow of food and fluids from the esophagus or stomach up to the throat or mouth. It is not the same as vomiting, whereby food and fluid is expelled forcefully due to strong contraction of the upper gut muscles. Reflux tends to indicate fluid flowing backward whereas tends to refers to partially or undigested food that is pushed or flows back up the path it entered. However, the distinction is not always as clear.
There are several ways in which the body prevents backward movement within the digestive tract. In the upper gut, there are sphincters to ensure that flow is in one direction in addition the rhythmic contractions (peristalsis) that only push in one direction. The lower esophageal sphincter (LES) lies between the esophagus and stomach, and the pyloric sphincter is a portion of the terminal part of the stomach where it then continues into the small intestine.
Also read more on GERD.
Signs and Symptoms
Regurgitation is a process whereby food and fluid flows backwards from the stomach and duodenum (small intestine) up the esophagus to the throat and even the mouth. As a result of this backward flow or the causes of regurgitation, there are a host of different signs and symptoms that may arise. This includes:
- Heartburn – a burning sensation in the chest area.
- Nausea – feeling of wanting to vomit.
- Bloating – sensation of fullness.
- Coughing – shallow and non-productive.
- Dysphagia – difficulty swallowing.
- Dysgeusia – strange taste in the mouth, usually sour or bitter.
Causes of Regurgitation
Most of the causes of regurgitation compromise the lower esophageal sphincter (LES) in some way. The LES prevents backward from from the stomach into the esophagus (food pipe). It is a band of muscles that wraps around the lowest part of the esophagus where it joins to the stomach. The tension of the sphincter depends on how tightly contracted these muscles are, which in turn is controlled by nerves of the autonomic nervous system (involuntary). Therefore when weakened in some way, the stomach and duodenal contents flow up into the esophagus and higher.
Overeating is one of the more common causes of regurgitation, even in children. There may be no predisposing medical condition for regurgitation with overeating. This is often seen with festive meals where there is a tendency to overindulge. Along with alcohol, a person is more likely to experience regurgitation during these times as the stomach stretches, food does not empty out fast enough and the LES may be weakened.
Alcohol and Drugs
Certain substances may weaken the lower esophageal sphincter for a period of time. Both alcohol and certain prescription medication can have this effect until it is metabolized fully. These substances may act directly on the muscles or on the nerves supplying it thereby weakening the tautness of the muscles. It is further compounded when consuming alcohol and overeating.
Increased pressure within the abdomen can also contribute to regurgitation. It can occur for various reasons such as the growing uterus in pregnancy, abdominal obesity and even tight clothing around the abdomen. Even abdominal exercises that increases the tautness of the abdominal muscls also increase the pressure within the abdominal cavity. This pushes the stomach contents up into the esophagus.
The LES can also become weakened over time, especially with any of the persistence of any of the factors mentioned above. This is more likely to occur with aging and tends to occur more frequently in people who are obese. Certain chronic medication may further contribute to it. Eventually the sphincter is permanently weakened and can only be corrected with surgical procedures like a Nissen fundoplication.
A hiatal hernia can also present with regurgitation. In this condition, a portion of the stomach protrudes through the opening in the diaphragm into the chest cavity. This protrusion affects the restriction of the stomach contents from flowing backward into the esophagus.
An obstruction in the upper gut, such as the end portion of the stomach, can also lead to regurgitation. Food and fluid that is consumed cannot pass out of the stomach. Eventually it backs up and flows backward up into the esophagus. This obstruction is usually not complete and small amounts of food eventually passes out of the stomach.
Muscle and Nerve Diseases
Various diseases can affect the muscles and/or nerves that comprise the lower esophageal sphincter (LES). Some of the conditions can arise suddenly while others develop gradually. It includes conditions like a stroke, Parkinson’s disease, multiple sclerosis, myasthenia gravis and motor neuron diseases.
How to Remedy Reguritation
Medical conditions need to be assessed and treated by a medical professional. However, a simple dietary and lifestyle remedies can help to reduce regurgitation alongside medical treatment.
- Avoid overeating. Many smaller meals throughout the day are advisable compared to fewer larger meals. This will ensure that the smaller quantity of food can pass through the stomach quicker.
- Do not lie down or sleep after eating. Wait at least 2 to 3 hours after a meal before going to bed. Even lying down flat although awake allows food and fluid to flow backwards due to gravity.
- Never undertake strenuous physical activity immediately after eating a meal, particularly a large meal. The contraction of the abdominal muscles and vigorous movement can push food and fluid upwards out of the stomach.
- Try sleeping on a wedge or elevate the head side of the bed. This helps to counteract food and fluid movement upwards ino the esophagus due to the action of the gravity.
- Minimize the intake of alcohol, especially with meals. Alcohol weakens the lower esophageal sphincter (LES) temporarily and this allows the food and fluid backwards.