One of the adventures and complications of traveling to all ends of the earth in pursuit of big game is exposing our digestive tracks to a multitude of different types of foods. With this exposure, travel and novelty comes an increased incidence of GERD. We docs love our acronyms so here goes: Gastro-Esophageal Reflux Disease.

Some of the dishes that have been prepared for us include raw seal fat in the far north to the heavily spiced delicacies in Central America to heavens knows what in the African bush. Most of us have experienced reflux to a variety of degrees even within our normal dietary habits at home. Some of us have the occasional mild case while other have it frequently and severe in nature. The overall perception from our patients is that it's just a nuisance with no particularly harsh potential consequences to it. It's really not just a disease exaggerated by drug companies to push their new pills and potions. Sure, it can be very simple and merely a brief inconvenience, but the reality is that uncontrolled reflux can set you up for some potentially very bad outcomes.

Let’s understand what reflux is to begin with. After ingesting a meal, the food in your stomach is exposed to strong acid. This is vigorously mixed even as you add to the load by your next swallow. There's a one-way valve made up of muscle called a sphincter, which controls the flow of food and allows passage into the stomach. Now this sphincter isn’t exactly the strongest muscle in your body. The esophageal sphincter can open up in a functional way; say if you eat spoiled food resulting in emesis (a nice way to say vomit). GERD occurs when food, which is actively being digested, is regurgitated back up into the esophagus because the esophageal sphincter is weak (incompetent).

The next thing to understand is that the cellular lining of the stomach is made to be able to handle the severe acidity but the esophagus is definitely not. This explains the burning feeling experienced with reflux. Besides the obvious discomfort and pain (which sometimes is mistaken for a heart attack) there are more serious problems with GERD. The two most serious things we all need to be aware of are that constant exposure of the lining in the esophagus to acid literally burns it. This chemical burning causes a change or transition of the lining from one type of cell to another in order to protect it more effectively. Unfortunately, that new cell type, known as Barrett’s esophagus is very prone to degenerating/predisposing you to esophageal cancer. Esophageal cancer is a killer.

The changing of the lining also brings with it a scarring type phenomenon. This scarring of a soft tubular organ causes stiffening and a restriction of the size of the tube. The result can be quite severe. Food starts to get stuck on the way down. This relatively frequent adverse effect ends up requiring dilatation. The dilation treatment is kind of medieval. A large caliber, long, flexible solid rubber hose that is passed down your throat into your stomach, which stretches the esophagus outwards again so, you can swallow normally again. Again, unfortunately once this process starts, you usually must be redilated every so often. There are many other problems associated with reflux that can mimic other disease processes and if they go unrecognized, one can endure a host of tests before the real culprit is found.