The lower esophageal sphincter (LES) is a muscular valve separating the esophagus from the stomach. Its main job is to open for food and liquids to pass into the stomach and then close tightly to prevent acidic contents from flowing back up into the esophagus. When this muscle relaxes or weakens, it causes acid reflux, which, if persistent, is known as Gastroesophageal Reflux Disease (GERD). Managing reflux symptoms often focuses on supporting or strengthening the LES through daily adjustments, dietary choices, and specific physical techniques.
Adjusting Daily Habits
Maintaining a healthy body weight is effective, as excess weight, particularly around the abdomen, increases intra-abdominal pressure. This pressure pushes stomach contents upward against the LES, causing acid reflux. Losing even a small amount of weight can significantly reduce this pressure and alleviate symptoms.
Avoiding clothing that fits tightly around the waist or abdomen is also helpful, as it minimizes external pressure on the stomach. Another important behavioral change is to avoid lying down immediately after eating. Experts recommend waiting at least two to three hours before going to bed or reclining. This wait time ensures the stomach has begun to empty before the body assumes a horizontal position.
For nighttime reflux, elevating the head of the bed uses gravity to keep stomach acid down. This is achieved by placing blocks or specialized wedges under the bedposts to raise the head by six to nine inches, rather than stacking pillows, which can worsen symptoms. Smoking significantly weakens the LES because nicotine relaxes the muscle, making quitting tobacco products a substantial step toward improving function.
Dietary Changes to Reduce LES Stress
Certain foods and beverages can trigger the stomach to produce more acid or chemically cause the LES muscle to relax, increasing reflux likelihood. Eating smaller, more frequent meals prevents the stomach from becoming overly full, reducing physical pressure on the LES. Consuming large meals delays stomach emptying and puts unnecessary strain on the valve.
High-fat meals should be limited because fat takes longer to digest, delaying gastric emptying. Common trigger items that relax the LES include chocolate, peppermint, and spearmint. Both caffeine and alcohol can also cause the LES to weaken, allowing stomach contents to back up into the esophagus.
Highly acidic foods, such as citrus fruits, tomato products, and spicy foods, may not directly affect LES tone but can irritate the esophageal lining if reflux occurs. Reducing these irritants lessens the severity of heartburn symptoms. Keeping a detailed food diary helps individuals pinpoint specific dietary triggers, as responses vary.
Targeted Physical Techniques
Physical exercises aimed at strengthening the diaphragm can indirectly improve LES function, as the crural diaphragm surrounds and supports the sphincter. Diaphragmatic breathing, often called belly breathing, involves deep, slow breaths focusing on the movement of the abdomen rather than the chest. This practice enhances the pressure exerted by the crural diaphragm, strengthening the anti-reflux barrier.
Regular diaphragmatic breathing training increases the resting pressure of the LES, a primary factor in preventing reflux. The technique involves inhaling deeply through the nose, expanding the abdomen, and then slowly exhaling through pursed lips. Regular practice may decrease the need for acid-suppressing medications and improve quality of life for those with GERD.
A more specialized technique is biofeedback training, which uses monitoring equipment to help individuals gain conscious control over involuntary bodily functions. In a clinical setting, this teaches a patient how to voluntarily contract the diaphragm to directly increase pressure on the LES. While effective, this technique requires specialized equipment and professional training and is less commonly implemented than simple diaphragmatic breathing.
When to Seek Medical Help
While lifestyle and dietary adjustments are often the first line of defense, they are not always sufficient to manage chronic reflux. Individuals should consult a healthcare provider if symptoms are persistent, frequent, or severe enough to interfere with daily life, despite making recommended changes. Other warning signs necessitating medical evaluation include difficulty or pain when swallowing, unintentional weight loss, or persistent hoarseness.
A doctor can prescribe pharmacological treatments, such as proton pump inhibitors (PPIs) or H2 blockers, which reduce stomach acid production. These medications treat the acid rather than directly improving the LES muscle function. For people with severe symptoms or who wish to avoid long-term medication, surgical options are available.
The most common surgical procedure is a fundoplication, such as the Nissen fundoplication, where the upper part of the stomach is wrapped around the lower end of the esophagus. This wrap physically reinforces the LES, creating a tighter valve to prevent reflux. Newer, less invasive options include the LINX device, a ring of magnetic beads placed around the junction to strengthen the barrier.