The lower esophageal sphincter (LES) is a muscular ring that functions like a valve, separating the esophagus from the stomach. This specialized muscle relaxes briefly to allow swallowed food and liquid to pass into the stomach, then immediately tightens to prevent stomach contents from flowing back up into the esophagus. When the LES weakens or relaxes inappropriately, it can lead to acid reflux and gastroesophageal reflux disease (GERD), causing uncomfortable symptoms like heartburn and regurgitation. While many people turn to medication for relief, non-invasive strategies focused on supporting and strengthening the LES’s function can be effective in managing symptoms.
The Mechanics of LES Failure
The LES is an involuntary muscle, but its ability to remain closed is heavily influenced by surrounding physical and chemical factors. LES dysfunction often stems from an abnormally high rate of transient LES relaxations—brief, spontaneous openings that allow reflux—or a defective basal LES pressure, meaning the muscle is not tight enough to begin with.
Increased pressure within the abdominal cavity is a mechanical force that compromises the LES’s integrity. Conditions such as obesity, pregnancy, and wearing tight clothing increase this pressure, forcing stomach contents upward against the sphincter. A hiatal hernia, where the upper part of the stomach pushes up through the diaphragm, also impairs LES function and contributes to reflux. Chemicals from certain foods, nicotine, and alcohol can also directly cause the LES muscle to relax, decreasing its pressure.
Lifestyle Changes to Reduce Strain
Making adjustments to daily habits is a cornerstone of strengthening the LES indirectly by minimizing physical and chemical stress. Managing body weight is one of the most effective changes, as reducing excess weight, particularly around the midsection, significantly lowers intra-abdominal pressure that pushes against the stomach and LES.
The timing of meals plays an important role in preventing nocturnal reflux. It is recommended to avoid lying down for at least two to three hours after eating, allowing the stomach to empty. Eating smaller, more frequent meals throughout the day, rather than three large ones, prevents the stomach from becoming overly distended, which reduces pressure on the sphincter.
Modifying the sleep environment can use gravity to the LES’s advantage. People who experience nighttime reflux should elevate the head of their bed by six to eight inches using blocks or a specialized wedge, as stacking pillows can bend the body and worsen symptoms. Avoiding known dietary triggers is also important, as these substances can directly cause the LES to relax or increase acid production:
- High-fat foods
- Chocolate
- Caffeine
- Alcohol
- Peppermint
- Citrus
- Tomatoes
Smoking cessation is advised because nicotine is known to weaken the LES and increase stomach acid levels.
Specific Physical Exercises for LES Support
While the LES is an involuntary muscle, specific physical exercises can strengthen the surrounding support structures, particularly the diaphragm. The diaphragm is a large, dome-shaped muscle whose crural muscles wrap around the LES, providing extrinsic pressure that assists the sphincter in closing. Strengthening the diaphragm through targeted breathing exercises can thus improve the LES’s function.
The primary exercise recommended is diaphragmatic breathing, which should ideally be taught by a trained professional. This technique involves sitting or lying down and focusing on expanding the abdomen—not the chest—while inhaling slowly and deeply. By consciously engaging the diaphragm, this exercise helps to increase the resting pressure of the muscle around the LES, which may reduce the incidence of reflux.
One simple method involves placing one hand on the chest and the other on the abdomen to ensure only the lower hand moves with the breath. Another technique involves applying gentle resistance to the abdomen with the hands while inhaling, providing a mild load to the diaphragm muscle. These exercises should be practiced consistently, often after meals, to train the diaphragm to provide stronger support to the LES.
Medical Management and Next Steps
Although self-management techniques can significantly improve symptoms, persistent or severe reflux requires professional medical evaluation. A physician can use diagnostic tools like endoscopy or esophageal manometry to determine the nature of LES dysfunction. Manometry, for instance, uses a pressure-sensing tube to measure the force of the LES closure and the movement of the esophagus.
Medical management often begins with medications designed to reduce acid damage. Over-the-counter antacids provide temporary relief by neutralizing stomach acid. More potent options include H2 blockers, which reduce acid production, and proton pump inhibitors (PPIs), which are the most effective at suppressing acid secretion. If symptoms remain severe despite lifestyle changes and medication, a physician may discuss further options, including prokinetic agents that aim to increase LES pressure or surgical procedures.