Gastroesophageal reflux disease (GERD) is more than just a case of occasional heartburn, it’s a chronic condition that can affect everything from your sleep to your daily comfort. If you’ve ever dealt with persistent acid reflux, you know how disruptive it can be. But to truly understand GERD and find lasting relief, it helps to understand what’s happening inside your body.
GERD isn’t just about what you eat, it’s also about how your anatomy works (or doesn’t) to keep stomach acid in its place.
Let’s dive into the inner workings of GERD, including the role of your diaphragm, the body’s natural anti-reflux barriers, and what happens when those structures weaken.
The Anatomy of GERD
Under normal conditions, food moves smoothly from your mouth through the esophagus and into the stomach, where powerful acids break it down for digestion. The stomach is designed to handle this acid, but the esophagus is not. When acid escapes back up into the esophagus, it can cause burning pain and damage over time.
GERD develops when this backward flow of acid becomes chronic. This happens when the body’s natural defenses against reflux no longer work properly.
The Role of the Diaphragm in GERD
Your diaphragm is more than just a breathing muscle, it also plays a critical role in digestion. Just below your lungs, the diaphragm supports the esophagus and helps the lower esophageal sphincter (LES) stay closed after you eat.
Due to aging, stress, or excess abdominal pressure, the diaphragm can be weakened, compromising its ability to assist the LES. That’s when acid can start to slip back into the esophagus more easily, leading to GERD symptoms.
The Outer Valve: Your Body’s Natural Defense Against Reflux
At the base of the esophagus sits the lower esophageal sphincter (LES), which is a muscular ring that acts like a valve, opening to let food in and closing to keep acid down. Just above the stomach, there’s also the gastroesophageal (GE) flap valve, another part of the anti-reflux barrier system.
When these structures are working well, they prevent acid from moving upward. But when the LES weakens or the GE flap valve becomes distorted, acid can escape into the esophagus more often and more forcefully. That’s when occasional reflux turns into chronic GERD.
When GERD Anatomy Goes Awry
One of the most common anatomical contributors to GERD is a hiatal hernia. This occurs when part of the stomach pushes up through the diaphragm and into the chest cavity. A hiatal hernia weakens the anti-reflux barrier and disrupts the alignment of the LES, making reflux more likely and more severe.
These structural issues not only worsen GERD but also influence how it should be treated. Addressing the root anatomical cause can lead to more effective and lasting relief.
Diagnosing GERD: Looking Inside
To fully understand what’s causing your personal GERD anatomy, it’s a good idea to see one of our doctors at Hoag. After listening to your symptoms, they might suggest one or more of these diagnostic tests:
- Endoscopy allows Hoag GI specialists to visually inspect the esophagus and stomach lining for inflammation or damage.
- EsoGuard is a DNA test for detection of esophageal precancer, and Hoag is one of the first and only to offer this tool for at-risk patients.
- Esophageal manometry measures the pressure and movement in the esophagus, including the strength of the LES.
- pH monitoring tracks how often and how long acid enters the esophagus over 24 hours.
- Hiatal hernia assessment helps evaluate the diaphragm’s position and function.
These tests provide a complete picture of what’s happening anatomically and what can be done about it.
Treatment Based on Your GERD Anatomy
For some people, lifestyle changes and medications are enough to control mild GERD. These might include avoiding trigger foods, elevating the head while sleeping, and taking acid-reducing medications like PPIs or H2 blockers.
But when GERD is driven by anatomical issues, more advanced interventions may be necessary. At Hoag Digestive Health Institute, our specialists offer a range of minimally invasive procedures, including:
- Endoscopic procedures, such as the TIF (Transoral Incisionless Fundoplication), which strengthen the anti-reflux valve without skin incisions
- Magnetic augmentation (LINX device) to restore proper valve function with a small ring of magnets
- Laparoscopic or robotic-assisted surgeries to repair a hiatal hernia and reinforce the LES
Dr. Kenneth Chang, Executive Medical Director at Hoag Digestive Health Institute Gastroenterology, is one of the world’s leading authorities and trainers on TIF and notes that a sizeable majority of patients have positive outcomes with a TIF. Hoag actually has one of the highest number of TIF providers in a single hospital.
Care Tailored to You at Hoag
At Hoag, treatment is always tailored to the patient’s specific GERD anatomy, symptoms, and overall health goals.
Understanding the anatomy behind GERD can make all the difference in choosing the right treatment and avoiding long-term complications. If you’re struggling with acid reflux or related symptoms, don’t wait to seek help. At Hoag, our GI physicians take a personalized, science-based approach to diagnosing and treating GERD at its root.
The earlier you understand what’s happening in your body, the sooner you can get the relief you deserve.
If you are experiencing a mental health or medical emergency, please call 911 or go to your nearest emergency room.
