Just between your chest and abdomen is where you’ll find one of the most important muscles you probably didn't know you had: the lower esophageal sphincter, or LES. When functioning properly, this ring of tissue plays a crucial role in helping us eat. But when the LES malfunctions, it becomes the main player in heartburn --a searing, sometimes sour-tasting chest-spasm that many people will experience at some point in their lives.
Između grudi i abdomena se nalazi jedan od najvažnijih mišića koji verovatno niste ni znali da imate: donji ezofagealni sfinkter, ili DES. Pri normalnom funkcionisanju, ovaj prsten mišića igra važnu ulogu u procesu jedenja. Ali kada DES loše funkcioniše, postaje glavni uzrok gorušice, osećaja gorenja, ponekad grčenja u grudima uz kiselinu u ustima, koji će mnogi ljudi doživeti u nekom trenutku svog života.
We know that humans have been battling heartburn for hundreds, if not thousands of years. But recently the incidence has risen, making it a common stomach complaint worldwide. When the symptoms of heartburn become more more regular and intense —such as twice a week or more-- it’s diagnosed as Gastroesophageal Reflux Disease, or GERD. But what causes this problem, and how can it be stopped?
Znamo da su se ljudi borili sa gorušicom stotinama, ako ne i hiljadama godina. Ali odskora se učestalost povećala, čineći je čestom stomačnom tegobom širom sveta. Kad simptomi gorušice postanu učestaliji i intenzivniji, npr. dva puta nedeljno ili češće, postavlja se dijagnoza gastroezofagealnog refluksa, ili GERD. Ali šta prouzrokuje ovaj problem, i kako se on može zaustaviti?
Heartburn starts in an area called the gastroesophageal junction, where the LES resides. This smooth, muscular ring of the LES is moderated by an intricate tree of nerve roots that connect to the brain, the heart, and the lungs. After food enters the stomach from the esophagus, the muscle’s task is to stop it from surging back up again. The LES contracts, squeezing the stomach entrance and creating a high pressure zone that prevents digestive acids from seeping out.
Gorušica počinje u oblasti zvanoj gastroezofagealni spoj, gde se nalazi DES. Ovaj glatki prsten mišića DES-a kontrolišu zapetljani nervni koreni koji se povezuju sa mozgom, srcem i plućima. Nakon što hrana uđe u stomak iz jednjaka, zadatak ovog mišića je da zaustavi hranu da se vrati nazad. DES se grči, stiskajući otvor želuca i stvara zonu visokog pritiska koja sprečava želudačnu kiselinu da izađe van želuca.
But if the LES relaxes at the wrong moment or gradually weakens, it becomes like a faulty, ill-fitting lid, causing the area to depressurize. That allows burning stomach acid-- and even chunks of food--to spurt into the esophagus, sometimes going as far up as the mouth.
Ali ako se DES opusti u pogrešnom trenutku ili postepeno oslabi, postaje nešto poput neispravnog, neodgovarajućeg poklopca koji prouzrokuje da se oblast oslobodi od pritiska. To mogućava gorućoj želudačnoj kiselini, pa čak i delićima hrane, da dospeju do jednjaka, a nekad dođu čak i do usta.
The cause of all this internal drama has long been put down to diet. Foods like caffeine and peppermint contain ingredients that may have a relaxing affect on the LES, which makes it incapable of doing its job. Other acidic foods, like citrus and tomatoes, can worsen irritation of the esophagus when they leach out with stomach acid. Carbonated beverages can similarly bubble up in the stomach, forcing open the valve.
Uzrok svih ovih unutrašnjih drama se oduvek pripisivao načinu ishrane. Namirnice kao što su kafa i pepermint sadrže sastojke koji mogu da imaju opuštajući efekat na DES, zbog čega nije u stanju da radi svoj posao. Druge kisele namirnice, kao što su limun i paradajz, mogu da pogoršaju iritaciju jednjaka kad procure zajedno sa želudačnom kiselinom. Gazirana pića mogu na sličan način da se nakupe u želucu, otvarajući zalistak na silu.
But researchers have discovered that food isn’t the only trigger. Smoking poses a risk, because the nicotine in cigarettes relaxes the LES. Consuming excessive amounts of alcohol may have a similar effect. Pregnant women often experience more heartburn due to the pressure of a growing baby on their stomachs. and the levels of certain hormones in their bodies. Obesity can cause hernias that disrupt the anti-reflux barrier of the gastroesophageal junction that normally protects against heartburn. Numerous medications, including those for asthma, high blood pressure, birth control, and depression can also have unintended effects on the LES.
Istraživači su otkrili da hrana nije jedini okidač. Pušenje predstavlja rizik, jer nikotin u cigaretama opušta DES. Konzumiranje ogromne količine alkohola može imati sličan efekat. Trudne žene doživljavaju često više gorušica zbog pritiska bebe koja raste na njihov želudac i nivoa određenih hormona u njihovom telu. Gojaznost može prouzrokovati hernije koje ometaju barijeru u gastroezofagealnom čvoru koja se bori protiv odliva i koja obično štiti od gorušice. Brojni lekovi, uključujući one za astmu, visoki krvni pritisak, kontraceptivne pilule i lekove za depresiju takođe mogu imati neplanirane efekte na DES.
An occasional bout of heartburn isn't necessarily something to worry about. But, if heartburn starts happening regularly, it can weaken the LES muscle over time, letting more and more acid escape. And if it goes untreated, this can cause bigger problems.
Povremena pojava gorušice nije nešto zbog čega nužno treba brinuti. Ali ako gorušica počne redovno da se dešava, može da oslabi DES mišić tokom vremena, oslobađajući sve više i više kiseline. I ako se ne preduzme nešto, ovo može da prouzrokuje veće probleme.
Over time, constant acid leakage from heartburn may form scar tissue which narrows the esophageal tube, making it harder to swallow food. Ongoing reflux can also damage the cells lining the esophagus--a rare condition called Barrett’s esophagus, which can elevate the risk of esophageal cancer.
Tokom vremena, stalno curenje kiseline zbog gorušice može da obrazuje ožiljak koji sužava ezofagealni kanal i otežava gutanje hrane. Neprekidan odliv takođe može da ošteti ćelije koje oblažu jednjak, što je retka bolest zvana Baretov jednjak, koja može da poveća rizik od ezofagealnog raka. Na sreću, gorušica se često može lečiti
Luckily, heartburn is often treatable with a range of medicines that can help neutralize or reduce stomach acid. In extreme cases, some people have surgery to tighten the LES to minimize their distress.
nizom lekova koji mogu da pomognu da se neutrališe ili smanji želudačna kiselina. U ekstremnim slučajevima, neki ljudi idu na operaciju da zategnu DES da bi smanjili neprijatnosti. Često možemo da zaustavimo gorušicu
But we can often stop heartburn before it reaches that point. Reducing the consumption of certain foods, not smoking, and maintaining a healthy weight can all dramatically reduce reflux. With proper care we can help our LES’s keep the chemical fountain of our stomachs in proper order and avoid having to feel the burn.
pre nego što dođe do tog trenutka. Smanjenje konzumiranja određene hrane, prestanak pušenja i održavanje zdrave kilaže može drastično smanjiti odliv kiseline. Adekvatnom negom možemo pomoći svom DES-u da održi hemijsku fontanu želuca u odgovarajućem stanju i da izbegnemo osećaj žarenja.