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.
在你的胸部和腹部之間, 有個非常重要的肌肉, 你可能不知道它的存在: 下食道括約肌,縮寫 LES。 當這一圈組織妥當運作的時候, 它是協助我們進食的關鍵角色。 但當 LES 機能失常時, 它就成了胃灼熱的主要成因了。 胃灼熱是一種燒灼的胸痙攣, 有時還帶有酸味, 許多人在一生中都會經歷到。
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?
我們知道人類一直在對抗胃灼熱, 若沒有數千年,也有數百年。 但近期,發生率開始提升, 讓它成為全球一種 常見的胃部不適。 當胃灼熱的症狀變得 越來越頻繁、越來越強烈, ——比如一週兩次,或更頻繁—— 會被診斷為胃食道逆流, 縮寫為 GERD。 但這個問題是怎麼造成的? 要如何讓它停止? 胃灼熱是從「胃食道連接部」 這個區域開始發生的,
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.
也就是 LES 的所在。 LES 這一圈平滑的肌肉 是由錯綜複雜的樹狀 神經根來管控的, 這些神經根和大腦、 心臟,以及肺部相連。 在食物從食道進入胃部之後, 這塊肌肉的任務就是阻止食物 再次向上回衝。 LES 收縮,擠壓胃部的入口, 創造出一個高壓區, 避免胃酸漏出。
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.
但如果 LES 在不對的時候放鬆, 或是漸漸弱化, 它會變成像是一個 不完善、不吻合的蓋子, 造成該區域減壓。 那就會讓燒灼的胃酸, 甚至食物塊噴出來, 然後進入食道, 有時還會衝到嘴巴這麼遠。
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.
這種在體內上演的情節 一直都被歸因為飲食。 像是咖啡因以及薄荷這些食物, 其成分可能會造成 LES 放鬆, 讓它無法好好地工作。 其他酸性食物,比如柑橘和蕃茄, 與胃酸一起釋放出來時, 會讓食道的刺激更嚴重。 汽水也很類似,會在胃部中冒泡, 迫使閥門打開。 但研究者發現, 觸發因子不僅是食物。
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.
抽菸也會造成風險, 因為香菸中的尼古丁 會讓 LES 放鬆。 飲酒過量也會有類似的效應。 孕婦常發生胃灼熱, 是因為胎兒的成長 會對她們的胃部產生壓力, 她們體內某種荷爾蒙的量 也是一個原因。 肥胖會造成疝氣, 破壞胃食道連接部本來是用來保護 避免胃灼熱的抗逆流阻障。 數種藥物,包括氣喘、 高血壓、避孕,和憂鬱用的藥物, 也可能無意間對 LES 產生影響。
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.
若只是偶發的胃灼熱就不需擔心。 但如果胃灼熱開始頻繁發生, LES 可能會隨時間變弱, 讓更多的酸流出來。 如果沒有治療, 可能會造成更大的問題。 胃灼熱的胃酸外漏 持續一段時間之後,
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.
可能會形成疤組織,讓食道變窄, 讓吞嚥食物變得更困難。 不斷逆流也可能會傷害食道細胞, 這是一種罕見疾病, 叫做巴雷斯特食道症, 它會增加食道癌的風險。 幸運的是胃灼熱通常 可以用一些藥物治療,
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.
有助於中和或減少胃酸。 有些很極端的個案是透過手術 讓 LES 變緊,減少其痛苦。
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.
但我們通常都可以在演變到 這種地步之前就阻止胃灼熱。 減少食用某些食物, 不要抽菸,保持健康的體重, 都能顯著減少逆流。 有妥善的照顧, 我們就能幫助我們的 LES 把我們胃部的化學噴泉給管控好, 進而避免必須經歷這種灼熱感。