Hiatus Hernia - ( reflux oesophagitis) is due to regurgitation of stomach contents into the oesophagus. Unlike the stomach, the lining of the oesophagus is damaged by gastric acid. The pain experienced during reflux is due to a chemical burn to the lining of the oesophagus by acid stomach contents. Little damage occurs during the day, as reflux caused by inadvertent bending gravitates back into the stomach when the up-right position is resumed. What little acid is left in the oesophagus is neutralised by the alkaline saliva. Most damage to the oesophagus occurs at night. Because of the curvature of the spine, the stomach is higher than the oesophagus and throat when the body is in the recumbent position. In the presence of reflux, stomach contents run down-hill all the way to the mouth.

The oesophagus and upper airway sustain maximum damage when they are exposed to this corrosive gastric content over-night. Overflow of contents into the airway may also cause chronic cough and accentuate chronic bronchitis and asthma. In addition, it causes bad breath and increase dental caries, and may lead to gum disease. With time the oesophageal lining becomes damaged (Barrett’s oesophagitis), and a tendency to develop cancer develops. Chronic damage also results in scarring and contraction in the diameter of the oesophagus, eventually causing narrowing and obstruction of the oesophagus. This may interfere with the ability to swallow food.

Use of medication to suppress acid secretion may not completely alleviate the problem as acid suppression is not complete. Residual acid secretion at night may result in persistent low-grade symptoms e.g. chronic cough, and in progressive damage to the oesophagus. Suppression of acid secretion may also interfere with the digestive process and contribute to malabsorption of micronutrients.

Damage caused by oesophageal reflux can be minimised by elevating the head of the bed with blocks and sleeping in the “head-up” position. Dietary modification will help significantly. Acupuncture is a very effective adjunctive treatment for reflux oesophagitis, and a combination of dietary changes, elevation of the head during sleep, and acupuncture therapy, will in most people control symptoms of acid reflux with little, if any, need for acid suppression.