A loose esophageal sphincter can result in gastro-esophageal reflux disease (GERD), where food and stomach acid flow back into the esophagus, causing heartburn and other symptoms. The problem and related condition can be treated in a number of ways. Many patients benefit from making lifestyle changes and taking medications. Severe disease can be alleviated with surgery.
The first line of treatment for a loose esophageal sphincter involves making lifestyle modifications that help prevent the symptoms of GERD: heartburn, problems swallowing, chest pain, and nausea. Affected patients are advised to avoid spicy, acidic, or fatty foods. Alcohol use and smoking are also discouraged. Patients should eat small meals, and drink plenty of water with their meals. They should avoid eating close to bedtime, and should sleep with the head of their bed raised.
The next step in the treatment of a loose esophageal sphincter is medication. The most effective medications function by decreasing the secretion of acid in the stomach. Two classes of antacid medications that are especially helpful include the H2 blockers and the proton pump inhibitors (PPIs). These medications are available either over-the-counter or by prescription, and are typically taken daily regardless of symptoms.
If the antacid medications alone are not effective in decreasing reflux symptoms, other adjunct medications can be used to treat a loose esophageal sphincter. Some options include prokinetic agents such as metoclopramide, and reflux inhibitors such as lesogaberan. Other patients benefit from the eradication of the bacteria Helicobacter pylori from their gastrointestinal tract with a course of antibiotic medications.
Failure of medical therapies could suggest a need for surgery. A variety of procedures can tighten the lower esophageal sphincter and prevent reflux. The most common surgery performed to treat a this condition is the Nissen fundoplication, a procedure that can be done with either laparoscopic or open surgery. Other procedures used to fix the lower esophageal sphincter include the Hill gastropexy or a gastric bypass surgery.
A loose esophageal sphincter can be diagnosed by performing a number of procedures. Monitoring the pH of the lower esophagus over a period of 24 hours can point to acid reflux; patients with this condition have lower-than-expected pH values. The technique of esophageal manometry can measure the pressure at the lower esophageal sphincter. Endoscopy, which is performed by inserting a flexible tube with a camera into the esophagus, allows doctors to visualize the lower esophageal sphincter. Other times, patients are given a presumptive diagnosis of GERD based on clinical history alone.