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What Causes Reflux Symptoms

When a reflux event takes place, we now know that the stomach contents end up in the esophagus or in the upper airway or the larynx.  But what causes the symptoms?  Is it the actual contents themselves causing a direct effect on the tissue or is there another mechanism of action that could better explain what is happening?

It’s important to understand this mechanism of action because current therapy is designed towards lowering acid levels by taking a pill to reduce the amount of acid.  This works variably in many people and the reason why it works variably is that it’s not the acid causing a direct effect on the tissue that causes the symptoms.

The fact is that medical evidence shows that in the wall of the esophagus there are receptors known as vanilloid receptors.  We call them TRPV1 receptors for short.  What these receptors do is directly interact with the nerves or they indirectly interact by allowing the secretion of different substances that are not normally present in great quantities in the wall of the esophagus.  It is the presence of these substances that can lead to thickening of the wall.  It can affect motility so your food cannot be swallowed as easily.  It can cause pain or even the symptom that we all commonly know as heartburn.

Activation of these substances, in this particular case, platelet activating factor or PAF, can also be directly toxic to the lining. Thus the ulcers or the erosions that many people will have are actually not due to the acid touching the tissue, which is protected by a mucus layer, but actually by the production of the PAF.

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