|
| Howard McCollister wrote:
> "Pete" <pete@nospam.net> wrote in message
> news:1209isoovn1e39@corp.supernews.com...
>
> Straining has nothing to do directly with the esophagus. It's muscle
> system is intrisinic and involuntary, mediated by a reflex arc from
> the spinal cord as part of the swallowing reflex. However, it's not
> quite that simple.
> The relationship between the esophagus and stomach is entirely the
> related to the pressures in the compartments in which they reside and
> the ability of the lower esophageal sphincter to keep the two organs
> separate. The chest cavity, where the esophagus lives, has negative
> pressure - let's say about -6 mmHg pressure. The abdominal cavity has
> positive pressure -
> maybe +6 mmHg. That means that there is a gradient of 12 mmHg across
> the LES trying to get gastric contents into the esophagus. That means
> that, at rest, the LES has to have a resting pressure of at least 12
> mmHg pressure in order to keep the esophagus pinched off from the
> stomach. Obviously, then, things that increase the intraabdominal
> pressure above +6 mmHg can blow gastric contents right by the LES
> because that pressure gradient exceeds the pressure of the LES. So,
> obesity for example, where there is more intraabdominal content, will
> exacerbate the liklihood of an excessive pressure gradient. So will
> bending over, for example. Even a full stomach may upset that
> gradient if the LES is abnormally weak.
> So, obviously, would power lifting - where abdominal straining can put
> tremendous pressure on the stomach, and cause reflux across the LES
> if the LES isn't up to the challenge. The concept behind
> fundoplication is reinforcing the LES to increase its resting
> pressure, AND to prevent it from being able to relax too much when
> pressure is put against it. Because that fundoplication wrap is done
> using a part of the stomach (the fundus) that normally relaxes during
> swallowing just like the LES does, the incidence of difficulty
> swallowing is (theoretically) minimized - it will still relax enough
> to let food through. So, the problem with power lifting is that too
> much abdominal straining too soon can put too much pressure against
> the wrap. This is a potential problem with patients that have a
> fundoplication that is done badly - where the wrap is too loose, or
> secured too low on the esophagus, or it there is
> unrecognized/unaddressed shortening of the esophagus. But if done
> properly, abdominal straining such as in power lifting should not be
> a problem after things have healed.
> HMc
Thank you Howard for the great explanation. So straining would indirectly
affect the LES via pressure on the stomach, and once it heals everything
should be okay. May I ask when your practice does the advanced fundo
procedures, what estimate of risk do you give most of your patients for bad
results like difficulty swallowing, or vomiting, or burping. If its greater
than one per cent (eg say 5%), I would worry like hell...Pete
|
|