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DIGESTIVE DISEASES: HOW DIGESTION WORKS
Normally, everything in the digestive tract works nicely to break down the food you eat so it can be absorbed by your blood and used for energy and body repair.
Chewed food is swallowed and drops down the food pipe, or esophagus, into the stomach. The stomach then churns and bathes it in acid and enzymes. In less than an hour, the stomach begins pushing the food through the pyloric sphincter and into the duodenum. More digestive fluids come from the liver (bile, which is stored in the gallbladder) and pancreas. From there, the food moves into the narrow, 20-foot-long small intestine, where more enzymes break down the proteins, fats, and starches into food molecules that pass into the bloodstream. Finally, the undigested food – mostly plant fiber – moves into the wider, 5-foot-long large intestine, or colon.
The conquest of heartburn? Trouble can start right in the esophagus. One American in 10 suffers daily from heartburn, so called because it generates a burning sensation in the region of the heart. Rick Tucker, 40, a car dealer in Wytheville, Virginia, had such a severe case of heartburn; he thought he was having a heart attack. “I started to get chest pains,” he says, “and symptoms of a heart attack – shooting pains in my chest and left arm. Just thinking it was a heart attack made my heartburn worse.”
Basically, heartburn occurs if your stomach splashes acid up into your esophagus. The bitter, acidic fluid gets past the cardio-esophageal sphincter, the muscle between the stomach and the esophagus, and burns the food pipe’s delicate lining. Doctors once blamed this condition on a hernia in the hiatus (opening) of the diaphragm, which leads to the stomach, but many hiatus hernia patients have no heartburn.
Dr. Richard McCallum, of the University of Virginia School of Medicine, Charlottesville, contends that many heartburn patients’ stomachs empty too slowly, causing the acid to collect and rise. Drugs are being developed to treat this.
Dr. Donald O. Castell, of Wake Forest University’s Bowman Gray School of Medicine, Winston-Salem, North Carolina, says heartburn has many causes, including excess stomach acid, which drugs can reduce. Doctors also now have bethanechol and metoclopramide, drugs that tighten the cardio-esophageal sphincter to help keep acid out of the food pipe.
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