Modern medicine mainly diagnoses heartburn and epigastric discomfort caused by gastric hyperacidity as gastroesophageal reflux disease or functional dyspepsia. In particular, gastroesophageal reflux disease refers to a condition where gastric acid refluxes into the esophagus, irritating the esophageal mucosa and causing inflammation. One of its key causes is dysfunction of the lower esophageal sphincter located at the junction of the esophagus and stomach. This sphincter normally acts as a door to prevent the reflux of stomach contents, but problems arise when it loosens too frequently or fails to close completely.
Why does the lower esophageal sphincter loosen? Multiple factors act together. Increased intra-abdominal pressure due to obesity, fatty, spicy, or salty irritating foods, caffeine, alcohol, smoking, and certain medications can all weaken sphincter function. The part we must pay attention to here is stress. The brain and gut are connected through a close neurological pathway called the gut-brain axis, and stress directly affects gastrointestinal function through this axis. Extreme stress can alter the activity of the vagus nerve, decreasing gastrointestinal motility or causing an imbalance in gastric acid secretion. In addition, increased secretion of stress hormones like cortisol worsens inflammatory responses in the gastrointestinal mucosa and increases visceral hypersensitivity, causing greater pain or discomfort even from small stimuli.
Recent studies show that an imbalance in the gut microbial environment, the microbiome, can also affect digestive function and inflammatory responses. A decrease in beneficial bacteria and an increase in harmful bacteria raise the permeability of the intestinal mucosa to cause inflammation, which in turn may contribute to the onset or worsening of gastroesophageal reflux disease. Helicobacter pylori residing in the stomach also affects gastric acid secretion by causing gastritis or ulcers, but in some cases, it causes atrophic gastritis and actually reduces gastric acid secretion, making it important to accurately understand each individual condition.
Many people take a proton pump inhibitor, but while effective for symptom relief, it cannot resolve fundamental causes such as sphincter dysfunction or stress. In fact, prolonged use may cause side effects such as impaired nutrient absorption and gut dysbiosis, requiring caution. Ultimately, modern medicine is increasingly recognizing that gastric hyperacidity and reflux esophagitis are not merely issues of gastric acid alone, but require an integrative approach encompassing dietary habits, lifestyle, stress management, and overall physical balance. This can be seen as sharing the same context with managing stomach heat mentioned in Donguibogam.
