April 2007

Pottenger's saucer and GERD

by Dr. Howard Loomis

I have stated in past columns that you cannot separate structure from function. Anatomy strongly influences physiology and vice versa. Of course, they are unquestionably linked neurologically. Every month I try to give you a recipe, a way to work some tried‑and‑true methods of detecting functional disorders problems in your patients.

The secret of your success will be determined by how quickly and accurately you can determine the source of your patient's stress, devise a plan of treatment, and confidently convey your findings to the patient.

To that end, I have been discussing a simple and easy examination that should take only a minute or two to perform yet yields a great deal of information. One minute well‑spent is always worth the effort when you consider that the vast majority of symptomatic patients do not have positive clinical test results.

The exam is designed to identify specific structural problems that may have an underlying functional disorder that is preventing correction of the structural finding.

Loss of the normal thoracic kyphotic curve is just such a finding. It is probably second only to sacro‑iliac fixations in chiropractic offices. Yet, its true meaning is often overlooked or misunderstood. It is clearly involved to some extent in most functional disorders such as digestive problems, irritable bowel, and fibromyalgia, to name just three.

The test

With your patient in a long‑sitting position, have the patient bend their head forward and then lean forward at the waist. Slide your fingers down the thoracic spinous processes and take note of a loss of normal kyphosis between the shoulder blades (T4 to T9). When the saucer is encountered, press headward on each of the spinous processes. They will be painful and there will usually be at least three vertebral segments involved.

The symptoms

The symptoms of GERD ‑‑ gastrointestinal reflux disorder ‑‑ are well‑known and include heartburn, regurgitation, and nausea. In fact, medicine recommends either antacids, H2 antagonists, or proton‑pump inhibitors based on those symptoms only, without objective findings.

Television, newspaper, and magazine advertising tell the public that excess stomach acid is the problem. But studies have proven convincingly that patients with these symptoms are deficient in hydrochloric acid production! While small amounts of acid may be regurgitated, more often it is pepsin and bile that have backed up into the esophagus. The liquid can inflame and damage the lining of the esophagus although this occurs in a minority of patients.

It may surprise you to know that reflux of the stomach's liquid contents into the esophagus occurs in most normal individuals. In fact, one study found that reflux occurs as frequently in normal individuals as in patients with GERD.

Normal function

Most reflux occurs during the day when we are upright and refluxed liquid is more likely to flow back down into the stomach due to the effect of gravity. When awake, we repeatedly swallow and each swallow carries any refluxed liquid back into the stomach. Also, saliva contains bicarbonate and with each swallow it travels down the esophagus and neutralizes the small amount of acid that remains in the esophagus after gravity and swallowing have removed most of the liquid.

It is important to always ask patients when they experience their heartburn and indigestion. At night while sleeping, gravity is not in effect, swallowing stops, and the secretion of saliva is reduced. Therefore, reflux that occurs at night is more likely to result in acid remaining in the esophagus longer and causing greater damage to the esophagus.

Structural causes of GERD

The most common cause is an abnormal lower esophageal sphincter and weak or abnormal esophageal contractions. Hiatal hernias are not believed to be a major contributing factor in GERD.

The most common physical finding is loss of the normal mid‑thoracic kyphosis. The phenomenon has been referred to by chiropractors as the anterior dorsal syndrome. Interestingly, this is not a chronic osseous problem. It is a transitory problem, caused by contractions within the spinal musculature and these have a visceral origin.

My clinical experience has taught me that patients presenting with Pottenger's saucer have digestive symptoms associated with deficient ‑‑ NOT excess ‑‑ hydrochloric acid production, biliary stasis, gas and bloating, and perhaps suffer from the symptoms of hypoglycemia. Low glucose levels always trigger a sympathetic cascade of physiological events that are quite predictable and easy to find with a palpatory examination. I will discuss diagnosing that cascade in future articles.

Also of enormous importance is the observation that patients suffering with muscle tension headaches present this loss of kyphosis and are relieved by its adjustment. Most acute attacks of heartburn or gastritis can be relieved immediately with an anterior dorsal adjustment and the appropriate upper cervical adjustment. These phenomena are important clinical observations and should never be overlooked.

(Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison,WI 53719 or by phone at 800‑662‑2630. Visit his website at http://www.loomisenzymes.com.)