When the polio virus attacked the bulbar area of the upper spinal cord, it also affected the brain stem, including the vagus nerve, according to Dr. Steven Martin.  He is a gastroenterologist and a member of the faculty of the University of Cincinnati Medical Center.

The Vagus nerve controls the voluntary (striated) muscles of the larynx and pharynx, as well as the involuntary (non-striated) muscles of the oesophagus, stomach, and trachea.  This, a common involvement in Bulbar polio, occurred in 20% of acute polio cases. The term Bulbar polio is descriptive of the area of the spinal cord that was affected.

Since the polio virus directly affected nerves to striated muscles, the upper one third of the esophagus may be weakened.  Diaphragm weakness may also occur in polio survivors even in the absence of any bulbar involvement.  Dr. Martin cited a 1999 study which found that about half of the polio survivors in the study were aware of the dysphagia (swallowing problems) and that a significant number had an abnormal swallow.  As this delayed oesophageal motility may be progressive, he encouraged polio survivors to consult a speech/language pathologist if there is any problem, and to initiate remedial strategies to avoid the consequences of dysphagia.

GERD - or REFLUX

Dr. Martin reported that digestive disease affects over 40 million people in this country and that diarrhoea is the third largest cause of death worldwide.
Gastroesophageal reflux is both a normal physiologic phenomenon and a pathophysiologic phenomenon (gastrointestinal reflux disease or GERD) that can result in mild to severe symptoms.  Thirty six percent of the population has a problem greater than once a month, with 7% having a daily problem.  Stomach fluids are very acidic and have a pH of 1.  The oesophagus is designed for a neutral pH of 7. Saliva is neutral and is continually flushing the esophagus to protect it.

Heartburn is a burning sensation or discomfort behind the breastbone and is the most common symptom of GERD.  Other symptoms include bloating, nausea, vomiting, persistent cough, and bad breath.  Polio survivors should be aware that, since the stomach is controlled by the vagus nerve, they may be at greater risk.

Complications of GERD include oesophageal erosion, ulcers, and pulmonary aspiration.  Factors that may exacerbate the symptoms of GERD include smoking, caffeine, chocolate, fatty foods, over-eating with gastric distention, tight clothing, the presence of a hiatal hernia (which may be more prevalent in polio survivors), and certain medications.  While avoidance of exacerbating factors may be helpful, there is relatively little data supporting the efficacy of lifestyle modification alone for the treatment of GERD.  For some patients, avoiding bedtime snacks and elevating the head of the bed are successful in relieving night-time problems.

Dr. Martin's principle patient goals are to relieve the symptoms, allow healing, and prevent scarring of the oesophagus.  Drug therapy consists of antacid buffers, H2 blockers such as Zantac and Pepcid that block one of the three arms that generate acid, and proton pump inhibitors such as Nexium and Prevacid that block all acid production.  Dr. Marin warned that, while certain ulcers are caused by bacteria, others are caused by medicines such as aspirin.

Some patients may have problems with complete stomach emptying.  There is medication as well as surgery that can be used for this condition.  This problem usually starts after age 50 and should be diagnosed.  Since polio survivors may have vagus nerve involvement, this condition may be more prevalent.

Reprinted by permission from Polio Connections, Cincinnati, Ohio
 

Tessa:   These are common problems in polio communities around the world.   Remember that stomach acid does have a proper function in the body and we need it there at the right time ie with our meals to digest food.  Most doctors don’t realise that reflux can also occur because of insufficient acid with a meal.  Unless your problem is so bad that oesophageal erosion has already occurred, you should find that you can fix indigestion by taking anywhere from between a teaspoonful to quarter of a cup of undiluted lemon juice or apple cider vinegar with a meal (or after if you forgot and have reflux).  So antacids should be a last resort.   Acid is needed in the stomach to digest protein foods particularly but also to help absorb B12 and minerals in foods or supplements.  Our own acid production lessens with age and low levels of zinc, B1 and B6.   When the stomach has sufficient acid the hiatus sphincter at the top of the stomach closes, stopping any further regurgitation.  Easy!  And it works! I find that if I have eaten a food that disagrees with me, like bread, that extra lemon juice will take away the indigestion and help to neutralise the problem food. Magnesium acts as an antacid eg Mucaine, and also helps the stomach muscles to work, esp if cramping.