Gastro-esophageal reflux disease (GERD) is among the most common chronic diseases in the Western world, affecting up to 30% of the general population in Europe and the US. It is a condition which develops when the acidic contents of the stomach flow backwards into the esophagus and cause what’s known as heartburn. While most patients respond well to the standard therapy of proton pump inhibitors which block acid-secreting cells in the stomach, we are still trying to understand the molecular reasons why 30-40% of reflux patients do not respond adequately to acid-suppressant therapy. Not only does GERD have a significant negative impact on health-related quality of life, but the over-subscription of ineffective drugs causes a significant economic burden on healthcare.

Heartburn is the most noticeable and troublesome symptom of GERD. From what we currently understand about the pathophysiology of the disease, we know that the reflux of acid evokes different types of pain, but the basic mechanisms and pathways by which this pain is generated is incompletely understood. The junction between the esophagus and stomach is structurally and functionally designed in a way to ensure that any acid secreted in the gastrointestinal tract flows towards the stomach, and not up onto the lining of the esophagus. This function is served by the muscle structure sitting at this junction, called the lower esophageal sphincter (LES), which ensures that the ingested food following a meal does not reflux. However, there are several factors which can make the LES’s job more difficult. One of the most obvious factors includes the excessive consumption of food, particularly during the later hours of the day. There is convincing evidence that 90% of reflux episodes occur post-prandially, due to minor elevations of intragastric pressure which causes the LES to relax and therefore allow the reflux of acid. In more advanced cases of reflux disease, acid pockets form at the gastroesophageal junction where unbuffered acid collects into a reservoir. When the LES fails in this setting, there is reflux of a higher volume of acid.

Focusing on the microscopic structure of the esophagus and stomach, we can see a minute yet essential difference between the linings of these two gastrointestinal organs. The esophagus has a stratified squamous epithelial lining, which acts as a tight protective barrier against food but is readily damaged when exposed to a chemical environment. On the other hand, the stomach is lined by tall columnar epithelium, which is designed to withstand very low pH and high levels of proteolytic activity. Our gastrointestinal tract (and the human body in its entirety) is perfectly designed to carry out the specific role of transporting food from the oral cavity from the esophagus to the stomach, where it is digested for our nourishment. It is oftentimes our greediness and overindulgence which disrupt the perfect order of our anatomy at a molecular level, resulting in the macroscopic changes we see at endoscopy and the symptomatic discomfort we feel from the painful circumstances of reflux. 

The stomach is our center of nourishment. Given that every food particle has the purpose of nourishing the cells of our body, why do we so commonly make the mistake of eating excessively, nocturnally, and quickly? Fatty foods influence the relaxation of the lower esophageal sphincter, along with alcohol, coffee, and acidic drinks. Large meals and rapid food intake distend the stomach, increase intragastric pressure and facilitating the reflux of acid from the stomach. Given these, it is plain to see that, in most cases, simple lifestyle changes can prevent the development of such chronic and discomforting diseases. The following verse in the Holy Qur’an offers a short but very effective prescription: “Eat and drink, but do not be wasteful” (7:31).

The philosopher and physician Ibn Sina (Avicenna) summarized the science of medicine as follows: “Eat little when you eat, and after eating do not eat again for a certain period of time; health lies in digestion. There is nothing heavier for the body to tolerate than putting food after food in the stomach.” Frugality in eating is also echoed in the teachings of Prophet Muhammad, peace be upon him, who famously said “There is no vessel which the son of Adam can fill more evil than his stomach, for it is sufficient for him to take a few mouthfuls in order to straighten his back; but if he must, then fill one-third with food, one-third with drink, and one-third with air” (Tirmidhi).

The lifestyle factors that are strongly associated with GERD are obesity and smoking. In the 30-40% of GERD patients who do not respond to acid-suppressant therapy, simple lifestyle changes such as cutting out acidic drinks and eating more slowly, and not after 7 pm have been effective alternative treatments. While our understanding of molecular pain mechanisms of the esophagus need further improvement, the simple act of making minor changes in our eating habits can ensure that the anatomy and function of our gastrointestinal tract remains optimal.

Hostility to Islam and Muslims was an integral part of most of the travellers’ mental makeup. David Roberts, a painter of the idealized landscapes of classical ruins, expresses his frustration in a dislike and hatred of Arabs whose forms litter the otherwise perfect scene: ‘Splendid cities, once teeming with a busy population and embellished …with temples, now deserted and lonely, or reduced by mismanagement and the barbarism of the Muslim creed to a state as savage as wild animals by which they are surrounded. Often have I gazed on them till my heart actually sickened within me.’1

As ‘the idea of travel as a means of gathering and recording information is commonly found in societies that exercise a high degree of political power, the traveler begins his journey with the strength of a nation or an empire sustaining him (albeit from a distance) militarily, economically, intellectually and, as is often the case, spiritually…’2

In 19th century travel accounts, the more routine designation of the Orient is feminine; its main symbols are sensual women, the harem, and the despotic -but curiously attractive- ruler. Moreover, Oriental women, like Victorian housewives, were confined to silence and to unlimited service. The English woman traveller, Miss Irby, who travelled throughout the Ottoman regions, defines the proper place of the oriental women:

‘To the Musulman, a woman was an inferior being, a chattel, to be bought and sold, kept secluded behind the screens of the women’s quarters, or, if produced in public, to be hidden behind the draperies of the litter, or muffled and secreted in long shapeless robes, face covered by the veil; the property of the man as was his dog, his servant, his horse, to wait on his pleasure, to sleep at his feet; yet withal, if the husband be rich, to be cossetted and adorned with jewels and fed with sweetmeats, to spend days in idleness and chatter.’3

In various 19th century Oriental books and tales like Vathek, the Giaour and Don Juan (especially Cantos 5-8) which are more or less fixated on the images of the Oriental harem, the figure of the veiled Eastern girl symbolising the colonial Other is created by a narrative structure in which a male subject’s attempts to liberate a female object from the tyranny of the harem is interrupted or arrested by a stereotypical patriarchal aggressor who prevents the achievement of narrative desire in the possession of the woman. In other words, the Orient is thus refigured as the harem fantasy of European imperialism that shows ‘the East’ as the obscure object of Western desire. The narrative structure of Vathek designates the Orient as a feminized place invaded by the masculine subject.

Reza Hammani and Martina Rieker criticize Ghoussoub’s Marxist approach which deprecates Islam as not good for women. However, they agree that Middle Eastern feminism is vitiated by its involvement in debates whose agenda was set in 19th century travel writing. They develop this idea further with the following explanation:

‘Two issues have dominated Western discourse about Middle Eastern women since the 19th century; the veil and the harem. The harem continues to be treated as a contemporary reality in popular mythology. Thus, Gloria Steiner cites freeing Saudi women from harems as one of her fantasies in her autobiography – we wish her luck in finding a harem in Saudi Arabia. Moreover, it is above all the veil which remains a central preoccupation… The veil is not always imposed; in many contemporary instances women have been instrumental in assuming it. This is not a matter of relativist interpretations but of power… In the case of women in Egypt since Sadat’s Open Door Policy, large numbers of working-class women have themselves mobilized to veil to signify their opposition to the regime.’4

Irene L. Szyliowicz remarks that historians and social scientists arc demonstrating that the traditional portrayal of women in these societies has been biased and based on Western judgements. European ethnocentrism and male chauvinism have combined to account for this phenomenon.5 As she thinks that French travel writer, Pierre Loti’s attitude toward Oriental women is particularly worth studying for several reasons, she points out in her Pierre Loti and the Oriental Woman (1988) that ‘since all the Oriental women essentially support and ratify their Occidental lovers, it is proper to conclude that Loti created these fictional characters as wish-fulfilment fantasies, to simultaneously reinforce and magnify his manhood.’6 When Loti made a speech titled ‘La Femme Turque’ (the Turkish Woman) before a large gathering of European women in the conference on ‘Feminine Life’, he concluded with a message: ‘Open the cages, open all the harems. Yet, don’t open them too quickly, for fear that the young, imprisoned birds should take a frantic flight before knowing properly where their inexperienced and fragile wings will take them.’7 According to Loti’s interpretation of Oriental women, which is quite similar to that of Byron, one might imagine that ‘they could be manipulated easily by their dominating masters, and further, this masculine paradigm presented these women, like their Occidental sisters as actually craving male domination.’8 Eventually, in the case of Oriental or exotic women created by Loti, the reader faces a different form; they are simple, primitive, dependent, often helpless, and they worship the hero as though he was God. ‘And despite the fact that he was still a product of his Occidental milieu and the prejudices with which he was raised, he prided himself on his objectivity toward various lands which he visited.’9

In sum, from the previously quoted remarks by 19th century travellers, it may be concluded that the most general point about travel literature (something also confirmed by Sir John Mandeville’s Travels) is that travel is undertaken for a great variety of purposes; the specific purpose involved in a given case is always, to a greater or lesser degree, determinant of what is noted or considered noteworthy. Consequently, the attention paid by the writer of a travel book is always ideological. A traveller usually comes from somewhere – from a country from a language community, class – and consciously writes the record of his journey for a particular public in the country he came from.10

Notes

1. As quoted in BALLANTINE, J. The Life of David Roberts, R.A. Compiled from his journals and other sources, Edinburgh, 1986, pp. 104-5.

2. KABBANI, R. Europe’s Myths of the Orient, Macmillan, London, 1986, p.1.

3. ANDERSON. D. Miss Irby and her Friends, Hutchinson, London, 1966, pp. 52-3.

4. HAMMANI, R. and RIEKER, M. ‘Feminst Orientalism and Orientalist Marxism’, New Left Review, 170, 1988, p. 93.

5. SZYLIOWICZ, I. L. Pierre Loti and the Oriental Woman, Macmillan, London, 1988, pp.1-3.

6. ibid.

7. ‘Et je dis avec eux, mais non sans inquietude: out ouvrez toutes les cages ouvrez tous les harems. Cependant ne les ouvrez pas trop vite, de peur que les jeunes piseaux prisonniers…’ P. Loti ‘La Femme Turque in Quelques aspect du vertige mondial, Ernest Flammarion, Paris, 1917, p. 182.

8. SZYLIOWICZ, p. 3.

9. ibid, p. 12.

10. PARKER, D. ‘Orientalism and its Problems’ in BOOLE, F. (ed.) The Politics of Theory, University of Essex, John Fletcher.