Gastroesophageal reflux disease, commonly called GERD, is one of the most common syndromes in the developed world. It is also called heartburn or simply acid reflux. In any case, it can manifest itself with several different symptoms caused by the irritation of the esophagus, larynx and mouth due to the contact with stomach acid, bile and food. During the last years, a variaton of the disease, called laryngopharyngeal reflux (LPR), has been established. In this case, stomach acid, pepsin and bile can irritate the larynx causing symptoms that aren’t the same as in the case of GERD.
GERD symptoms appear to be common in at least two-thirds of the population in the developed world but the diagnostic criteria are fulfilled by one out of four people. In any case, we are talking about a chronic, relapsing-remiting condition.
-Burning sensation in the chest, especially after eating or at night.
-Regurgitation of food or acid.
-Acid taste in the mouth.
-Burning sensation in the tongue.
-Globus sensation (lump in the throat).
The medical approach in this condition is based on the suppression of stomach acid and, in selected cases, surgical procedures.
-H2 blockers: These medicines reduce the production of stomach acid and, therefore, limit the amount of acid that reaches your esophagus. The side effects are limited and, therefore, H2 represent the first step in the therapy. Examples: Ranitidine.
-Proton pump inhibitors: These drugs block the enzyme in the wall of the stomach that produces acid. Omeprazole is the most commonly prescribed pill and the short term side effects are almost non-existent. However, these drugs weren’t originally developed for long term use and there’s quite a long list of side efects in these cases.
-Surgical procedures: Many cases of reflux are caused by hiatal hernias or malfunctioning lower esophageal sphincters that can be repaired surgically in some cases: Nissen fundoplication is the most common procedure and it’s quite effective in 9 out of 10 cases. Complications are uncommon but do exist and the effects of the surgery become less efective after ten years in almost half of the subjects. There are several new procedures such as Stretta (surgical strenghtening of the esophageal valve) and Linx (a magnetic ring that strenghthens the sphincter). Both are quite new and appear to be safe and useful. However, the long term effects haven’t been evaluated and these procedures aren’t offered in most hospitals.
Risks of conventional treatments:
H2 blockers don’t have important side effects although they don’t treat the real cause of the problem. Proton Pump Inhibitors can cause magnesium and vitamin B12 deficiencies during long term treatments. In extremely long treatments (+2 years) which are quite common in GERD patients, PPIs have been linked to increased risk of osteoporosis, stomach atrophy, stomach and esophageal cancer, dementia, gynecomastia (swelling of breasts in men) and alterations of the bowel flora. All these risks must be taken into account when receiving a therapy that, remember, doesn’t treat the underlying cause of the disease. Surgical procedures are normally safe and the best treatment option in some cases but some complications such as perforation or bacterial sepsis can be life threatening.
What is the cause of GERD?
Conventional medicine treats GERD and LPR as diseases caused by excessive acid production by our stomach. Although there are some cases in which this is true, stomach acid suppression isn’t the long term solution in the majority of patients. Many cases are due to hiatal hernias that should be surgically repaired especially in young to middle aged patients taking into account the risks of long term treatment. Other cases are due to some kind of malfunction of the lower esophageal sphincter (LES). Obviously, acid suppression won’t treat the underlying malfunction. We do know that the LES is sensitive to the pH of our stomach and acid suppression can end up causing an increase in GERD symptoms due to further opening of the sphincter. Moreover, increased intraabdominal pressure due to bacterial fermentation in the bowel can case further opening of the LES. Finally, some cases are caused by food sensitivities, being gluten, dairy and alcohol the most common culprits. As it can be seen, GERD and LPR are multifactorial diseases and in most cases the patients will need to find the cause before receiving correct treatment.
What are the risks of untreated GERD or LPR?
Chronic reflux of stomach acid, pepsin and bile will end up causing Barrett’s esophagus and esophageal cancer in some patients. There’s also increased risk of laryngeal cancer in LPR patients and dental erosions are common in most patients. Obviously, the quality of life is decreased and both diseases shouldn’t be left untreated.
Why conventional treatments are not enough?
Surgery is curative in many cases but it isn’t offered to most patients. The other alternatives are related to significative risks in the long term and do not cure the disease. PPIs increase the risk of stomach cancer and do not prevent the progression to esophageal cancer in Barrett’s patients.
A few words about LPR:
Some scientists consider that, in the case of LPR, pepsin is the culprit as it becomes activated in the throat when in contact with stomach acid. The evidence is still non conclusive and, even if that was the case, the treatment of both GERD and LPR should be based around avoiding any backflow of food or acid from the stomach to the esophagus.
Natural treatment for GERD and LPR:
Get tested for Helicobacter pylori: This bacteria can cause reflux in some patients. If you test positive, get treated but remember to combine the triple therapy prescribed by your doctor with some natural remedies that have been found useful in the treatment of this infection and can increase the possibilities of eradication:
- Bismuth: When combined with antibiotics, it increases the eradication and prevents the development of antibiotic resistance.
- Broccoli sprouts: Although they don’t eliminate the bacteria, they can prevent their growth and therefore increase the efficacy of the antibiotics.
- Mastic gum: Some studies have shown that mastic gum can kill H.pylori and it seems to increase the effects of antibiotics when combined.
- Probiotics: both Saccharomyces boulardii and lactic acid bacteria have been found helpful and can reduce the side effects of antibiotics.
- Lactoferrin: This protein can disrupt the biofilm in which H.pylori hides in the stomach, allowing the antibiotics to do their job more efficiently.
If you test negative, the most common causes of your condition can be either a food sensitivity or a malfunctioning LES:
- Do an elimination diet in order to find your trigger foods: scientific trials have shown that there’s no specific food that affects all patients and the suggestion of avoiding spicy and acid food seems to be a myth. Low carb and low FODMAP diets have been found useful in the treatment of GERD as they reduce bacterial fermentation and therefore intraabdominal pressure. We suggest reading our guide for elimination diets in chronic diseases as there you will learn how to find your trigger foods in only two weeks.
We also recommend some other books that many patients have found useful in the treatment of GERD and LPR:
If you don’t seem to have food sensitivities or your condition doesn’t seem to improve, try these other interventions that may be the answer in your case:
- Betaine HCL and digestive enzymes: As we said before, the LES closes when the pH of our stomach decreases. Many people, especially those after the fourth decade of life, suffer from low stomach acid and find that supplementing with Betaine HCL and digestive enzymes before each meal puts their GERD in remission. Start slowly as excessive acid can irritate your digestive tract. The digestive enzymes help you by reducing the consequent bacterial fermentation and intraabdominal pressure.
- Melatonine: An interesting study found that melatonine can be even more useful than PPIs in the treatment of GERD. Take into account that the dose used was quite high and that your body can create tolerance. Furthermore, melatonine supplementation can worsen your symptoms if you suffer from an autoimmune condition. In summary, be very careful, stay on the lowest dosage.
- DGL (Licorice): DGL has a soothing effect on your esophagus and stomach. Although it doesn’t cure the underlying condition it can help manage your symptoms without the side effects of PPIs. DGL has also some anti-inflammatory effects that can help reverse the damage caused by acid exposure. Both marshmallow root and slippery elm have similar properties and can also be helpful.
- Anti-inflammatory herbs: Bio-available curcumin, boswellia and ginger reduce the damage caused by reflux and can reduce cancer risk especially in those with Barrett’s esophagus.
- D-Limonene: Although it may surprise you, treatment with 1000mg of D-Limonene every other day for twenty days helped almost all GERD sufferers during two scientific trials. It is not entirely clear how D-Limonene works but we have found many patients that stayed in remission after just one treatment or can mantain a disease-free state if they follow treatments every six months. D-Limonene has no side effects (apart from the funny orange burps).
- Gaviscon advance: This OTC drug produces a layer over your esophagus reducing acid exposure. Although it’s not a completely natural alternative, its lack of side effects makes it more interesting than PPIs or H2 blockers in the long term. LPR patients seem to get the biggest benefit.
- Change your lifestyle: Don’t lay flat after eating, sleep on the left side, buy a bed wedge and have dinner at least two hours before going to bed. Try to eat more meals and limit the quantities ingested.
- Respiratory physiotherapy: You can actually increase the pressure of your LES through breathing exercises. Half an hour per day seems to be enough. Watch the following video to understand the exercises:
If you have a hiatal hernia:
In this case surgery is obviously the long term solution. A chiropractor or physiotherapist that knows how to manipulate your stomach and diaphragm will be able to correct temporarily your hernia if it’s small and sliding. There are some exercises that may help although they don’t have any scientific support. Watch the following videos for some tips:
If you want us to review your personal GERD or LPR case write us a message through the contact form and we will arrange a consultation:
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