Gastroesophageal Reflux Disease- Not as Simple as Acid Suppression
Gastroesophageal reflux disease, GERD, is a condition in which the contents of the stomach reflux backward up into the esophagus, creating chest pain and pressure, chronic cough and discomfort. Sometimes individuals may not have any of the common symptoms of GERD and are diagnosed after an endoscopy, a camera that can visualize the tissue of the stomach and esophagus. Not only is GERD a nuisance, but with continual back flow of the acidic contents of the stomach into the esophagus, it can lead to a precancerous condition called Barrett’s Esophagus.
The most common treatment for GERD are antacids which neutralize stomach acid and acid reducing medications that limit the release of acid into the stomach, thereby, reducing the symptoms of burning and discomfort in the esophagus. While this may be a temporary solution, chronic use and abuse of these medications may lead to malabsorption of nutrients, bacterial overgrowth and can put you at a higher risk of certain conditions like osteoporosis.
Stomach acid is one of the body’s first lines of defense as acid helps to kill off offending bacteria and pathogens that enter the body. Acid also plays several rolls in digestion including triggering the release of digestive enzymes like pepsin, which is needed for the breakdown of proteins. Stomach acid also aids in the absorption of essential nutrients including vitamin B12, calcium, magnesium and iron. Vitamin B12 is needed for proper nervous system conduction and deficiency can be seen as tingling in hands and feet, depression and fatigue. Calcium and magnesium are needed for bone mineral density and when low can lead to osteopenia or osteoporosis. Iron is essential for red blood cell production and when not absorbed properly can show as anemia and be felt as fatigue and inability to focus. These are just a few of the major roles acid plays in the maintenance of health, thereby further illustrating the need for investigation onto the causes of GERD rather than masking the symptoms with acid neutralizers and blockers.
A Brief Anatomy and Physiology Lesson
Digestion starts in the mouth with mastication (chewing). Food is mixed with saliva, which starts to break down the food bolus. After chewing comes swallowing and propulsion of food toward the stomach. Once in the stomach, digestive enzymes and acid are mixed with food to further breakdown food into a substance called chyme which is then sent to the small intestine for further digestion and absorption. The separation between stomach and esophagus, the lower esophageal sphincter, is meant to remain closed unless food is entering the stomach. When there is dysfunction with the sphincter, stomach contents are allowed to backwash up into the esophagus leading to esophageal erosion. There are tests that can be done to ensure proper tone of the lower esophageal sphincter and avoidance of carminatives like mint which further relax the sphincter can be helpful in reducing GERD symptoms.
Conditions Associated with GERD:
Too Little Acid
More often than not, the stomach may not be producing enough acid to digest food appropriately, prolonging the time it takes to digest and move food from the stomach to the small intestine. When the digestive process is slowed, this can increase the chance of backflow into the esophagus. Ways to test the acidity of your stomach include the Heidelberg test or the Betaine HCL challenge test.
The Heidelberg test is the most accurate way of testing stomach acidity. It requires a small capsule with a pH transmitter to be swallowed by the patient after fasting for at least 8 hours. An electrode placed on the stomach will read the fasting pH of the stomach. Once a fasting pH is established, the patient is asked to drink an alkaline solution of sodium bicarbonate and further readings of pH will be taken to decipher the amount of time it takes for the stomach to reestablish the original fasting pH.
The Betaine HCL challenge is a much less invasive test that can be done at home that can also help detect decreased stomach acid production. The test involves Betaine HCL capsules to be taken with protein meals until you feel a burning or hot sensation in the stomach. Starting with one HCL capsule with a high protein meal, working up to as many capsules needed to feel a burning or hot sensation in the stomach. The more capsules it takes, typically no more than 3, indicates a low production of stomach acid. If burning is felt at first dose, this is a sign of adequate stomach acid production. Note: NSAIDS like Aleve and Ibuprofen can increase the risk of stomach damage with HCL, physician approval is recommended prior to performing the Betaine HCL challenge.
Food intolerances are different from a food allergies in that food allergies create hypersensitivity reactions that can lead to life threatening situations like obstruction of breathing. Food intolerances can create low-level inflammation in the gastrointestinal system that can lead to indigestion and increase the chances of reflux. Inflammatory food triggers can be different for each person and can be quantified through food intolerance testing. Pinpointing inflammatory foods and elimination of them from the diet can bring about resolution of symptoms.
An intact neurological system is needed for proper chewing, swallowing and propulsion of food into the stomach. Conditions that affect the neurological system like strokes, cerebral palsy, brain tumors, dementia and multiple sclerosis can all affect the central nervous system control of the process of swallowing. Neurological disorders usually have other symptoms associated than just digestive disruption but can also be a cause of GERD.
With so many causes for the symptoms of GERD it is worthwhile to further explore your particular triggers rather than masking the symptoms given that long-term suppression of symptoms can lead to further health deterioration.
Dr. Ashley Burkman is a board certified naturopathic physician at Connecticut Natural Health Specialists, LLC, where she is accepting new patients for her family practice. Dr. Burkman is in network with most insurance companies. To make an appointment, please call (860)533-0179.