By Michael Biamonte, C.C.N.
What is Gerd?
Gastroesophageal reflux disease (GERD) is a chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus, mouth and even your sinusitis.
The obvious signs and symptoms of GERD include acid reflux and heartburn. Both are common digestive conditions that most people experience from time to time. When these signs and symptoms occur more than twice each week or interfere with your daily life, doctors term this GERD. Most people can manage the discomfort of heartburn with lifestyle or diet changes and over-the-counter medications. But for people with chronic GERD, these remedies may offer only temporary relief. People with chronic GERD may resort to stronger medications, that can have harmful side effects, Osteporosis being a common one. Some people have more subtle symptoms of Gerd,, Chronic sinusitis, running nose, sore throats, etc.
Signs and symptoms of Gerd
The most-common symptoms of GERD are listed below. A Gerd sufferer can have any combination of these depending on their individuality:
- Trouble swallowing
Less-common symptoms include:
- Pain with swallowing
- Excessive salivation (this is common during heartburn, as saliva is generally slightly basic and is the body’s natural response to heartburn, acting similarly to an antacid)
- Chest pain
GERD sometimes causes injury of the esophagus. These injuries may include:
- Reflux esophagitis causing ulcers near the junction of the stomach and esophagus.
- Reflux esophagitis causing ulcers near the junction of the stomach and esophagus.
- Esophageal strictures—the persistent narrowing of the esophagus caused by reflux-induced inflammation.
- Barrett’s esophagus (changes of the epithelial cells from squamous to columnar epithelium) of the distal esophagus.
- Esophageal adenocarcinoma—a rare form of cancer.
Several other atypical symptoms are associated with GERD, but there is good evidence for causation only when they are accompanied by esophageal injury. These symptoms are:
- Chronic cough
- Laryngitis (hoarseness, throat clearing)
- Erosion of dental enamel
- Sinusitis and damaged teeth
Some people have proposed that symptoms such as pharyngitis, sinusitis, recurrent ear infections, and idiopathic pulmonary fibrosis are due to GERD.
What is Gerd?
Gerd is not an ulcer, it is a splash back of acid and digestive juices into the throat. It’s that simple. The question becomes, “what is causing this to occur”.
A simple but important concept to grasp is that if the stomach doesn’t produce enough acid to correctly digest your food, the food will regurgitate up your throat and cause GERD or as the Italian people call it ‘AGEDA”. Food that is not digested well in the stomach will not be allowed to pass from the stomach into the intestines, instead it will reflux back up your esophagous. This is one of the more common forms of Gerd. This is due to a lack of stomach acid, not an excess. This will be covered in detail in this article as it is a major cause of Gerd which is commonly misunderstood.
While “stress” was a popular basis for stomach ulcers years ago, Helicobacter Pylori has become known as the primary cause for peptic and duodenal ulcers since its discovery by two Australian doctors, Robin Warren, M.D., and Barry Marshall, M.D., in the early 80’s. Some doctors place the bacterium’s involvement as high as 90%, but ulcer-inducing drugs, alcohol, and other lifestyle stimulants are still a common factor in the development of ulcers.
As mentioned above, H Pylori itself can lower stomach acid, this can cause the food to “repeat or reflux” creating the symptoms called Gerd.
H Pylori can also be inhibited by increasing the amount of stomach acid. So if one has H Pylori drinking Apple Cider Vinegar (ACV) will inhibit the H Pylori, increase the stomach acid allowing for more complete digestion and therefore lessen Gerd.
Unfortunately, people with reduced acid levels frequently suffer from what they assume is elevated stomach acid (heartburn, bloating, nausea, frequent burping), and subsequently take acid-lowering drugs or remedies. This can temporarily improve the symptoms of Gerd because the stomach contains a sensor which allows food to leave and pass into the small intestines when it is detected that the stomach acid levels are declining. The body would like to believe the levels are declining because the stomachs digestive process is completed. But, it can be tricked into thinking its completed by taking anti-acids which would then signal the opening of the valve that allows food to leave the stomach and continue its digestive journey through the small and large intestines.
Also, by doing such one is encouraging greater H. Pylori activity and thus increase the risk to develop peptic or duodenal ulcers, pancreatic / gastric cancer, and mucosa-associated lymphoid tissue (MALT) lymphoma.
GERD AND H PYLORI
About 60% of all the patients I have seen with Gerd have H Pylori. It is controversial in mainstream medicine as to whether or not H Pylori causes Gerd. The confusion usually stems from two factors. 1. The testing used to determine H Pylori is often inaccurate. The test I favor is a Stool Test called the GI EFFECTS TEST. This test looks for DNA of H.Pylori as well as other microorganisms that can cause Gerd. This test is the most accurate way I know of to detect H Pylori. The 2nd factor is that esophageal reflux (GERD) can be caused by a lack of stomach acid not excess stomach acid. Because it assumed that Gerd must be from excess acid, not inadequate acid which H Pylori could cause testing is often omitted. After the discovery of Helicobacter Pylori, and once medical science accepted it as being a significant factor with ulcers, predictions were made that ulcers and related stomach complaints would become a thing of the past. However, there are as many patients as ever complaining of stomach problems, including those who had been cured” of H. Pylori. The reason is very simply low stomach acid – which had not been corrected as part of the treatment. As a self-test if the consumption of Hcl tablets or Apple Cider Vinegar worsens the symptoms of Gerd, it would lessen the possibility that H.Pylori was the underlying cause of Gerd. However this not fool proof!
THE PROBLEM OF TESTING
Physicians don’t generally test for Helicobacter Pylori unless a patient exhibits gastric complaints, and even if a patient suffers from non-gastric symptoms, there is little chance of the average practitioner relating any then, patients themselves have to frequently convince – or even beg their GPs to run a test after learning about H. Pylori through a news flash or reading about the long-term risks associated with its infection. Unfortunately testing can also be inaccurate. Blood antibody tests that are often preferred can give false negatives as can gastric biopsies.
I prefer the GI EFFECTS STOOL TEST. This is a test that looks for DNA of various harmful micro-organism. The key problem I have found is that Doctors testing for H Pylori will not find it though its present, so they can’t correlate its presence to GERD or others digestive maladies. When using blood tests for H Pylori it is not uncommon that the blood may remain positive for H Pylori for up to 9 months after the infection is cleared. This also makes the correlation of H Pylori difficult with testing and treatments. The lack of effective testing to properly indentify H Pylori has resulted in flawed research and conclusions on how common H Pylori can be in Gerd related disorders.
THE DIFFERENT TYPES OF CASES
Low Acid Case
It is very important to understand the cause the of patients Gerd rather then simply suppressing the symptoms. In many cases patients with Gerd actually have low stomach acid and not excess as explained earlier. In these cases the low stomach acid causes food to be improperly digested so it is regurgiatated and therefore causes Gerd. These cases may have H Pylori which decrease stomach acid and a Hiatal Hernia which then entraps the acid.
High Acid Case
The other type of case is where the person actually does produce excess stomach acid. This can be due to stress or any condition that causes the “Sympathetic nervous system” to become excessively stimulated. This can occur in the “Type-A” personality who is on the go and under a lot of stress. They may also consume substances like coffee, tobacco, herbal stimulants, drugs, etc that are stimulating and may further increase their stomach acid. Excessively high Adrenal, Thyriod or Pancreatic function can be a cause. Galllstones, a blocked or congested Gallblader can also be a cause.
Candida and Parasites
Other microorganism such as Candida, protozoa (parasites) bacteria can also cause reflux. I have been quite surprised over the years in observing just how many of our Candida patients have had their Gerd resolve as the Candida was eliminated. Many protozoa(microscopic parasites) such as Amobeas, Giardia, Entamoeba, etc can all cause Gerd, However, other symptoms such as nausea, loss of appetite, and an upper gastro-intestinal uneasiness will normally accompany the Gerd. These signs are often followed or accompanied by a sudden onset of explosive, watery, foul-smelling diarrhea. Stools associated with Giardia infection are generally described as loose, bulky, frothy and/or greasy with the absence of blood or mucus, which may help distinguish giardiasis from other acute diarrheas. Other gastro-intestinal disturbances associated with giardiasis include: flatulence, bloating, anorexia, cramps, and foul sulfuric belching (sometimes called ‘purple burbs’).
CHIROPRACTIC CAN HELP!
So these are the 2 basic types, too little acid or too much. The other condition that can cause Gerd is structural. By structural I am referring to a mechanical imbalance in the alignment of the spine, or a problem with the valves that lead from the esophagus to stomach, stomach to small intestines, small intestines to colon etc. The valves can become sluggish and can remain particilally opened or closed which allows the Gerd. These valve problems can cause bile to produced by the liver flow unchecked into the small intestine which then triggers partially digested food in the upper part of the small intestine and the stomach to reflux up the esophogous and cause “Gerd”.
- Hiatial Hernia.
- Ileocecal Valve
- Houstons Valve
Very often reflux or Gerd can occur due to structural problems that can cause either a Hiatal Hernia, which can entrap acids, the improper function of the valves in the intestinal tract, or specific spinal misalignments that can cause improper nerve flow to the digestive organs. A chiropractor who understands these concepts and is skilled in correcting them will actually realign these area and get the structural back in balance. Many chiropractors specialize in “Illeocecal Valve” problems. Illeocecal valve problems can lead to reflux and other digestive problems.
Could it be your Ileocecal Valve?
The Ileocecal valve is often an underlying cause of Gerd which will go completely ignored unless the patient is lucky enough to visit a practitioner who is familiar with its function and dysfunction as the case may be. The Ileocecal Valve is located between the ileum (last portion of your small intestine) and the cecum or ascending colon (first portion of your large intestine; the appendix lays just below it.. Its function is to allow digested food materials to pass from the small intestine into your large intestine. The ileocecal valve also blocks these waste materials from backing up into your small intestine. It is intended to be a one-way valve, only opening up to allow the digested material to pass through and then closing to prevent the fecal contents from “falling” back into the small intestine. When the small intestine/large intestine is not active in the process of digestion or stool production), the value is relaxed, neither open or closed.
Ileocecal Valve Syndrome
When the ileocecal valve is stuck open waste products can back up into the small intestine (much like a backed up kitchen sink drain) disturbing your digestion and also creating unhealthy toxins that are absorbed into the body. Also, if the ileocecal valve is stuck closed waste products are prevented or constricted from passing into the large intestine. Either way the end result can be Gerd. Unfortunately, this disorder is often overlooked by the medical profession. A dysfunctional ileocecal valve can result in a combination of symptoms. Ileocecal valve problems can very often produce GERD.
Ileo-Cecal Valve Syndrome Signs & Symptoms:
- Dark circles under eyes
- Bowel disturbances (diarrhea / constipation)
- Weakness of the Psoas, Iliacus or Quadriceps muscles – muscles involved in posture and locomotion
- Low back pain – esp. pain on bending over
- Severe lumbar disc complaints (sharp sudden pain)
- Sinus problems, post nasal drip, headaches, tinnitus
- GERD symptoms
- Joint pains
- Pelvic congestion and pain
- Chronic inflammatory or toxicity complaints
Self Help Treatments
Until one can get properly tested to determine the true underlying cause of your Gerd, the following self treatments can serve:
To help the symptoms, or until any of several possible causes for low stomach acid or high acid are resolved, a digestive aid containing Glutamic acid + Betaine + Pepsin should be taken with every larger meal. Some patients also have good results using Lemon or Lime Water. The only contraindications are gastritis, the presence of an ulcer, or when stomach acid levels are high, which would prohibit the use of acid-raising supplements. Bromelain, known for its anti-inflammatory and digestive support, may be another consideration to help a low stomach acid environment – with or without reflux, but particularly when reflux is present, provided there are no contraindications to bromelain’s mild blood-thinning properties. When antibiotics and natural approaches have not been successful in eradicating H. Pylori, or when there is intolerance to most of the remedies that are usually helpful with low-acid symptoms, then regularly drinking Pineapple Juice with meals, or sipping it slowly throughout the day may be another option that has helped many patients reduce their symptoms and improve general digestion.
Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. If your weight is healthy, work to maintain it. If you are overweight or obese, work to slowly lose weight — no more than 1 or 2 pounds (0.5 to 1 kilogram) a week. Ask your doctor for help devising a weight loss strategy that will work for you.
Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and lower esophageal sphincter.
Avoid foods that trigger heartburn. Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, mint, garlic, onion and caffeine may make heartburn worse.
Don’t lie down after a meal. Wait at least two to three hours after eating before lying down or going to bed.
Elevate the head of your bed. An elevation of about six to nine inches puts gravity to work for you. Placing wood or cement blocks under the feet of your bed at the head end. If it’s not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores.
Don’t smoke. Smoking decreases the lower esophageal sphincter’s ability to function properly.
Above all, find a doctor who will examine you and test you to find the cause!
Andrew S. Chu, MD, “Esophagitis” E-Medicine, Nov. 19, 2004
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Michael C Biamonte CCN.