Gastroesophageal Reflux Disease (GERD), a chronic digestive disorder that affects millions globally, can significantly impair one’s quality of life. If left untreated for prolonged periods, GERD has the potential to progress into Barrett’s Esophagus, a condition characterized by precancerous changes to esophageal cells.
When seeking medical assistance for this condition, patients are often prescribed treatments before undergoing comprehensive diagnostic testing to identify the underlying cause. A common line of treatment is Proton Pump Inhibitors (PPIs), drugs that suppress gastric acid production.
Yet, these acid suppressors don’t always deliver the expected relief. As Azzam RS noted in his study, “persistence of symptoms occurs in 25% to 42% of patients who use PPI once-daily and in 10% to 20% who use PPI twice-daily.” Further, while PPIs decrease the frequency of acid reflux episodes, they increase the incidence of “non-acid” reflux, leaving patients to grapple with persistent reflux symptoms despite medication. His research suggests that the issue may not lie in the treatment but rather the diagnosis itself (1).
Exploring Beyond the Obvious:
In this article, we delve into the alternative culprits behind reflux symptoms, emphasizing the importance of ruling out the underlying causes rather than merely alleviating symptoms. Unmasking these hidden causes is vital to providing long-term relief from GERD and enhancing overall digestive health.
Key Points:
- GERD symptoms
- Other physiological causes that may cause reflux symptoms
- Why PPI’s fail and adverse effects of long-term PPI use
- Misconceptions about GERD
- Naturopathic approaches to GERD
Understanding GERD Symptoms:
The most common symptom of GERD is persistent heartburn, characterized by a burning sensation in the chest. This is due to the reflux of stomach acid into the esophagus. However, GERD’s presentation isn’t confined to heartburn alone; it can also cause other symptoms such as regurgitation of food or sour liquid, difficulty swallowing, sensation of a lump in your throat, and even sleep issues.
Other Physiological Causes of Reflux Symptoms:
While GERD is often the prime suspect when it comes to reflux, other physiological conditions can also cause similar symptoms. Conditions like gastritis, peptic ulcers, gallbladder diseases, and even heart disease can present with heartburn-like symptoms. Additionally, “silent” reflux or Laryngopharyngeal Reflux (LPR) can also mimic GERD symptoms, leading to possible misdiagnosis.
Other physiological factors that may cause reflux symptoms that warrant further exploration before prescribing an acid-suppressant (2)
- Delayed gastric emptying (gastroparesis)
- Hiatal hernia (if symptomatic)
- Decreased defenses (saliva, esophageal mucosa)
- Impaired esophageal clearance (motility disorder)
- Increased intra-abdominal pressure (from gas, pregnancy, obesity, breath holding, etc)
- Reduced lower esophageal sphincter (LES) pressure
- Visceral hypersensitivity
Why PPIs Fail and Adverse Effects of Long-Term PPI Use:
As noted earlier, PPIs can decrease acid reflux frequency but can also lead to an increase in “non-acid” reflux, resulting in persistent symptoms. Furthermore, long-term PPI use has been linked with potential side effects, including increased risk of kidney disease, osteoporosis, vitamin B12 deficiency, and certain gastrointestinal infections (3). This highlights the importance of looking beyond the conventional approach of merely suppressing stomach acid.
Misconceptions about GERD
Myth 1: Only spicy or fatty foods cause GERD.
Fact: While spicy or fatty foods can indeed trigger GERD in some people, the condition is actually more complex than that. GERD is primarily a result of the lower esophageal sphincter (LES) not functioning correctly, allowing stomach acid to reflux into the esophagus. Various factors can contribute to this, including obesity, smoking, certain medications, and even stress.
Myth 2: All heartburn equals GERD.
Fact: Occasional heartburn does not necessarily mean you have GERD. Heartburn is a common symptom that can result from various conditions, including the type of food you eat, alcohol consumption, stress, and more.
Myth 3: GERD is a minor problem and doesn’t affect your overall health.
Fact: While GERD may seem like a minor annoyance, if left untreated, it can lead to more severe health complications, including ulcers and Barrett’s esophagus, a condition that increases the risk of esophageal cancer.
Myth 4: GERD is Always Caused by Excessive Stomach Acid
Fact: Contrary to the widespread belief that GERD is caused by excessive stomach acid, research indicates a more complex picture. Hypochlorhydria, a condition characterized by decreased stomach acid production, can paradoxically give rise to GERD-like symptoms. Surprisingly, augmenting stomach acid levels has been found to alleviate many GERD symptoms, challenging traditional perspectives on its treatment.
This highlights the importance of comprehensive diagnostic testing to accurately identify the root causes of GERD symptoms.
Root Cause Analysis: A Naturopathic Approach
Naturopathy takes a holistic view of health, striving to understand and treat the root cause of an ailment rather than just managing its symptoms. For instance, instead of automatically labeling chronic heartburn as GERD, a naturopathic doctor may consider whether low stomach acid, food intolerances, bacterial imbalances, stress, or other lifestyle factors are contributing to the problem.
Addressing these underlying issues often provides more sustainable relief and better overall health than simply suppressing stomach acid production.
Once the underlying cause has been established, these interventions have been shown to significantly alleviate GERD symptoms.
- Dietary Changes: Alterations to your diet, such as avoiding food triggers or incorporating certain foods that help manage acid reflux.
- Lifestyle Adjustments: Modifying daily habits, such as meal timing, sleep patterns, and stress levels, can significantly optimize your digestion.
- Herbal and Nutritional Supplements: Specific herbs, probiotics, or other nutritional supplements cansupport digestive processes.
- Mind-Body Therapies: Stress and anxiety can contribute to GERD symptoms. Mind-body therapies such as meditation, yoga, and deep breathing exercises can help manage these mental stressors, indirectly aiding in GERD relief.
- Identification and Management of Underlying Conditions: In some cases, GERD may be a symptom of another underlying issue, such as hypochlorhydria, H. pylori infection, or even food sensitivities. A functional lab test can help identify these potential causes.
Conclusion
If you’ve been diagnosed with GERD but aren’t finding relief with conventional treatments, you may have been misdiagnosed, or there could be underlying issues that need addressing. Through a naturopathic approach, you can explore alternative diagnoses and revitalize your health from its very foundations, rather than simply masking the symptoms. Schedule a free phone consultation with me, here.
Disclaimer: This blog post is for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.
References:
- Azzam RS. ARE THE PERSISTENT SYMPTOMS TO PROTON PUMP INHIBITOR THERAPY DUE TO REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE OR TO OTHER DISORDERS?. Arq Gastroenterol. 2018;55Suppl 1(Suppl 1):85-91. doi:10.1590/S0004-2803.201800000-48
- Sandberg-Lewis, S. (2017). Functional Gastroenterology: Assessing and Addressing the Causes of Functional Gastrointestinal Disorders. NCNM Press.
- Heidelbaugh JJ, Kim AH, Chang R, Walker PC. Overutilization of proton-pump inhibitors: what the clinician needs to know. Therap Adv Gastroenterol. 2012 Jul;5(4):219-32. doi: 10.1177/1756283X12437358. PMID: 22778788; PMCID: PMC3388523.
