“Our gut and brain are connected through our enteric nervous system, which is the neural network in our gut. We have 500 million neurons in our gut, which is why it's called the second brain. It can even operate on its own without our brain, which is really fascinating.” Dr. Sarah Williams
There's one thing that is overlooked when it comes to reflux- Dr. Sarah Williams discusses this plus the other common factors that cause reflux and what to do about them.
Reflux is a common gastrointestinal issue that often goes beyond a simple discomfort. In this video, Dr. Mary Pardee and Dr. Sarah Williams, both specializing in chronic gastrointestinal issues, discuss reflux, exploring its various facets, causes, and treatment options.
Exploring a Case Study
Consider Brittany, a 50-year-old female grappling with reflux for a year. Her journey, marked by a dull ache, burping, and a burning sensation, led to a diagnosis of mild gastritis/esophagitis. Omeprazole provided initial relief, but she was able to totally resolve her symptoms by avoiding trigger foods, stress management, and weight loss. In three months, Brittany saw a 90% improvement, shedding light on the significance of lifestyle modifications.
Understanding Reflux
Reflux affects 10-20% of the Western world. Pathologic reflux, often linked to GERD, can cause injury to the mucosa leading to inflammation of the esophagus called esophagitis.
Symptoms of GERD
While heartburn and regurgitation are hallmark symptoms, "silent reflux" can manifest as difficulty swallowing, chest pain, globus sensation, chronic cough, hoarseness, nausea, asthma, post-nasal drip or sinusitis, or bad breath.
Causes of Reflux
Reflux is multifactorial, it involves transient lower esophageal sphincter relaxations, decreased pressure or the lower esophageal sphincter (sphincter connecting the esophagus to the stomach), acidity levels, esophageal clearance, mucosal lining integrity, and anatomical disruptions like hiatal hernias.
Anxiety, Stress and Reflux:
A research study found that people with GERD were twice as likely to have anxiety (1). While there is not a lot of research on this area, Dr. Mary and Dr. Williams discuss how they commonly see anxiety or stress being a cause of reflux. When anxiety/stress is managed symptoms of reflux resolve.
Risk Factors for Reflux
Being overweight is one factor because it puts more pressure on the sphincter between the stomach and the esophagus. A hiatal hernia, which is when part of the stomach pushes up into the chest, can also be a risk.
Pregnancy is another risk factor due to the increase in pressure from the fetus pushing upwards as well as higher progesterone levels slowing down gut motility.
Eating certain foods (like fatty, spicy, or fried), drinking caffeine or alcohol, and smoking can also contribute because they make the sphincter between the esophagus and stomach weaker.
Low stomach acid, called hypochlorhydria, is not very common, only about 4-5% of people have it. It can happen with certain infections or long-term use of specific medications. It's more common in older adults.
Stress and anxiety are important factors that people might miss. Feeling anxious is more common in people with reflux.
Having trouble breathing during sleep, called obstructive sleep apnea, can change the pressure in the stomach valve, especially if someone is overweight.
Complications and Diagnosis
Complications of reflux include Barrett's esophagus. This is when cells in the lining of the esophagus change to abnormal tissue (precancerous cells), predisposing someone to esophageal cancer. Esophageal strictures are also complications of untreated reflux. Diagnosis relies on clinical symptoms, sometimes an endoscopy will be done to visualize the tissue of the esophagus and stomach.
Treatment Strategies
Addressing reflux involves various treatment strategies that aim to alleviate symptoms and reduce the risk of long-term complications.
Weight Loss (if needed):
Shedding excess weight can alleviate pressure on the stomach and improve symptoms.
Dietary Changes:
Modify your diet by avoiding overeating, heavy fatty meals, and fried foods.
Limit intake of coffee, tea (caffeine), peppermint, chocolate, dairy, soda/carbonated beverages, and tomato/red sauces.
Lifestyle Adjustments:
Quit smoking and reduce alcohol consumption.
Refrain from eating 2-3 hours before lying down.
Sleeping Position:
Elevate the head of your bed using bed risers to help keep stomach contents down.
Mindful Eating and Stress Management:
Practice mindful eating to prevent overconsumption.
Engage in stress management techniques and vagus nerve exercises.
Demulcents (DGL):
Deglycyrrhizinated licorice (DGL) is a natural remedy that may provide relief for some people.
H2 Blockers (Pepcid):
Histamine-2 (H2) blockers like Pepcid can help reduce stomach acid production.
Proton Pump Inhibitors (PPIs):
PPIs are effective in decreasing acid production and reducing the risk of long-term complications like Barrett’s esophagus.
However, prolonged use may lead to deficiencies in magnesium, calcium, B12, and iron.
Osteoporosis concerns have been raised, but causality is yet to be established. Long-term use, especially beyond one year, may pose a potential risk.
It's essential to note that the association between PPI use and bone fractures is plausible, with a 35% higher risk observed in women using PPIs regularly for at least two years. Normal, short-term use (8 weeks) likely does not pose an increased risk.
These treatment strategies offer a multifaceted approach to managing reflux symptoms and promoting overall digestive health. Always consult with a healthcare professional before making significant changes to your treatment plan.
Myth: Apple Cider Vinegar (ACV): While ACV is commonly mentioned for the treatment of reflux, there is currently no conclusive research supporting its efficacy in treating reflux. Since it is an acid itself it should only be used if low stomach acid is suspected as the cause.
Citations:
Bai, Pooja et al. “Gastroesophageal Reflux Disease in the Young Population and Its Correlation With Anxiety and Depression.” Cureus vol. 13,5 e15289. 28 May. 2021, doi:10.7759/cureus.15289
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