What is acid reflux?
GERD, more commonly known as acid reflux, stands for gastro-esophageal reflux disease. This is very prevalent, affecting up to 27.8% of adults in the United States. It is often mild; however, it can progress and become severe and complicated, making treatment very important.
Conventionally, management typically involves lifestyle modifications and pharmaceuticals.
Signs and symptoms of GERD
- Heartburn or a burning sensation in your throat or lower down in the esophagus
- Acid regurgitation up into your mouth
- Persistent dry cough
- Pain in the center of your chest after meals
- Tooth decay
- Asthma or shortness of breath
- Bad breath
- Unexplained sore throat
What causes GERD?
Inappropriate relaxation of the LES
What does that even mean? The LES, or lower esophageal sphincter, is a bundle of muscles at the lower end of the esophagus, where it meets the stomach. The LES stops acidic stomach contents from going back up into the esophagus. It is important to note that the LES muscles are not under voluntary control.
Now you might be wondering, well, what affects the lower esophageal sphincter?
A review done in 2019 found that those who drank more alcohol or drank alcohol more regularly had a greater likelihood of reflux. Alcohol consumption has been known to relax the lower esophageal sphincter allowing acidic contents from the stomach to go up into the esophagus.
Other lifestyle factors, like cigarette smoking, can cause aggravation. A study looked at the effect of cigarette smoking on the lower esophageal sphincter pressure and it showed a reduction in pressure during cigarette smoking. They concluded that those who smoked, regardless of the presence or absence of reflux, were significantly lower on as a group than that of non-smokers.
There are certain medications that can affect the tone of the LES. Common medications include antihistamines, bronchodilators, calcium channel blockers, theophyllines, tricyclic antidepressants, and diazepam. There are also medications that lead to direct damage of the mucosa such as aspirin and NSAIDs.
Hypochlorhydria or low stomach acid can also cause reflux. Now, you might be wondering how low stomach acid can cause reflux, when medications intended for reflux often stop acid production. The stomach plays a really important role in digestion by helping to break down our foods. It is also very important for proper functioning of the LES. When there is a lack of acid in our stomach, it can stimulate the LES to weaken allowing acid to creep up.
Many food items have been shown to be involved in reflux. Patients with GERD seem to have an intolerance to multiple food items causing the sphincter to be relaxed. Common foods include caffeine, cow’s milk, chocolate, peppermint, carbonated beverages, tomato, and onions. Food sensitivity testing (which we do in office) can be a great way to find out which foods are causing your symptoms. It’s helpful to note that acidic foods may make symptoms worse (once there is already acid in the esophagus, any additional acid will add to the burning sensation), but may not be the root cause in and of themselves.
We have found in our practice that two of the most common root causes of reflux are food sensitivities, and SIBO (Small Intestine Bacterial Overgrowth). For more on the relationship to SIBO, click here.
Anatomic disruption of esophageal/stomach junction
Hiatal hernias, which are a mechanical issue, are often associated with GERD. This is when part of the stomach moves out of its normal position and goes through the diaphragm. However, hernias can be present independently and not cause any symptoms. Nevertheless, the presence of a hiatal hernia plays a vital role in the development of acid reflux because it disrupts the function of the lower esophageal sphincter.
Increased intra-abdominal pressure
A meta-analysis concluded that obesity was associated with an increased risk of developing GERD symptoms. The reason for this is that increased fat raises the intra-abdominal pressure.
Similar to obesity, pregnancy can also lead to reflux because of the increase in pressure. However, increased pressure is not the only reason. In pregnancy, the hormone progesterone is elevated which causes muscle to relax, including the LES. It also increases allergic responses, so if food sensitivities are present beforehand, they will often worsen during pregnancy.
You may have just one, or a variety of possible causes for GERD. In some cases there may be just one root cause, but other exacerbating factors to be aware of during the process of healing. Naturopathic medicine can help with identifying and addressing your root cause.
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