• The Natural Treatment of GORD

     

    Gastro oesophageal reflux disease, or GORD, is a digestive disorder that affects the lower esophageal sphincter (LES), the ring of muscle between the oesophagus and stomach.

    In normal digestion, the lower esophageal sphincter (LES), a band of muscles which separates your stomach from your oesophagus, which in conjunction with the diaphragm, opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the oesophagus. The LES normally opens to permit swallowed food and liquids to pass easily into the stomach. Except for belching, this is the only time the LES should open.

    When the LES relaxes at inappropriate times or is otherwise compromised, stomach contents ‘refluxes’, or comes up, into your oesophagus.

    If the LES is working properly, it doesn’t matter how much acid we have in our stomachs. It’s not going to make it back up into the esophagus. But if the LES is malfunctioning, as it is in GORD, acid from the stomach gets back into the esophagus and damages its delicate lining.

     

    Symptoms of GORD

    • Chronic heartburn
    • Acid regurgitation
    • Belching
    • Difficulty or pain when swallowing
    • Waterbrash (sudden excess of saliva)
    • Dysphagia (the sensation of food sticking in the oesophagus)
    • Chronic sore throat
    • Laryngitis
    • Chest pain
    • Chronic cough
    • Inflammation of the gums
    • Erosion of the enamel of the teeth
    • Chronic irritation in the throat
    • Hoarseness in the morning
    • A sour taste
    • Bad breath

     

    What causes GORD?

     

    Common belief is that GORD is caused by excessive production of acid in the stomach but there is little or no evidence to support this conclusion for most cases of GORD. In one study, the presence of esophagitis was not associated with elevated levels of acid secretion or with a lower gastric pH than in normal subjects. (1)  Another study indicated that mild erosive esophagitis can occur in the presence of decreased as well as normal acid secretion, (2) and in the absence of Barrett’s esophagus, acid secretion in patients with esophagitis is not different from that in normal subjects. (3)

     

    ‘Treating gastroesophageal reflux disease with profound acid inhibition will never be ideal because acid secretion is not the primary underlying defect. Acid secretion is normal in most patients with reflux disease and acid inhibitory therapy makes it abnormally low …The pathophysiology of acid reflux concerns the dysfunction of the gastroesophageal barrier and research needs to refocus on ways of restoring its competence rather than merely suppressing gastric acid secretion.’ (4)

    Download the Free Guide and discover:

    • The latest research on the causes of IBS.
    • Which foods you should be avoiding (for now).
    • Which tests can help you identify the cause of your symptoms.
    • Easy tips for better digestion.



    The problem with acid-suppressing medication.

     

    PPI’s, H2 Blockers and antacids are effective at reducing the symptoms of GORD but don’t address the underlying factors causing GORD. 

     

    Most people don’t realise that the use of PPIs should be limited to no longer than 3 months and are not safe for long-term use. When PPIs were first marketed, patients were advised to take them for a maximum of six to eight weeks.

     

    New evidence has shown that long-term use of PPIs causes a decrease in absorption of some key vitamins and minerals, diminished pancreatic function, gut dysbiosis, and rebound stomach acid hypersecretion. Recently the FDA in America issued several warnings concerning the long-term risks of PPIs, including bone fractures and infections.

     

    The current use of PPIs focuses primarily on symptom management rather than addressing the problem of why stomach acid reaches the esophagus.

     

    So if too much stomach acid isn’t the cause of GORD, what is?

     

    There are many potential causes of GORD, including:

     

    • Hiatal Hernia – promotes lower oesophageal sphincter dysfunction.
    • Delayed stomach emptying – results in gastric distension, which can increase the rate of lower oesophageal sphincter relaxations.
    • Decreased oesophageal mucosal defence – neutralises  the back diffusion of hydrogen ion into the oesophageal tissue.
    • Impaired oesophageal clearance –  leads to prolonged acid exposure of the mucosa.
    • Obesity – prolonged oesophageal acid exposure has been found to occur more frequently in obese individuals than in those with normal weight.
    • Increased Intra Abdominal Pressure.
    • Small Bacterial Overgrowth (SIBO).

     

    SIBO and GORD

     

    Small Intestinal Bacterial Overgrowth (SIBO) is an under recognised cause of GORD and is often not tested for in people experiencing the symptoms of GORD.

    SIBO occurs when bacteria becomes overgrown in the small intestine leading to increased fermentation and gas production.

    Learn more about SIBO and its causes.

    Gas produced by the bacteria in the small intestine can cause it to expand, increasing pressure in the abdomen. 

    • This pressure can push upwards causing stomach contents to push against the lower esophageal sphincter (LES) and and up into the oesophagus. 
    • Gas produced by the bacteria can travel back up to be belched out. This gas weakens the LES by causing pressure on the valve. 
    • The bacteria overgrowth can lead to damage of the small intestine lining reducing its capacity to break down and absorb nutrients, this can slow the digestive process meaning food sits longer in small intestine increasing the volume which increases abdominal pressure.
    • SIBO is associated with bloating and altered bowel movements which is often experienced by people with GORD.

     

    In clinic I commonly see SIBO in patients experiencing heartburn, reflux and other symptoms of GORD, especially if they are experiencing other IBS like symptoms such as bloating and altered bowel movements.

    What tests should I have?

     

    The first step in treating GORD is to understand the underlying cause/s which may be many and complex. Depending on your symptoms a Gastroenterologist can perform:

    • Gastroscopy – looks for gastritis, oesophagitis, ulcers and hiatal hernia.
    • Oesophageal manometry – a swallowing test that can help determine if your oesophagus is able to move food to your stomach normally.
    • Gastric emptying study – used to measure whether your stomach is emptying as it should.
    • A hydrogen/methane breath test for SIBO. (This is not typically or routinely done by GPs or Gastroenterologists)

     

    How is GORD treated?

     

    Once we have an understanding of what is causing your symptoms of GORD a treatment plan typically consists of:

    • Removing foods from your diet that relax the LES and aggravate symptoms of heartburn and reflux.
    • Remove fermentable carbohydrates from your diet, these foods tend to ferment and create gas in the intestines which can increase intra abdominal pressure.
    • If SIBO is present treating the bacterial overgrowth with herbal antimicrobials.
    • Improving gut motility and digestive secretions with herbal medicines.
    • Reducing inflammation and repairing the lining of your gastrointestinal tract with herbal medicines and nutritional supplements.
    • If hiatal hernia is present referral to a chiro/osteo/visceral therapist who can help treat it.
    • Diaphragmatic breathing exercises – the diaphragm muscle surrounds the lower esophageal sphincter, and helps to prevent gastroesophageal reflux, a  number of studies have shown that diaphragmatic breathing can reduce symptoms of reflux.

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    To learn more about the testing and treatment options available it is recommended you take a free 15 minute phone consultation. During this call you can learn more about the programme and have all your questions answered. This call is to determine if we are a good fit for one another rather than a history or complete consultation. There is no obligation, and no strings attached.

    It is quick and easy to book your free 15-minute phone consultation using the online calendar. Just click the button below, choose a date and time convenient for you, enter your details, and Matt will call you at your chosen time.