Maybe it was all the overeating during the holidays (myself included!), but lately I have been seeing a lot more patients with acid reflux symptoms. This past year, I have been on a campaign to try to wean patients off of Proton Pump Inhibitors (PPIs), the powerful acid blockers that many take when the usual Tums and Rolaids just doesn’t cut it. Although some research is inconclusive, long-term PPI use has been associated with increased risk of C. difficile colon infection, microscopic colitis, small intestinal bacterial overgrowth, malabsorption of vitamins and minerals, and possibly kidney disease, dementia, pneumonia, and overall mortality.
PPIs are wonderful drugs that can be very beneficial in certain circumstances. For example, they are absolutely necessary after a gastric bleed, and in people with Barrett’s esophagus (when repetitive acid exposure in the esophagus causes the cells to change, which can potentially lead to cancer if not controlled). These patients should follow their treatment plans per their gastroenterologist’s recommendations. However, a majority of people with mild-moderate nonerosive acid reflux do not (and should not) be on these medications long-term. In fact, many people do not ever need to start them, as symptoms can be controlled with other measures.
GERD is most often a motility disorder, not an acid-producing disorder. Something is causing the lower esophageal sphincter (LES), the little valve between the esophagus and stomach that keeps the stomach contents where they should be, to relax, allowing small physiologic amounts of acid from the stomach to retrograde flow into the esophagus. Obesity (increased abdominal pressure!), hiatal hernias, spicy and fatty foods, caffeine and chocolate (both of which I am consuming as I write this!), are all examples of things that can cause the LES to relax.
Because GERD is a functional disorder, it can be well treated without medications. Try these lifestyle modification and alternative therapies first. If your symptoms persist despite a month of consistent use, then see your doctor to discuss prescription options.
Lifestyle Modifications for Treatment of GERD:
Weight loss if overweight.
Wait 2-3 hours after eating dinner before lying down in bed. Elevate head of bed.
Trial avoiding caffeine, chocolate, carbonated beverages, peppermint, spicy and greasy/fatty foods.
Tobacco and alcohol cessation.
Alternatives Therapies for GERD:
Iberogast (prokinetic)
Slippery Elm (2-3x/day, or as needed) (demulcent)
Aloe Vera and Zinc L-Carnosine 15mg zinc/60mg carnosine 1-2 caps daily (repair)
Do you suffer from GERD? What has helped with your symptoms?
