15 Sep Heartburn, Gastroesophageal Reflux (GERD)
So-called “heartburn” is a condition where the stomach clinches and forces its contents up into the esophagus (that’s reflux). The acid and enzymes in the stomach irritate the thin-walled esophageal lining, causing pain about mid chest and earning the term heartburn.
The stomach contents can even be driven as far as the throat. Irritation there can cause persistent cough. This is a version of so-called silent reflux, where there may be little stomach acid, but the enzymes from the stomach irritate the throat.
GERD (gastroesophageal reflux disease) is called that because the muscle valve at the bottom of the esophagus and top of the stomach is somehow breached. The muscle usually does a good job of allowing swallowed food to enter the stomach, while preventing backflow.
A number of rationalizations have been offered for reflux, the most popular being “hiatal hernia.” The opening in the diaphragm muscle through which the esophagus passes to the stomach is called a hiatus. When the stomach protrudes upward through this opening, it’s a hernia. However, not everyone who has a hiatal hernia refluxes and not everyone who refluxes has a hiatal hernia. So most of the time the problem is due to another factor.
Going back to muscles, they only know how to do one thing, shorten. So if a muscle is continually irritated, it may spasm, sort of a Charley horse. So what could be irritating the lining of that hollow muscle we call a stomach? Several possibilities are easily envisioned.
First, there may be an unknown food allergy irritating the stomach lining. Second, the stomach is thick-walled to withstand the two quarts a day of hydrochloric acid for digestion generated there by glands. If the acid further aggravates an already irritated stomach lining, then it contracts and there go the contents into the esophagus.
Third, in cases where there is little glandular production of acid, there is little sterilization. (That’s one of many purposes to the production of hydrochloric
acid in the stomach, protection against microorganisms.) If one places food in a warm, dark, wet place, it’s going to ferment, aggravate the tissue it’s on, and generate gas, Getting it to go down is not usually as fast as going up.
The medical habit of offering a drug to stop production of hydrochloric acid from the parietal cells of the stomach is a desperation move to stop damage to the esophagus and pain. Such drugs lower digestion of food, possibly encourage food allergy, reduce absorption of vitamin B12 and minerals, and have been shown to foster osteoporosis. It would be best to deal with the cause.
In 2003, the writer published a report on GERD (The Problem of Gastroesophageal Reflux Disease. Integrative Medicine 2003;2(2):18-21). While there was discussion of food allergy aggravation and hydrochloric acid deficiency, the central point was the use of a plant-extracted molecule that tightened the lower esophageal sphincter muscle. That worked to various degrees. However the reader may recognize that this was not dealing with ultimate cause, but supplying a somewhat sophisticated Band-Aid.
It was after the publication of the report that the writer realized that, at least in his medical practice, most with GERD had gluten intolerance. This is an autoimmune condition that already has a track record of being able to cause difficulties anywhere from the scalp to the toes.
So checking for gluten intolerance (celiac disease) along with its favorite display, poor absorption in the small intestine, has become the starting point in beginning the search to solve someone’s GERD puzzle. Other considerations, other stomach aggravating factors, hydrochloric acid, and anything causing hair-trigger muscles (like magnesium deficiency) come next.
Unfortunately some physicians still think gluten intolerance is a fad and don’t understand that establishing gluten intolerance cannot always be done with one simple test. And it should not be forgotten that some few have a problem apparently solved only by surgery. However, it seems that should be considered last and not first.
Davis W. Lamson, MS, ND