Acid Reflux Disorders

Almost everyone experiences some form of digestive disturbance during their lifetime. For many, minor indigestion or heartburn is often manageable. However, when these seemingly mild symptoms become more than a simple annoyance, something more critical may be developing.

Several million Canadians suffer from more serious digestive disorders known as acid reflux, gastroesophageal reflux disease (GERD), and gastric ulcers.

Heartburn explained

Approximately one-quarter of the population experiences heartburn daily or more often. Much like water bubbling into a sink from a plugged drain, most heartburn occurs when the stomach is full and there is a reverse flow of gastric contents into the esophagus due to a compromise in the sphincter, or muscular valve, of the lower esophagus.

When does heartburn happen?

A burning pain behind the breastbone that ascends into the throat, coupled with regurgitation and an acidic taste in the mouth are tell-tale symptoms of acid-related digestive disorders. Characterized as heartburn, these sensations arise during common day-to-day events such as

• eating
• bending over
• lying down
• certain physical activities
• pregnancy

What are the symptoms of heartburn?

The stomach’s digestive juices contain hydrochloric acid, hence the term acid reflux. When the refluxed stomach contents touch the lining of the esophagus, a burning sensation is felt in the mid-chest or in the upper part of the abdomen. This can be accompanied by indigestion or abdominal pain, also known as dyspepsia.

A constellation of various symptoms also describe a broader disorder known as GERD, or gastroesophageal reflux disease:

• bloating
• discomfort
• early satiety
• nausea
• heartburn
• postprandial fullness (prolonged persistence of food in the stomach)

What is GERD?

GERD is an often misunderstood disorder, with a prevalence of approximately 13 percent among Canadians, involving the reflux of stomach contents into the esophagus, oropharynx, larynx, or airway. Heartburn is the predominant feature, and is considered an expression of GERD when it becomes troublesome and severe, occurring two or more times per week.

GERD involves a highly efficient barrier, known as the lower esophageal sphincter (LES), between the stomach and the esophagus, which acts as a valve that normally prevents reflux of stomach contents into the esophagus.

The LES can become abnormally relaxed over time due to various factors such as obesity, smoking, pregnancy, certain medications, and hiatal hernia (when the upper part of the stomach slips through an opening in the diaphragm into the chest).

This results in prolonged exposure of gastric juices refluxing into the esophagus, which can injure the esophageal lining and underlying muscle. Besides abdominal pain and vomiting, the harmful refluxed hydrochloric acid can also enter the airways and lungs from the throat, causing respiratory symptoms such as hoarseness, asthma, pneumonia, laryngitis, and difficulty swallowing.

It is important to note that longstanding gastroesophageal reflux can cause damage to the tissues of the esophagus, resulting in complications such as Barrett’s Esophagus, esophageal ulcer, or esophageal adenocarcinoma—one of the fastest growing cancers in the western world.

Acid suppressants— a double-edged sword?

Medications for the spectrum of reflux disorders include acid suppression, usually with over-the-counter antacids, H2-receptor antagonists, and proton-pump inhibitors (PPIs). PPIs work by blocking hydrochloric acid; however, many safety concerns have arisen regarding adverse effects and the long-term harm associated with prolonged periods of acid suppression.

This is because stomach acid is necessary for the absorption of nutrients such as calcium, iron, magnesium, and vitamin B12. Several studies point to health problems arising from these nutrient deficiencies as a result of treatment with gastric acid suppressants.

• Vitamin B12 and folic acid deficiencies can lead to neurological problems, anemia, and depression.
• Considerable evidence shows increased risk of hip, spine, and wrist fractures as well as osteoporosis and bone loss with calcium deficiency.
• Iron-deficiency anemia is a consequence of decreased iron absorption.
• Symptoms such as fatigue, seizures, and cardiac arrhythmias can develop from magnesium deficiency.
• Inadequate stomach acid secretion also influences the pH of the small intestine and may contribute to the overgrowth of fungus and bacteria such as clostridium difficile.

Try natural treatments instead

Bitter herbs

Stimulating the secretion of stomach acid is an effective approach in improving nutrient digestion and absorption, often achieved by using bitter herbs such as dandelion and artichoke. Both have been used traditionally for thousands of years to treat heartburn and dyspepsia by activating receptors on the tongue, which in turn trigger the release of pancreatic enzymes, gastric acid, bile salts, and other compounds necessary for optimal digestion.

Artichoke leaf

Artichoke leaf minimizes damage to gastric tissues through its antioxidant action. In a prospective cohort study of 311 patients with dyspepsia, 38 percent reported significant reduction of symptoms after 60 days of treatment using a blend of dry extracts of artichoke leaf, dandelion, turmeric, and rosemary.

Melatonin

Melatonin’s many beneficial properties include its antioxidant, anti-inflammatory, and relaxation actions in the digestive tract. Shown to diminish the symptoms of esophageal reflux disease, melatonin may also prevent the development of gastric ulcers due to its protective action on the mucosal barrier.

Demulcents

Other healing herbs known as demulcents have been used traditionally to soothe an inflamed digestive tract; they also exhibit anti-ulcer benefits. Some of these demulcents include

• licorice
• marshmallow
• slippery elm

Probiotics

Consuming more probiotic-rich foods, or supplementation with capsules or powders, also ameliorates digestive symptoms. Probiotics are live bacteria that alter gut ecology, producing beneficial short-chain fatty acids and deconjugating and absorbing bile acids while limiting the growth of pathogenic bacteria.

Probiotics exert potent anti-inflammatory and immune-enhancing effects, and evidence from trials shows improvement in digestive symptoms and abdominal pain. Fermented foods such as yogurt, kefir, tempeh, and sauerkraut are rich in probiotics, and supplemental probiotic powders and capsules are also widely available.

Lifestyle changes

Sometimes lifestyle modifications have a dramatic effect in reducing symptoms of heartburn. Understanding that drinking alcohol and smoking can play a large role in triggering or exacerbating symptoms is a good first step.

Diet

• Avoid trigger foods such as coffee, alcohol, chocolate, spicy or fatty foods, and carbonated drinks.
• Replenish lost nutrients such as vitamin B12, calcium, and magnesium.
• Reduce weight, if overweight.

Yoga

Engaging in exercises such as yoga has shown a positive impact on digestive disorders. Yoga exercises such as Kapalbhati and Agnisar Kriya have been demonstrated to be beneficial in GERD as they increase diaphragmatic tone, thereby decreasing esophageal reflux.

These types of pranayama (breathing control techniques) strengthen the diaphragm and LES tone, and improve gastrointestinal motility. Stress triggers gastric acid secretion which may aggravate peptic ulcers and other digestive complaints. The physiological relaxation response induced by yoga also makes this an ideal practice to improve digestion.

These strategies are effective alternatives to reliance on pharmaceutical interventions that often come with side effects. A healthy digestive tract is the first line of defence, and an imbalance in this system is usually at the root of most other health disturbances.

The body’s delicate messaging system typically alerts us toward these imbalances, but if left ignored, recurring digestive symptoms can lead to more chronic and serious disorders. Seeking guidance from a knowledgeable health practitioner is also an essential aspect of effective self-care.