- From the desk of Dr. Brkich
Gastroesophageal Reflux Disease (GERD)
The medical definition of Gastroesophageal Reflux Disease (GERD) is regurgitation, or reflux, of too much acid from the stomach back up into the esophagus. Medscape, a website that provides medical information and continuing education for doctors, states that “gastroesophageal reflux disease (GERD) occurs when an excess of gastric juice refluxes into the esophagus”.
The cause of acid reflux is widely assumed to be too much stomach acid. The assumption goes unquestioned because it appears self-evident and makes sense logically. Heartburn sufferers get relief when they take antacids or drugs that inhibit the production of stomach acid, and this is used as proof that too much acid is the cause of the reflux. Unfortunately, this is a specious conclusion that is neither supported by science nor consistent with what I have observed in practice. The definition of specious is having the ring of truth but is actually fallacious. It is a wrong conclusion that sounds plausible but is false. Too much stomach acid (hyperchlorhydria) is very rare. Not enough stomach acid (hypochlorhydria) is far more common. The assumption that acid reflux is caused by too much stomach acid unfortunately results in unnecessary consequences from long term acid suppression, ultimately leading to increased morbidity (disease) and mortality (death).
The Purpose of Stomach Acid
Stomach acid is essential for digestion of food and absorption of nutrients. Without adequate hydrochloric acid in the stomach, digestion cannot take place. Undigested food simply stays in the stomach for too long. This is called gastroparesis, a disorder of stomach motility. Food in the stomach cannot move downward into the small intestine until the pH in the stomach is acidic enough. Low stomach acid results in the food just sitting in the stomach, going nowhere. Instead of being digested by the body’s own digestive enzymes, which depend on high acid in the stomach, the undigested food is broken down by microbes. Microbes, such as bacteria and yeast, produce gas and toxins as they ferment and putrefy (rot) the food. The less acid in the stomach, and the longer the food stays in the stomach, the more gas is produced by the microbes, as the rotting continues.
The amount of pressure from gas in the stomach can get quite high. If both valves of the stomach remain closed, the gas becomes trapped in the stomach and has nowhere to go, neither up nor down. The gas forces the stomach to expand and push up against the diaphragm. Sometimes the top portion of the stomach is squeezed upward through the diaphragm, called a hiatus hernia. Expansion and contraction of the diaphragm is what enables breathing. Pressure on the diaphragm by an expanding stomach can inhibit breathing if the diaphragm is unable to expand downward because of the distending stomach pushing up against it. The more food that sits in the stomach, the more gas is produced by the microbes, and the more pressure is exerted against the diaphragm. If the diaphragm can’t expand, breathing can become impaired.
In addition to breathing impairment, the pressure exerted on the diaphragm can force open the one-way valve between the esophagus and the stomach. Stomach contents can reflux backwards up the esophagus, into the throat, and can be inhaled into the lungs. Even a small amount of acid from the stomach can be extremely irritating to tissues that are not designed to withstand acid. The stomach is the only organ that can tolerate acid and is designed to tolerate very strong acid to function properly. Stomach acid is supposed to be very strong in a healthy person and is often compared to acid in a car battery which can cause severe burns. Even a small amount of acid inhaled into the lungs can cause a reaction mimicking asthma. Acid reflux into the esophagus can cause excruciating chest pain. Many acid reflux sufferers go to emergency, thinking they are having a heart attack.
Is suppressing stomach acid the best way to treat heartburn?
