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Dr Sharma Diagnostics



Gastro-Oesophageal Reflux Disease GORD, Hyperacidity:Treatment Options


A lot of people today struggle with acid reflux for which they pop antacids such as Rennies or Gaviscon regularly as they are available over the counter. Many of us recognise what causes such reflux and can change lifestyle or nutritional habits to avoid the problem.

Being overweight causes abdominal fat to push acid up the food pipe (oesophagus) especially when we lie down at night. The oesophagus does not have the thick mucus production that protects the stomach lining and therefore a burning sensation can be the outcome. Hot drinks especially caffeinated tea and coffee, spicy food, fried foods, foods with high refined sugar content and alcohol, especially on an empty stomach, all irritate the stomach lining, can cut down on mucus production and can increase stomach acid production.

Please visit the following site for more advise on diet. http://www.healthline.com/health/gerd/diet-nutrition#1

The causes are numerous and some have more scientific evidence that others - but pharmaceutical paid for studies are generally only done if the outcome is likely to sell a drug so life-style, food allergy, and weigh gain are not markedly tested and out-comes not aggressively promoted.

The causes are sufficiently listed here: http://www.smartnutrition.co.uk/ibs-gut-disorder-clinics/digestive-health/heartburn-heartburn-acid-reflux-gastro-oesophageal-reflux-disease

These symptoms if taken to a GP or gastroenterologist generally lead to the prescribing of two groups of drugs known as antacids or proton pump inhibitors (most commonly Omeprazole and Lansoprazole) which cut down acid production. Such treatment does not get to the underlying cause and whilst it may cut back on the acid production thereby reducing symptoms I believe that little consideration has been taken into account about the short, medium and long-term effects of cutting back on our stomach acid. Stomach acid is, obviously, there for a reason and that is predominantly to break down food.

I also question whether we are incorrectly diagnosing the problem. Authorities described the frequently under-diagnosed condition of hypochlorhydria as follows:

Hypochlorhydria is an extremely common problem in which insufficient acid is secreted by the stomach reducing the efficiency of digestion of foods especially proteins. It can have many clinical symptoms including symptoms of GORD and hyperacidity. This sounds rather counter-intuitive but the valve at the end of the stomach, the pyloric sphincter, is pH (acid/alkaline) sensitive and unless an acidity of around pH 1 or 2 (very strong acid) is achieved then the stomach may fail to empty. Poorly digested foods, especially proteins, lead to potentially allergy-causing molecules to pass through the small intestine triggering allergic responses. Undigested fats and carbohydrates are preferred foods for bowel bacteria and yeasts that live in the gut allowing overgrowth. Yeasts ferment sugars triggering alcohol production which itself can irritate the bowel wall further and the fermentation process results in increased production of wind, gas and bloating to add to the potential reduction in absorption caused by the irritated bowel lining”.

Hypochlorhydria is often caused by inflammation of the stomach lining caused by the foods mentioned above but also through stress and allergy. As we age our ability to produce stomach acid declines as well.

Furthermore when there is hypochlorhydria this reflects upon the amount of alkali produced in the saliva and can reflexly reduce the amount of pancreatic enzymes produced – vital for full digestion of our nutrients.

Symptoms of GORD, hyperacidity, indigestion or reflux may therefore not benefit from the use of antacids or proton pump inhibitors long-term. Initial relief might occur but we need to look at the underling causes and also consider the paradoxical treatment of hyperacidity symptoms which the use of hydrochloric acid capsules taken at the time of a meal and the use of pancreatic enzymes at the end of the meal. In combination with dietetic and lifestyle changes this may resolve the problem and reduce the need for long-term antacid use. We are starting to see potential risks from the use of long-term proton pump inhibitors including osteoporosis (thinning bones) and increased risk of chest infections and pneumonia. PPI reduce vitamin B 12 levels leading to risks of anaemia and a rise in a B12 dependant arterial damaging protein Homocysteine – leading to possible heart and stroke risk. Add this to the theoretical risk of increased allergy and you can see why I am a little reluctant to make antacids and in particular proton pump inhibitors my first-line treatment for GORD.


Investigations

A pioneering test by Acumen Laboratory, Tiverton, Somerset, England has found correlation between stomach acid production and Vascular Endothelial Growth factor, a protein measurable in a saliva sample. As research continues, if this finding is ever shown the light of day ( imagine the losses to the pharmaceutical industry if antacid sales were reduced in favour of natural dietetic and life style changes), we may find what I have in my practice – namely that many individuals treated with acid reducing drugs are already struggling with low levels.

Food allergy testing (blood) needs to be preceded by an intestinal permeability study (urine test) to rule out the absorption of large undigested molecules that can trigger enhanced acid production as a theoretical issue in GORD

Stomach acid VEGF saliva test - £130
Leaky Gut Test - £194
ALCAT food intolerance testing - £365 - £600


Integrated Treatments

Altered life style, diet assessment and changes even the simple expedience of chewing more, eating smaller quantities and eating slowly are all potential cures.

Specific ‘alkaline’ diets, certain supplements and natural extracts can be very beneficial. A discussion with Dr Sharma would generally include trying options such as L-Glutamine, NAC, L-carnitine, Quercetin, (supplements that help repair the gut lining), Slippery elm and a fermented soya extract Sano-Gastril.


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