Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is one of the most common health conditions of the gastrointestinal (GI) tract. GERD occurs when contents of the stomach flow back (“reflux”) into the esophagus causing heartburn and injury to esophageal tissue. Nearly 20% of Americans experience weekly heartburn. Repeated long-term exposure of the esophagus to acid reflux can damage tissue and lead to a condition known as Barrett’s esophagus.

In the United States alone, pharmaceutical giants rake in over 14 billion dollars annually from the sale of proton pump inhibitors (PPIs). These acid-blocking drugs can hinder nutrient absorption and lead to dangerous vitamin and mineral deficiencies in calcium, vitamin B, iron, and magnesium. When discontinued, PPIs then cause a rebound effect which can worsen the original symptoms.

With GERD, the esophageal sphincter (the gate between the esophagus and the stomach) has lost its ability to stay closed. Large meals, reclining after eating, frequent bending at the waist, physical activity, pregnancy, and obesity can thereby increase the likelihood of acid reflux.

Symptoms & Diagnosis

Aside from heartburn, there are several other symptoms associated with GERD that reduce quality of life. These include nausea, hypersalivation (increased saliva production), globus (the sensation of a constant lump in the throat), trouble swallowing, bad breath, and dental erosion.

Prolonged exposure of the esophagus to gastric reflux can result in dramatic alterations to its function. One serious complication of GERD is peptic stricture, a narrowing of the esophagus from deposits of fibrous scar tissue. As the esophagus shortens, it pulls the stomach through the esophageal hiatus and results in a hiatal hernia. Another consideration is Barrett’s esophagus, a change in the cellular makeup of the mucous membrane of the esophagus. The cells become thicker and more similar to those found inside the stomach and can increase the eventual likelihood of esophageal cancer. A confirmed diagnosis requires a biopsy of the esophageal mucous membrane.

Diagnostic tests for GERD may include a barium esophagram, an upper GI endoscopy, and esophageal pH monitoring, considered the current gold standard for GERD diagnosis.

Medical Treatment

Conventional medical treatment strategies call for increasing the dosage or adding additional acid blocking drugs when initial PPIs fail to relieve GERD symptoms. This occurs in upwards of 33% of cases. As much as 69% of prescriptions for PPIs are written for inappropriate indications. Some of the most popular and expensive drugs are Prilosec, Prevacid, Nexium, and Tagamet.

Acid suppression therapies are the mainstay of pharmaceutical GERD treatment by neutralizing or reducing stomach acid secretion. These therapies include antacids, histamine receptor blockers, and proton pump inhibitors (PPIs), all of which have their own negative repercussions. For example, iron, vitamin B12, and calcium all depend upon stomach acid for proper absorption. Suppression of secreted stomach acid can result in the following: iron deficiency anemia from decreased iron absorption, elevated homocysteine (inflammation) from vitamin B12 deficiency, and increased fracture risk from decreased calcium absorption. Also, an increased risk of infection results from hindering the ability of hydrochloric acid to neutralize ingested microorganisms.

Another major problem with PPI drugs is that they are often taken for much longer periods than recommended, thereby compounding the side effects mentioned above. Many patients take these drugs permanently even though some PPIs are approved only for 14-day intervals and no more than three times annually.