Gastrointestinal reflux disease (GERD) a common digestive disorder characterized by chronic symptoms resulting from abnormal reflux of contents from the stomach into the esophagus leading to mucosal damage. The underlying cause GERD is multifactorial and can result from stress, poor diet, impaired digestion, dysbiosis, hiatal hernia, and esophageal sphincter dysfunction. Risk factors associated with GERD include smoking, alcohol, and NSAID use.

Previous research that I have shared demonstrated that the damage of the esophagus in GERD to be cytokine mediated due to inflammation and not caused directly by the acid in the stomach. 

Pharmaceutical interventions may provide symptom management but they do not correct many of the underlying factors and have side effects. Lifestyle changes and nutritional support are usually sufficient to address acid reflux. Patients should consider eat smaller portions at meals. In addition, avoid laying down after meals and avoid eating before bed. Also, alcohol and specific foods can trigger symptoms.

Although these medications may help with the symptoms, proton pump inhibitors may not be the solution. Recent previous studies have linked PPIs to chronic kidney disease as cardiovascular disease and an increase risk of a heart attack. PPIs can also lead to other problems such as dysbiosis and small intestinal bacterial overgrowth (SIBO).

According to a new review published two weeks ago in Nutrients, researchers investigated the effects of probiotics in mitigating the severity and frequency of symptoms in GERD. Benefits of probiotics are less known on supporting upper gastrointestinal health. Probiotics are associated with modulation of the immune system and accelerate gastric emptying via their action with stomach mucosal receptors.

This review included thirteen prospective studies published in twelve articles. Seventy-nine percent reported benefits of probiotic supplementation and symptoms of GERD and 45% reported benefits specifically associated with reflux symptoms. These included a reduction in regurgitation and improvements in heartburn or reflux. Five of the eleven positive studies demonstrated an improvement in dyspepsia symptoms and nine of the studies showed an improvement in upper gastrointestinal symptoms including nausea, abdominal pain, belching, gurgling, and burping. As a result, this review demonstrates the potential benefits for probiotic supplementation for patients with GERD.

Other nutritional supplements to consider include deglycyrrhiizinated licorice (DGL) and melatonin. DGL is a well-established anti-ulcer and mucosal healing botanical that is soothing and protective to the gastric mucosa and mucous membranes lining the digestive tract. Melatonin is often used to support sleep or for its antioxidant properties in cancer, however, the entero-endocrine cells in the gastrointestinal tract are a major source of intestinal melatonin. One of the main functions of melatonin produced by the GI tract is to protect the esophageal and gastric mucosa from stressors and irritants. Melatonin is a potent antioxidant that can influence all major functions of the GI-tract including secretion, motility, digestion and intestinal absorption. It has an inhibitory influence on gastric acid secretion resulting in an increase in gastrin release, which increases the contractile activity of the lower esophageal sphincter reducing the symptoms of GERD.

Helicoacter pylori can also contribute to gastritis. Mastic gum, methylmethionesulfonium, zinc-carnosine and vitamin C have anti-H. pylori as well as healing properties to the gastric mucosa.

An alternative approach is typically more effective than what is provided by proton pump inhibitors and does not have side effects or other complications that can be associated with them such as mineral deficiencies, bacterial infections, and dysbiosis.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Cheng J, Ouwehand A. Gastroesophageal Reflux Disease and Probiotics: A Systemic Review. Nutrients. 2020 January 2; 12(1).

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