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Dx GERD Dx G.E.R.D. Dx Gastro-Esophageal Reflux Disorder Treatment: Read more...


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Observations of Naturopathic Physicians:
There is a balance between the hydrochloric (ACID) released by the gastric (stomach) cells to activate and assist DIGESTIVE ENZYMES in dissolving the food eaten. Once the churning stomach mixes the enzymes and acids, the lower gastric syphincter opens. This allows the predigested food to be absorbed by the jejunum and ileum (small bowel).

Dumping the strong acid contents into the small bowel would cause a duodenal ulcer that could bleed and perforate. So, the sphincter refuses to opens and forced the food back into the stomach and even reflux up into the esophagus. This is the heartburn and reflux we speak of.

. Normally the body releases bile from the gallbladder which is highly basic. This neutralizes the stomach acid. When the acid-base level reaches closer to normal pH (acid balance).

Therefore, the best treatment for G.E.R.D. and heartburn is to first try digestive enzymes and ox bile first! Ox bile n digestive enzymes can be bought together in the same pill called Bilex(TM).

Achlorhydria is the state of little or no hydro-chloric acid production. The over-the-counter treatment is Betaine HCl. Add this to the Bilex as a second step and most symptoms of G.E.R.D. and gastritis will resolve without the need for proton pump inhibitor (Nexium(TM), Prilosec(TM), omeprazole, Nexium(TM) or others.

Observations of Allopathic Physicians (M.D. and D.O.) :
G.E.R.D.: Gastro-Esophageal Reflux Disease

The Merck Manual Home Edition
states:
"In gastroesophageal reflux (gastroesophageal reflux disease [GERD]), stomach acid and enzymes flow backward from the stomach into the esophagus, causing inflammation and pain in the esophagus.Reflux occurs when the ring-shaped muscle that normally prevents the contents of the stomach from flowing back into the esophagus (lower esophageal sphincter) does not function properly.The most typical symptom is heartburn (a burning pain behind the breastbone).

The diagnosis is based on symptoms
*Treatment is avoiding trigger substances (such as alcohol and fatty foods) and taking drugs that reduce stomach acid.
*The stomach lining protects the stomach from the effects of its own acid. Because the esophagus lacks a similar protective lining, stomach acid and enzymes that flow backward (reflux) into the esophagus routinely cause symptoms and in some cases damage.
*Acid and enzymes reflux when the lower esophageal sphincter, the ring-shaped muscle that normally prevents the contents of the stomach from flowing back into the esophagus, is not functioning properly. When a person is standing or sitting, gravity helps to prevent the reflux of stomach contents into the esophagus, which explains why reflux can worsen when a person is lying down.
*Reflux is also more likely to occur soon after meals, when the volume and acidity of contents in the stomach are higher and the sphincter is less likely to work properly. Factors contributing to reflux include weight gain, fatty foods, chocolate, caffeinated and carbonated beverages, alcohol, tobacco smoking, and certain drugs. Types of drugs that interfere with lower esophageal sphincter function include those that have anticholinergic effects (such as many antihistamines and some antidepressants), calcium channel blockers, progesterone, and nitrates.
*Alcohol and coffee also contribute by stimulating acid production.
*Delayed emptying of the stomach (for example, due to diabetes or use of opioids) can also worsen reflux.

Complications
*Inflammation of the esophagus (esophagitis) may cause bleeding that is usually slight but can be massive. The blood may be vomited up or may pass through the digestive tract, resulting in the passage of dark, tarry stools (melena) or bright red blood, if the bleeding is heavy enough.
*Esophageal ulcers, which are open sores on the lining of the esophagus, can result from repeated reflux. They can cause pain that is usually located behind the breastbone or just below it, similar to the location of heartburn.
*Narrowing (stricture) of the esophagus caused by reflux makes swallowing solid foods increasingly more difficult. Narrowing of the airways can cause shortness of breath and wheezing. Other symptoms of gastro-esophageal reflux include chest pain, sore throat, hoarseness, excessive salivation (water brash), a sensation of a lump in the throat (globus sensation), and inflammation of the sinuses (sinusitis).
*With prolonged irritation of the lower part of the esophagus caused by repeated reflux, the cells lining the esophagus may change (resulting in a condition called Barrett's esophagus). Changes may occur even without symptoms. These abnormal cells are precancerous and progress to cancer in some people.

Diagnosis
The symptoms point to the diagnosis, and treatment can be started without detailed diagnostic testing. Specific testing is usually reserved for situations in which the diagnosis is not clear or treatment has not controlled symptoms. Examination of the esophagus using an endoscope (a flexible viewing tube), x-ray studies, pressure measurements (manometry) of the lower esophageal sphincter, and esophageal pH (acidity) tests are sometimes needed to help confirm the diagnosis and check for complications.

Prevention and Treatment
Several measures may be taken to relieve gastro-esophageal reflux. Raising the head of the bed about 6 inches (about 15 centimeters) can prevent acid from flowing into the esophagus as a person sleeps. Causative foods and drugs should be avoided, as should smoking. A doctor may prescribe a drug (for example, bethanechol or metoclopramide) to make the lower sphincter close more tightly. Coffee, alcohol, acid-containing beverages such as orange juice, cola drinks, and vinegar-based salad dressings, and other substances that strongly stimulate the stomach to produce acid or that delay stomach emptying should be avoided as well.
Many of the drugs used to treat gastritis and peptic ulcers also help prevent and treat gastro-esophageal reflux (see see Antacids). Antacids taken at bedtime, for example, are often helpful. Antacids can usually relieve the pain of esophageal ulcers by reducing the amount of acid that reaches the esophagus. However, proton pump inhibitors, the most powerful drugs for reducing acid production, are usually the most effective treatment for gastro-esophageal reflux, because even a small amount of acid can cause significant symptoms. Healing requires drugs that reduce stomach acid over a 4- to 12-week period. The ulcers heal slowly, tend to recur, and, when chronic and severe, can leave a narrowed esophagus after healing.

Medications Used in Treatment:
1. Proton Pump Inhibitors: Prilosec®/omeprazole, Prevacid®/lansoprazole, Nexium®/esomeprazole, Dexilant®/dexlansoprazole, Aciphex®/rabeprazole dr, Zegerid®/omeprazole-sodium bicarbonate, Axid®/nitatidine, esomeprazole strontium
2. Histamine-2 Anatagonists: Zantac®/famotidine, Tagamet®/cimetidine
3. Aluminum Complexes: Carafate®/sucralfate
4. Dopamine Receptor Antagonists: Reglan®/metoclopramide
5. Hydrochloric Acid and Digestive Enzymes: lipase, protease, pancrealipase, Betaine HCl

Suggested Links:
*N.H.S. Choices
*Medscape


* [Editor] You need enough acid, that is a pH of 2, for the esophageal sphincter to close. Aging, smoking, diabetes, and chronic nutritional deficiencies of B vitamins and especially B12, keeps the acini cells of the stomach from making enough hydrochloric acid. We know if you take 2 Betaine® HCl capsules from Biotics® before the meal, avoid the food triggers noted above, and then add two (2) digestive enzymes such as Intenzyme® from Biotics® at the end of the meal, most individuals will not have G.E.R.D., heartburn or need prescription medications. This natural approach allows your body to digest its food; the stomach acid suppresses growth of bacteria in the upper stomach that causes 'gas'. The prescription medications work by opening the lower stomach sphincter so undigested food passes into the intestine: not good for nutrition. Usually, patients add the Betaine® HCl and Intenzyme® to their Prilosec®/omeprazole/other proton-pump inhibitor for a few days and then eliminate one and then the other dose of the OTC/prescription medication, successfully. If the G.E.R.D. continues, it might be best to order Laboratory Testing On-Line for anemia (CBC and metabolic) and a test for Helicobacter pylori, the bacteria that causes peptic ulcers. With this information, you will be better prepared to meet with your physician to discuss future diagnostic options and treatments.

*[Editor] The mistaken most often made is not taking enough Betaine HCl. Start with two (2) Betaine HCl and two (2) digestive enzymes at the beginning of the meal. But for half of heartburn/ G.E.R.D. sufferers, they need to take 1 to 2 more Betaine HCl and digestive enzymes also at the end of the meal. Only if the user finds that this regimen causes a gastric burning should the dose be lowered.

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