I have a tendency to be pragmatic and perhaps sometimes cynical,
and apply logic in my approach to analysis and problem-solving. The heading of this HealingWell messageboard is
“GERD – Heartburn”, but I feel there is a need to define and clarify those
terms. I realize that both the symptoms
and diagnosis of this condition(s) is not always black-and-white, but for those
new to the discovery that they have to begin making lifestyle adjustments to
find some comfort, I think it’s important for some things to be understood.
Even with the advances today in medicine, a lot is not
understood about reflux and its causes. The
following is an incomplete list of possible/theoretical causes:
weakness of lower esophageal sphincter (LES),
upper esophageal sphincter (UES), or both.
hormonal imbalances resulting in nausea/regurgitation
reactive stomach to certain foods, or perhaps
poor stomach emptying
excessive gas from lower GI tract “backing up”
Only the first item on this list (and perhaps the second, if
you allow the impact it has upon the LES), that of mechanical, physiological
problems with the esophagus leading to reflux, is classified as GERD. The symptoms one may experience in whatever
category he/she belongs to may be the same, but the classification is not. Reflux regurgitation can occur even if the
LES is structurally OK, and, within limits, can be normal. Chronic reflux may very well be GERD, but
again, it may not. The importance of
this fact is in the treatment of symptoms.
If you belong to one of the other categories, there are a
multitude of possibilities in terms of treating or alleviating symptoms. Some on this messageboard have reported
success with diet, or herbal supplements.
The confusion results when these people call their condition “GERD” when
they have never been officially diagnosed with this disease. Perhaps they have been to a doctor who used
an empirical methodology with his diagnosis, and prescribed PPIs for
treatment. But this still does not represent
an official diagnosis, only an “observational” one. The only way GERD can be accurately diagnosed
is through pH testing, and sometimes manometry, although this is often
inconclusive. Even an EGD/endoscopy can
not be relied upon for a diagnosis.
Dr. Jamie Koufman has had some success treating her reflux
patients with diet, although she recognizes that not all respond to this
approach. In my opinion, she has success
with those patients who belong to other categories of reflux, but not GERD
patients. It’s also possible that for
those who have reflux as a result of poor diet choices (trigger foods, eating
before bed, etc.), improvements may be found from more dietary discipline. If you have GERD, however, your options are
less for relief than those whose reflux has another cause. Dr. Koufman coined the term, LPR, and some of
her patients experience relief from these symptoms…which is interesting…but I’m
not sure that one can draw any significant conclusions from these successes
without more information.
Lately, it seems I am seeing more and more posts from folks
claiming that they have “cured their GERD” through supplements and/or diet, and
are giving advice to others who come to this forum. These newer members may not be knowledgeable
with what they (or their children) are dealing with, and are perhaps somewhat
vulnerable. If you are fearful of
doctors and the unknown, do not have insurance or don’t have the money to spend
on testing and treatments, you can be reluctant to see a doctor, and may be
more willing to experiment with herbal/dietary suggestions. This was the position I was in several years
ago as I struggled with advancing symptoms of GERD. I had the misfortune of going to doctors who
didn’t know how to help me, or sent me down blind alleys, and I wasted months
and dollars experimenting with “internet cures”.
To those who claim a cure for reflux, I would like to see a
scientific methodology applied to their claims.
How long have they experienced freedom from symptoms? Can this resolution be attributed to a single
supplement, or was the individual taking several? Is the cure absolutely confirmed from a single
supplement, or is it possible they have experienced a spontaneous physiological
remission due to some other factor? Has
the reflux stopped, or are they just having success in masking symptoms? Do you see where I’m going with this? A “cure” has to withstand vigorous scientific
methodology, be able to be independently verified, and duplicated.
I would hope that those with some experience with this
condition carefully consider how they classify themselves when posting, as well
as dispensing advice. I would also
caution new members to read and weigh carefully the content of what they see
here, and while doctors may not always provide satisfactory treatments, don’t
avoid medical opinions as a result of something you saw on this messageboard.