I have been thinking through the causes and treatment of GERD. I realized that most doctors just treat GERD symptomatically without regard to its root cause. It's hardly surprising because there are so many causes of GERD. Each patient can have uniquely different characteristics. There are a number of mechanisms that prevent over-exposure of esophageal tissue to acid, if any fails, you get GERD. This also explains why certain patients react positively to certain natural remedies while others do not.
1. Abnormally high abdominal pressure
- Pregnancy - last for only 10 months, treat symptomatically with lifestyle modification, OTC antacid, H2RA and PPI.
- Obesity - lose weight
- Bacterial overgrowth in intestine - Probiotics, low-carb low-fat diet
- Indigestion resulting in gases or wind - Probiotics + digestive enzymes, sometimes ACV can help too, low-carb low-fat diet
- IBS - ?
2. Abnormal gastric motility
- Weak stomach, prolonged gastric emptying - prokinetic agents such as motilium, cisapride or metoclopramide / dieting / acupuncture
- Low acidity - ACV (provided the patient does not have gastrisis or esophagitis symptoms) / dieting.
- Hyperacidity - H2RA / PPI / akaline diet
3. Hiatus hernia
- Mild form - still under debate in medical community whether it is a cause
- Severe form, paraesophageal - nissen, TIF, LINX
4. Abnormal esophageal motility
- Weak LES - treat symptomatically, or surgery.
- Slow acid clearance - treat symptomatically, carafate.
- high rate of tLESR - baclofen (new drugs are coming, which are baclofen derivatives)
5. Other causes, self-perpetuating causes (vicious cycle)
5.1. Stress & anxiety may cause GI problems leading to reflux which in turn also results in more stress & anxiety - Relaxation therapy, meditation, breathing exercise, Yoga, anti-depressant
5.2. Esophagitis, inflammation of LES can cause LES to be weakened further - H2RA / PPI
5.3. Gallbladder issue - treatment for gallbladder
5.4. Gastrisis? - treatment for gastrisis
5.5. Diabetes mellitus causes prolonged gastric emptying, resulting in increased gastric contents and gastric pressure - respective treatment for diabetes.
Please list your reference. Thank you.
Below I give two review articles from medical sources as reference. They both provide the definition of GERD and the standard protocol of how it is managed. Because I am not satisfied with the symptomatic treatment approach to GERD, I give the breakdown of the various causes and suggest the treatment approach to each. This is something not found in the medical journals. So this post is FYI only!
References:Gastroesophageal Reflux Disease - MedscapeMedical management of gastroesophageal reflux disease
Post Edited (WJF) : 5/5/2012 6:13:15 PM (GMT-6)