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Acid Reflux and GERD

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Additional Information and Links to Scientific Studies - For more information on GERD, GER, acid reflux, heartburn, and related diseases:

  1. The National Digestive Diseases Information Clearinghouse, a service of the NIH, gives reliable basic information concerning acid reflux (GER): http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
  2. By 2014, meta-review of studies of incidence of Gastrointestinal Reflux Disease (GERD) by such conservative groups as the Houston Veterans Affairs Medical Center, in Texax, U.S.A. showed that incidence and prevalence of GERD has reached astounding levels in the United States and East Asia, with as many as 27.8 percent of the entire population of the U.S. afflicted with this multifactorial syndrome of dysfunction. The disease burden of GERD is increasing worldwide and is not being addressed by standard medicine: http://www.ncbi.nlm.nih.gov/pubmed/23853213
  3. A 2013 assessment of GERD at the University of Chicago Pritzker School of Medicine, and the Center for Esophageal Diseases, in Chicago, Illinois, U.S.A. noted that GERD in now the most prevalent gastrointestinal disorder in the U.S., emphasizing that the 'disorder' is a functional disease of the whole GI system, not just a problem with stomach acid excess. These experts also noted that there was still little apparent awareness in standard medicine that GERD is potential lethal, and that GERD is related to many respiratory disorders that often eventually lead to death as well. The oversimplified treatment with overprescription of acid-inhibiting drugs had created a 10 billion dollar per year industry, these experts noted, implying that the profit motive had led to devastating consequences. The cavalier insistence on easy prescription, and now availability of Proton Pump Inhibitors without prescription, and stubborn resistance to integration of Complementary Medicine to solve this multifactorial problem and restore gastric and intestinal health and function has led to a crisis in healthcare: http://www.ncbi.nlm.nih.gov/pubmed/23615806
  4. By 2012, the consensus is that transient lower esophageal sphincter relaxations (TLESR) are the central mechanism in GERD, although they occur as well in healthy individuals. The difference between transient lower esophageal relaxations in healthy and unhealthy patients is that stomach dysfunction creates a cycle of poor emptying of gastric acidic chyme, and the more frequent and prolonged TLESRs in GERD thus reflux acid: http://www.ncbi.nlm.nih.gov/pubmed/22460568
  5. In 2006, study at the Medical College of Wisconsin, in Milwaukee, Wisconsin, found that scientific study shows that transient lower esophageal relaxations, a focal point of the GERD problem, is neurally controlled and must precede the reflux opening of the gastroesophageal sphincter. This definitively ended the debate that a simple excess of stomach acids and pressure from a full stomach was responsible for GERD: http://www.ncbi.nlm.nih.gov/pubmed/16401472
  6. In 2011, a study at Peking University in Beijing, China, found that electroacupuncture at ST36 and P6 could reduce both the frequency of transient lower esophageal relaxations (TLESR) and common cavity waves (sudden waves of increased pressure in the stomach). Prior studies showed that this appeared to be mediated at the brain stem and vagal nerve: http://www.ncbi.nlm.nih.gov/pubmed/22379788
  7. In 2005, a study at the Royal Adelaide Hospital showed that electroacupuncture stimulation at P6 acupuncture point inhibited the frequency of transient lower esophageal sphincter relaxations (TLESR) in response to gastric distention. The study used human volunteers and was randomized: http://www.ncbi.nlm.nih.gov/pubmed/15831714s
  8. A 2010 randomized controlled human clinical trial of a short course of standard acupuncture therapy for GERD and the standard protocol of a short-term course of gastric acid inhibiting drugs, at Xinxiang Medical College, in Hunan, China, found that 6 weeks of acupuncture treatment reduced measurable dysfunction in GERD as well as a combination of Omeprazole (Prilosec) and Mosapride (Prevacid), but that at 4 weeks after stopping treatment, the measured GI functions were still improved with the acupuncture therapy. Treatment in Chinese hospitals and clinics involves short frequent courses of acupuncture, repeated for a few courses, which is still rarely adopted in the United States with limited insurance and governmental health care coverage, but such studies show that proper TCM therapies could save much money in the long run. The addition of proper herbal and nutrient therapy to the acupuncture in the United States would insure a greater chance of success with less frequent needle stimulation: http://www.ncbi.nlm.nih.gov/pubmed/20697939
  9. In 2000, a meta-review of all scientific studies of GERD, by Professor Gajanan S. Gaude, head of pulmonary medicine at J.N. Medical College in Belgaum, India, noted that GERD is also linked to lung disease, especially COPD and asthma, and this often occurs even in the absence of a heartburn symptom. Symptoms such as chronic recurrent cough, wheeze, noncardiac chest pain, referred abdominal pain, and even postnasal drip with throat irritation are noted in these patients. Known contributors to GERD include the chronic use of antihistamines and theophyllines to treat allergies, asthma and COPD, as well as calcium channel blockers and nitrates to treat hypertension and cardiac disease. Consideration of the whole picture in the pathology of GERD is thus important: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714564/
  10. A 2015 study at the Tongji University School of Medicine, in Shanghai, China, noted that with improved diagnostic testing to differentiate Gastrointestinal Reflux (GER) chronic cough syndromes, which are now prevalent, that with improved technology the incidence of non-acid reflux related chronic cough is proving to be much more prevalent than previously assumed. Such study shows that the almost religious adherence to a simplified explanation for GERD and overprescription of acid-inhibiting drugs has indeed failed a great many patients, and that a holistic and restorative protocol is needed to correct this problem: http://www.ncbi.nlm.nih.gov/pubmed/26759577
  11. A 2015 study at China Medical University, in Shenyang, China, noted a prevalence of GERD in 64 percent of patients diagnosed with Idiopathic Pulmonary Fibrosis (IPF), and more importantly, the absence of typical acid reflux symptoms in these patients. For hospitals not set up to test with advanced esophageal pH monitoring, a simple GERDQ (DeMeester questionaire) could be successfully used to differentiate these patients to better guide treatment protocol. Of course, the adherence to a single type of problematic treatment, use of gastric inhibiting drugs, especially Proton Pump Inhibitors, with high risk of adverse effects over time, is not sensible, and integration of Restorative Medicine with CIM/TCM should be utilized: http://www.ncbi.nlm.nih.gov/pubmed/26674625
  12. A 2015 study at the Frederico II University School of Medicine, in Naples, Italy, showed that the incidence of Eosinophilic Esophagitis, a chronic immune disease associated with immune dysfunction and allergies, and often mistaken for GERD, is now reaching an unexpected high incidence in the adult population. The diagnosis demands esophageal biopsy, but a more careful diagnostic analysis and attention to problems with Proton Pump Inhibitor (PPI) responsiveness needs to be utilized, according to these experts. Treatment in standard medicine is problematic, as the elimination diets used for infants do not appear to work, and the too easy prescription of corticosteroid medication, now often used due to the failure of high-dose PPO therapy, presents many problems. The stubborn resistance to use of Complementary and Integrative Medicine (CIM) in the treatment protocol is leading to mounting crisis:http://www.ncbi.nlm.nih.gov/pubmed/26600973
  13. Experts at the University of North Carolina School of Medicine, in Chapel Hill, North Carolina, U.S.A. stated in 2014 that Eosinophilic Esophagitis (EoE) is now well known as a major cause of dysphagia (discomfort in swallowing and the sensation of a glomus or food impaction), and the now standard guideline to just use a very high dose of Proton Pump Inhibiting drugs (PPI) to treat this condition is very controversial. The findings of PPI-REE (PPI-responsive esophageal eosinophilia) has led to a belief that high-dose PPI therapy perhaps temporarily works by some inexplicable anti-inflammatory effects. These experts are obviously concerned that the guidelines of first using a very high dose of problematic PPI drugs when diagnosing this immune dysfunction disease is not actually sensible, but we see the extreme reluctance to even directly criticize such industry treatment guidelines: http://www.ncbi.nlm.nih.gov/pubmed/25904830
  14. A thorough 2007 descripton of the poorly understood childhood and adult Eosinophilic Esophagitis is presented here by the American Gastroenterological Association in the U.S.: http://www.gastrojournal.org/article/S0016-5085%2807%2901474-6/fulltext?refuid=S0002-8223%2811%2901543-4&refissn=0002-8223
  15. A 2012 review of scientific literature concerning the homeostasis of gastric acid and the complex hormonal feedback that regulates it by Virginia Commonwealth University Health System in Richmond, Virginia, reveals that modern medicine still has an incomplete understanding of the complex homeostatic mechanisms of gastric acid secretion. They acknowledge that normal and healthy gastric acid secretion is vitally important to digestion of difficult proteins, as well as absorption of a number of very important molecules vital to our health and well being. Gastric acid secretion also plays a vital role in immune protections and control of allergies. 5 systems interact to regulate the secretion of gastric acid: neural, hormonal, paracrine, chemical, and bacterial (biotic), and dysfunction of this complex array of systems is implicated in a number of common diseases. The implication is that restoration of gastric homeostasis is very important to our health: http://www.ncbi.nlm.nih.gov/pubmed/22954692
  16. An overview of the acid-base metabolism in the body is available at this website: http://www.enotes.com/nursing-encyclopedia/acid-base-balance
  17. In 2009, as study at the Tohoku University Graduate School of Medicine in Japan identified low stomach acid, or hypochloridia, as a significant independent risk factor in esophageal cancer, contradicting earlier assumptions that only high stomach acid was a significant risk. http://www.ncbi.nlm.nih.gov/pubmed/19513836
  18. A 2002 study of potential IBS patients at the GI Motility Center in Los Angeles found that 71 percentage of GERD patients studied tested positive for IBS (Irritable Bowel Syndrome), double the percentage seen in non-GERD patients being examined for various digestive disorders. http://www.ncbi.nlm.nih.gov/pubmed/11873099
  19. A 2000 study of inflammatory bowel pathology at Baylor College of Medicine, in Houston, Texas, found that adenosine deaminase deficiency, perhaps caused by proton pump inhibiting drugs with long term use, may lead to immunodeficiency of the small intestine, gut associated lymphoid tissues. http://www.ncbi.nlm.nih.gov/pubmed/10720488
  20. A 2006 study of the explosive growth in Clostridium difficile infection in the intestinal tract, a leading cause of both acute and chronic diarrheas, and now a common antibiotic-resistant infection acquired in hospitals and nursing homes, is heavily linked to both GERD and the use of acid-inhibiting drugs to treat GERD: http://wwwnc.cdc.gov/eid/article/16/2/09-0953-t3.htm
  21. A 2012 FDA warning noted that the chronic use of stomach acid inhibiting drugs known as proton pump inhibitors (Prilosec, Nexium, Prevacid, Protonix, Omeprazole, AcipHex, Zegerid, Vimovo, and Dexilant) may be associated with increased risk of acute and chronic diarrhea attributed to overgrowth of Clostridium difficile, a problem now prevalent in nursing homes and hospitals and largely caused by antibiotic-resistant strains of the bacteria: http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm290838.htm
  22. The U.S. CDC information on Clostridium difficile infections show that these account for 15-25 percent of all antibiotic-associated cases of diarrhea, the testing for C. difficile is very problematic and thus often is not performed, and that C. difficile is a spore-forming anaerobic bacteria that may easily return in growth after being eradicated with antibiotics: http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html
  23. A 2009 study at the GI Motility Program of Cedars-Sinai Medical Center in Los Angeles found that standard medication for acid reflux, the proton pump inhibitor, did not effect hydrogen production on lactulose breath tests in patients with Irritable Bowel Syndrome, a condition linked to hypochloridia, or poor stomach acid function. This signifies that either these drugs do not work, or that there is a condition of low stomach acid in IBS patients that would nullify the actions of the drugs, which include Prilosec, Prevacid, Nexium, Protonix, Aciphex and others. http://www.ncbi.nlm.nih.gov/pubmed/19834807
  24. A 2009 study at Kuwait University Department of Physiology found that omeprazole, a proton pump inhibitro (Prilosec et al), increased cellular uptake of adenosine to inhibit gastric acid secretion, potentially contributing to a deficiency of extracellular adenosine, a key inflammatory modulator that protects the intestines. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
  25. A 2009 study by the Digestive Health Center and Southern Tennessee Internal Medicine found that increased extracellular adenosine is an important modulator of inflammation that suppresses and resolves chronic inflammation in Irritable Bowel Disease. http://www.ncbi.nlm.nih.gov/pubmed/19777607
  26. A 2009 study published in the American Journal of Gastroenterology cites the link between chronic use of proton pump inhibitors, the chief medication prescribed for GERD, and hip fractures. High homocysteine levels imply a dysfunction of the glutathione metabolism, and you may read more about this on the article on Glutathione on this website: http://www.ncbi.nlm.nih.gov/pubmed/19240711
  27. A 2009 study at the Hacettepe University Department of Internal Medicine in Turkey found that the proton pump inhibitor omeprazole (Prilosec et al) is associated with low bone mineral density by inhibition of the absorption of calcium as well as inhibition of proton pumps in the bone, which imparied osteoclastic activity, or the absorption of calcium into the bone: http://www.ncbi.nlm.nih.gov/pubmed/19196364
  28. A large 2013 study by Kaiser Permanente, in Oakland, California, confirmed that acid inhibiting medications are significantly associated with increased risk of hip fracture due to malabsorption of essential minerals, especially when at least one other risk factor for osteoporosis was present, such as concurrent use of steroid medications and/or immune suppressant drugs, perimenopausal hormone imbalance, hyperthyroidism, hyperparathyroidism, deficiency of testosterone and estrogen, eating disorders, use of various medications to treat seizures, depression, autoimmune disorders, or cancer, as well as aging and family history. Since the most prevalent side effects of drugs used to treat osteoporosis are gastric symptoms, the prescription of gastric acid inhibiting drugs has been a common practice when biphosphonates and other osteoporosis medications are prescribed. To counter medication side effects with immune suppressants, steroids, antidepressants, and pain medications, acid-inhibiting drugs are also routinely prescribed, creating increased risk for osteoporotic fractures: http://www.ncbi.nlm.nih.gov/pubmed/20353792
  29. A 2002 study at the University of Colorado Health Sciences Center and Department of Pharmacy Practice found that the chronic use of histamine-2 receptor antagonists and proton pump inhibitors used to treat gastric acid pathology will likely lead to Vitamin B12 deficiency, a serious disorder that may cause pernicious anemia, neurological disorders and contribute to a host of health problems - it only took standard medical journals like the Journal of the American Medical Association (JAMA Dec.11, 2013, vol. 310(22) 2435-42) to publish the ongoing studies of JR Lam and Jim Ruscin, which showed that a significant B12 deficiency was expected in just 2 years of use: http://www.ncbi.nlm.nih.gov/pubmed/11978157
  30. A large cohort study designed by experts at The Johns Hopkins University School of Medicine, entitled the Risk in Communities study, found that chronic use of proton pump inhibiting drugs to treat gastric dysfunction was associated with a significantly higher risk of acquiring chronic kidney disease: http://archinte.jamanetwork.com/article.aspx?articleid=2481157
  31. A 2011 study and review of all scientific study regarding hospital-acquired pneumonia association with overprescription of gastric acid inhibiting drugs, performed by experts at the University of Michigan School of Medicine and Hospitals, noted that there is a high association between these drugs, such as proton-pump inhibitors (Nexium, Protonix, Prevacid, Omeprazole) and hospital-acquired pneumonia. The reasons for this is the reduction of the natural gut immune protections engendered by use of these drugs. The use of acid-reducing drugs also doubled the risk of acquiring Clostridium difficile diarrhea in the hospital. Restoring gastric function and improving gastrointestinal health and immune function with Complementary Medicine would actually lower the incidence of these infections, theoretically: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124633/
  32. A 2016 large retrospective cohort study by the German Center for Neurodegenerative Diseases found that chronic use of proton pump inhibitors to treat GERD was associated with a 44 percent increased risk for acquiring dementia with aging: http://media.jamanetwork.com/news-item/proton-pump-inhibitors-may-be-associated-with-increased-risk-of-dementia/
  33. A 2012 meta-review of all published randomized controlled human clinical trials (RCTs) of TCM therapies of asthma complicated by GERD, at Capital Medical University, in Beijing, China, showed that significant proof of efficacy of Chinese Herbal Medicine was evident in these clinical studies, although to date, only 6 high-quality RCTs had been published. Since this therapy is safe and inexpensive, integration into standard protocol would make sense for public health, yet there is still a strong reluctance to publish such scientific study in medical literature: http://www.ncbi.nlm.nih.gov/pubmed/22594096
  34. A 2012 study at Woosuk University in Chonbuk, South Korea, found that electroacupuncture stimulation at a single point, ST36, improved mucosal health, production of gastrin, serotonin, and calcitonin gene-related peptide, as well as insulin and pancreatic peptide. These were determined by immunohistochemical staining methods on biopsied tissue of the stomach and small intestine: http://www.ncbi.nlm.nih.gov/pubmed/22483184
  35. A 2010 study at Tsukuba University of Technology in Japan found that either manual or electroacupuncture stimulation has been proven in laboratory studies to improve gastrointestinal motility via spinal reflex and activation of sympathetic nerve responses, or the vagal nerve, depending on the points used: http://www.ncbi.nlm.nih.gov/pubmed/20663717
  36. A 2011 review of acupuncture in the treatment of gastrointestinal diseases by the Medical College of Wisconsin and Zablocki VA Medical Center in Milwaukee, Wisconsin, notes that acupuncture presents much promise in Integrative Medicine, exerting a number of scientifically proven responses to treat these diseases, and that the traditional explanation of balancing of Yin and Yang appears to correlate with modulating imbalances between the parasympathetic and sympathetic activity of the autonomic nervous system: http://www.ncbi.nlm.nih.gov/pubmed/21992155
  37. A 2012 randomized study of 500 patients with GERD, at Xinxiang Medical College in Weihui, China, found that a combination of herbal therapy and acupuncture stimulation provided better efficacy and long-term benefit, and better long-term results than standard medication (Mosapride, Omeprazole, Amitriptyline). The effects on refluxing times, times of long-term reflux, pH < 4 time per 24 hour period, bilirubin absorbance value, symptoms, endoscopic score, and quality of life were measured. A standardized electroacupuncture was used at ST36, Ren12, P6, LV3, and SP4, and Dalitong tablets (Chai hu, Zhi ke, Chen pi, Ban xia, Pu gong ying, hawthorn, Bing lang, Paederia scandens, Dang shen, Yan hu suo), a typical formula for gastic hypofunction and inflammation: http://www.ncbi.nlm.nih.gov/pubmed/22741253
  38. A 2013 randomized controlled study at the Babasaheb Bhimrao Ambedkar University School of Medicine, in Lucknow, India, showed that the oil of the herbal seed Perilla frutescens (Zi su ye) significantly improved esophagitis, inhibiting gastric acid, total acidity, and improving esophageal tissues, providing antioxidants, Omega-6 alpha linolenic acid, and other chemicals that modulate histamine type 1 and exert anticholinergic modulation: http://www.ncbi.nlm.nih.gov/pubmed/24027769
  39. A 2012 study at Chengdu University, in Sichuan, China, found in a randomized controlled human clinical trial, that acupuncture stimulation improved the symptoms of dyspepsia, and improved quality of life, with significant benefit over sham acupuncture. The true acupuncture was also found, with neuroimaging, to deactivate related cerebral activities, modulating effects related to dyspepsia in the brainstem, anterior cingulate cortex, insula, thalamus, and hypothalamus, while the sham acupuncture had no effect in these areas: http://www.ncbi.nlm.nih.gov/pubmed/22641307
  40. A 2002 study at the University of Colorado Health Sciences Center and Department of Pharmacy Practice found that the chronic use of histamine-2 receptor antagonists and proton pump inhibitors used to treat gastric acid pathology will likely lead to Vitamin B12 deficiency, a serious disorder that may cause pernicious anemia, neurological disorders and contribute to a host of health problems - it only took standard medical journals like the Journal of the American Medical Association (JAMA Dec.11, 2013, vol. 310(22) 2435-42) to publish the ongoing studies of JR Lam and Jim Ruscin, which showed that a significant B12 deficiency was expected in just 2 years of use: http://www.ncbi.nlm.nih.gov/pubmed/11978157