Probiotics, defined as ‘live microorganisms, which when administered in adequate amounts, confer a health benefit on the host’, are finally becoming an option for gastroenterologists in Canada, after being available for many years in Japan, Europe and the United States of America. Unfortunately, Health Canada and the US Food and Drug Administration have not controlled the use of the term ‘probiotic’ or put into place United Nations and World Health Organization guidelines. The net result is that a plethora of products called ‘probiotics’ are available that are not truly probiotic. Make no mistake there are some dangerous strains of probiotics.
Heartburn is a burning sensation in the chest that can extend to the neck, throat, and face. It is often worsened by bending over or lying down. It is the primary symptom of gastroesophageal reflux disease (GERD), which is the movement of stomach acid into the esophagus. GERD is caused by frequent acid reflux, the backup of stomach acid into the esophagus. When swallowing, the lower esophageal sphincter which is a circular band of muscle around the bottom part of the esophagus, relaxes to allow food and liquid to flow down into your stomach. Then it closes again. However, if this valve relaxes abnormally or gets weak over time, stomach acid can flow back up into the esophagus, causing frequent heartburn episodes (Figure 1). This constant backwash of acid can irritate the lining of the esophagus, causing it to become inflamed. Chronically, the inflammation can erode the esophagus, causing complications such as bleeding or breathing problems.
Risk Factors for the Development of GERD
There are several potential risk factors for the development of GERD, with the most common two being obesity and aging in general. GERD risk increases with age as the body becomes less efficient in carrying out digestive processes. Other risk factors for the development of GERD are having a hiatal hernia, pregnancy, excess alcohol consumption, smoking, dry mouth, asthma, diabetes, delayed stomach emptying – usually from over eating or as a result of having connective tissue disorders such as scleroderma, or Zollinger-Ellison syndrome. In addition, certain drugs such as: diazepam (Valium), meperidine (Demerol), theophylline, morphine, prostaglandins, calcium channel blockers, nitrate heart medications, anticholinergic and adrenergic drugs (drugs that limit nerve reactions), including dopamine, can relax the lower esophageal sphincter, leading to GERD issues.
Complications of GERD
Chronic inflammation from GERD can lead to the following complications: Esophageal narrowing (stricture) – Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing difficulty swallowing.Ulcers – Stomach acid can severely erode tissues in the esophagus, causing an open sore to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.Precancerous changes to the esophagus (Barrett’s esophagus) – In Barrett’s esophagus, the color and composition of the tissue lining in the lower esophagus change. These changes are associated with an increased risk of esophageal cancer and esophageal rupture over time.
Treatment Options for GERD – The Pros and Cons of Using Standard Medications
Antacids (e.g. Rolaids, Tums): work to neutralize stomach acid and may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation. H2 blockers (e.g. Tagamet, Zantac): reduce the production of stomach acid. This makes the stomach less acidic so that any digestive juices that get into the esophagus are less irritating. This relieves symptoms and allows the esophagus to heal.Proton Pump inhibitors (PPIs) (e.g. Nexium, Prevacid): work by blocking the “pump” that transports acid into the stomach, thereby decreasing the acidity and the overall volume of gastric acid. Proton pump inhibitors are also used to treat stomach ulcers caused by bacteria (Helicobacter pylori) or drugs (non-steroidal anti-inflammatory drugs, NSAIDs). They are also used to promote healing in erosive esophagitis.Common side effects from these medications: Some of the common side effects of using these medications can include constipation, diarrhea, nausea, abdominal pain, dizziness, drowsiness, headache, runny nose, sore throat, rash and weakness.
Heliobacter pylori (H. pylori) and GERD – A Confusing Issue
H. pylori (Camphylobacter) is a gram-negative bacterium found in the stomach. It is frequently observed in patients with chronic gastritis and gastric ulcers, conditions that were not previously believed to have a microbial cause. It is also linked to the development of duodenal ulcers and stomach cancer. However, over 80 percent of individuals infected with the bacterium may be asymptomatic. The relation between H. pyloriinfection and gastro-oesophageal reflux disease is controversial. Studies on the prevalence of H. pylori in patients with gastro-oesophageal reflux disease have given conflicting results. Recent guidelines recommend eradication of H. pylori in patients requiring long term proton pump inhibitors, essentially for reflux disease.In a systematic review of 20 GERD studies, the prevalence of H. pylori infection was significantly lower in patients with GERD, than without. However, geographical location was a strong contributor to the differences between studies. Patients from the far east with reflux issues had a lower prevalence of H. pylori infection than patients from Western Europe and North America, despite a higher prevalence in the general population.
What About Other Natural GERD Treatment Options?
De-Glycyrrhized Licorice (DGL): Most people don’t get ulcers because of over secretion of acid. The cause in many cases is a breakdown in the integrity of the intestinal lining. While common drugs including antacid medications can block symptoms and promote temporary healing, they don’t address the underlying cause. DGL addresses the underlying factors to help promote true healing. Rather than inhibit the release of acid, licorice stimulates the normal defense mechanisms that prevent ulcer formation. Specifically, flavonoids present in DGL inhibit the growth of H. pylori (in vitro), while the whole extract improves both the quantity and the quality of the protective substances which line the intestinal tract, increases the life span of intestinal cells, and improves blood supply to the intestinal lining. Mastic Gum: has been shown to wipe out H. pylori bacteria, the cause behind the majority of gastric and duodenal ulcers. Clinical studies have clearly shown the effectiveness of this resin with 80% of patients receiving mastic gum for two weeks reporting significant improvements in their symptoms.
Zinc-Carnosine: has received much attention lately thanks to its ability to up-regulate key antioxidant enzymes thereby preventing free radicals from damaging cells. Studies have confirmed that Zinc-Carnosine has antiulcer properties and prevents gastric mucosal injury. Animal studies also show that Zinc-Carnosine is indicated in H. pyloriinfections as the molecule prevents the development of H. pylori related gastritis. Potassium Nitrate: is a precursor to Nitric oxide. Nitric oxide is a potent vasodilator and increases blood flow to the gastric mucosa, enhancing repair and the inflow of nutrients and oxygen. Higher nitric oxide levels in the stomach were also shown to increase effective peristalsis movements. Studies also clearly demonstrate that Nitric oxide precursors are effective anti-inflammatory agents with protective effects against gastritis.Alginic acid: a viscous substance found in algae which absorbs water extremely quickly to form a “raft” on top of the gastric contents. This “raft” has two effects: it prevents the gastric contents from being pushed back up the esophagus and also coats the esophagus if the gastric contents were to reach the esophagus. An added bonus is that alginic acid works extremely quickly providing relief within a few minutes.Many of the previously mentioned ingredients are found in Gastro Relief (an AOR formula). The premise behind Gastro Relief is to provide quick and effective relief from the symptoms of heartburn while addressing any fundamental pathology which would cause the problem. Heartburn is a very common condition that needs quick attention. Ignoring symptoms can lead to long term complications. Standard medications may be helpful but may not address the underlying causes, and long term use may result in undesirable side effects. Natural treatments as outlined above can be very effective for many individuals and should be seriously considered as an option for first line treatment.
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