A Discussion on Non-Surgical “Acid” Reflux Treatment
When our patients discuss their chronic reflux or GERD, a condition that affects more and more people every year as we continue to struggle with the obesity epidemic, we often add the word “acid.” To some degree, this makes sense as the stomach produces acid, which has a known adverse effect when refluxing onto the sensitive lining of the esophagus. But does including the word acid miss the point of reflux therapies? And is treating the acid alone enough to neutralize the damaging effects of reflux? The answer is a resounding no, and there are a few reasons.
Even without acid, the fluid refluxing into the esophagus is still caustic. Not many patients know or understand this, instead thinking that taking antacids or proton pump inhibitors (PPIs) has solved their issue and risk of esophageal damage in the future. But the stomach can also pass into the esophagus base or alkaline compounds that can be just as harmful to the esophagus as the acid we commonly treat. It’s good to analogize this with an ordinary alkaline battery in many electronics. If the battery has been in the device long enough, the alkaline liquid often spills out. This high-pH liquid is the opposite of acid but has similar corrosive effects. A similar situation can happen in the stomach. When we neutralize the acid with antacids or inhibit the production of stomach acid through PPIs, we don’t address the root cause of the reflux but rather allow alkaline gastric juices to reflux into the esophagus. This is why surgical intervention is the only permanent solution to avoid damage to the sensitive lining of the esophagus that can result in precancerous (Barrett’s Esophagus) or malignancy.
What Are the Consequences of PPIs That Target Acid in the Stomach?
The acid in our stomach is balanced to help with digestion and the normal function of the GI system. When we inhibit this acid production, we may allow for abnormal bacterial proliferation, including the possible build-up of harmful bacteria in the stomach that would have otherwise been controlled by the very harsh environment created by the acid. A 2016 study in the BMJ showed that PPI use created bacterial deviation in the stomach and gut, and a more significant number of oral and pathogenic bacteria were found in the GI system of PPI patients.1
PPIs are only approved for six weeks of continuous use. But many patients believe there must be little or no risk of taking them longer since they are now sold over the counter. This is decidedly untrue; Long-term PPI use has been shown to increase the risk of bone fractures, amongst other side effects. And, of course, as with most medications, they do not address the root of the problem. As soon as they are discontinued, acid production in the stomach will restart, and patients will again feel the adverse effects of stomach juices washing up into the esophagus.
For those patients concerned about a surgical procedure, the significant rise in esophageal dysfunctions, malignancy, and other concerns has led to innovations to treat it. For decades, our only and best option was a fundoplication, where the upper part of the stomach was wrapped around the base of the esophagus to offer extra pressure and keep gastric juices where they belong. Now, this is an excellent surgery and one that we still use today in certain patients; but we also have a tiny implantable device known as the LINX reflux management system that wraps around the lower esophageal sphincter – the valve that separates the stomach from the esophagus. This creates enough pressure to stop reflux but not too much that food and drink cannot pass through. With these two options available, our patients have a minimally invasive, safe, and effective way to control their reflux. They also avoid the longer-term issues associated with PPIs and the resultant suppression of acid production in the stomach. We encourage you to contact our office to learn more about these procedures and whether you may be a candidate.
As a final note; for patients also suffering from obesity and who qualify for bariatric surgery, gastric bypass is, at its core, partly an anti-reflux procedure. Bypass patients resolve their reflux alongside incredible improvements in medical problems, including diabetes and, of course, excellent weight loss. We encourage you to speak to our office about bariatric surgery, especially now that bariatric patient qualification guidelines have been revised to be more inclusive and reflective of today’s excess weight reality.
1Imhann F, Bonder MJ, Vich Vila A, et al Proton pump inhibitors affect the gut microbiome Gut 2016;65:740-748.