GERD: The Surprising Source of Many
RELATED DISORDERS (ARD)
By Dr, Kurt A. Barrett
GERD (Gastroesophageal Reflux
Disease), a simple diversion from the normal state of health (specifically
the movement of hydrochloric acid and stomach contents upward into the
food tube) causes the body to protect itself and results in “sinus”,
“allergies”, and other medical conditions. There is no recognized
entity of GERD in non-industrialized countries. I wish I knew why.
Hydrochloric acid is one of the
harshest, most chemically irritating substances there could possibly be.
All people make hydrochloric acid. It’s intended to aid digestion and be
confined to the stomach except when it travels “downstream” where it
is immediately diluted as part of normal digestion. Something in our
industrially developed cultures causes our bodies to change. A one way
muscular check valve at the stomach-esophagus junction is the barrier to
regurgitation and is intended to contain acid within the stomach. It
somehow fails to keep the acid where it belongs. The acid escapes
upwardly, past the check valve into the esophagus. The esophagus was not
designed for exposure to corrosive gastric contents. Our body very
correctly interprets this as a clear and imminent danger. The afferent
(input) portions of the autonomic nervous system perceives the dangerous
nature of this acid located in a place where it is not
supposed to be. A very significant warning signal is generated. It
tells the body to respond in a protective fashion. The tissues of the body
respond through a variety of mechanisms including making mucous. The
response mounted by the body takes the “edge” off the caustic nature
of the regurgitated stomach contents. This reaction by the body tries to
prevent the acid from traveling further from its point of origin.
Depending on how your body reacts to this whole scenario you
may not have heartburn or it may be mild or infrequent. It is not
intuitive that something that happened the night before while you were
asleep (regurgitation of stomach acid) results in problems the next day.
As the stomach contents move up in the food tube one of the major dangers
is contact with the extremely fragile and delicate tissues of the lungs.
Most lay people and, a great number of health care professionals believe
that this event (the movement of the stomach contents into the esophagus
from the stomach) is heralded by heartburn. It often is,
but not in everyone all the time! Historically we have believed
that reducing the caustic nature of the regurgitated stomach contents, to
the extent that relieves heartburn, is “good enough”. I see this all
the time. Patients and doctors alike treat only enough to keep heartburn
under control. The more involved I have become in this issue of acid
related disorders, the more perplexed I am by this style of thinking.
Other, very troublesome problems are in want of resolution! This model of
therapy is driven by traditional, widely disseminated guidelines for
therapy. Medical professionals are repeatedly reminded to follow these
recommendations. Deviation from this standard care demands labor
intensive, time consuming justification. This makes professional life
frustrating. I have a daughter who wouldn’t be better if
for GERD with heartburn were adhered to.
The body can respond to this escaped
acid in a number of ways: blood vessels are directed to leak like a
sprinkler system; tissues weep to cause swelling; muscles are encouraged
to squeeze and contract to the point of spasm; and an altered gummy,
sticky mucus can be produced. All this in an effort to neutralize, trap,
dilute, and absorb the dangerous stomach contents that have traveled up
the esophagus from the stomach thru the faulty check valve. The body
perceives this as such an immediate danger that it diverts its limited
resources away from other health issues. The demands placed on the finite
resources our body has to protect the esophagus, and respiratory tract can
use up our “metabolic energy”. There are studies that show alterations
of the reticulo-endothelial system (the immune system) and this represents
a very serious consequence. The body’s defense mechanisms can only
protect against a certain number of insults at any one given time. It’s
as if the body makes a priority list of what and just how dangerous these
insults are. It also appears that reflux of stomach contents, moving in
the direction of the respiratory tract, is extremely high on the list of
things that need to be protected against. In doing this, the body seems to
ignore, or is unable to cope with, other less immediate, although
extremely significant insults.
A pH scale is a “thermometer of
acidity”. The scale goes from 0-14, 7 is neither acidic, nor basic, but
“neutral”. Stomach acid routinely measures below 2.0 on this scale,
thus making it extremely acidic. Because we make acid during the night
time hours, people may awaken in the morning with their most profound
symptoms. Unless they encounter other irritating events, they sometimes
get better as the day goes on. Their symptoms may become less troublesome.
This is not always the case by any means. It is harder for the acid to
“climb” the esophagus when you are up and around all day than it is
when you lie down at night because of gravity. However, some occupations
and activities seem to predispose to this daytime reflux. One example is
long haul truck drivers. They spend a great deal of time sitting, often
with a belt that acts like a cinch. This gives a “tourniquet effect”
to the bowel which causes a low grade obstruction to the flow of
intestinal contents. The end result is a large percentage of truck drivers
Bending over at the waist can act
the same way. One elderly patient recently caused an episode of sinus
problems. She was picking strawberries, something she would not ordinarily
do, but her husband was too ill to pick them. She would use her cane as a
support, placing it firmly against her upper abdomen and then bend at the
waist because of arthritic knees and ankles. The cane thus pressed against
her stomach while she picked strawberries. It didn’t cause any abdominal
pain or heartburn. It made her believe she had contracted some type of
sinus trouble. In fact, she was forcing the stomach contents up into the
food tube with her posture. Her body made the mucous in the sinuses
because of the “close connection” to the esophagus. All this as an
automatic reflex to protect herself from the dangers of the stomach
contents being forced up the food tube toward the respiratory tract. The
end result was sinus trouble. No gastrointestinal complaints at all. Treat
her stomach acid regurgitation and the sinus problem disappears.
Another lady is in complete
remission from GERD and sinus symptoms except when she plays golf.
“There is something on the golf course that makes my eyes water, my nose
runs and I cough. I must be allergic to something there.” It turns out
that she is not allergic or coming in contact with sensitizing chemicals
or other external substances that caused her to produce the mucous. It was
what she does while she is on the golf course. Bending over at the waist
to handle the golf ball causes the retrograde flow of stomach contents
into the esophagus (no heartburn mind you). The body is protecting her
from this acid reflux by making mucous. Not just by making mucous in the
esophagus, but in the ears, nose, throat, and elsewhere.
GERD is a problem that runs in
families. In my experience there is rarely just one family member
involved. This is an extremely common condition that affects millions of
Americans. The first step in solving a problem is recognizing that a
problem exists. Right now, until we get a better concept about why gastric
contents escape so frequently, therapy that helps the majority of people
is reducing the harshness of the stomach acid. This doesn’t “cure”
everyone because there are different reasons why people regurgitate
stomach contents. The proton pump inhibitors (Prilosec, Prevacid, Aciphex,
Protonix, and Nexium) are all very closely chemically related. These
medications are non-toxic, extremely well tolerated, and appear to be very
mild in terms of side effects. The overwhelming majority of authorities
agree that these medicines are not only effective, but extremely safe,
both long and short term.
One has to consider the potential
consequences of untreated acid reflux disorders. Untreated GERD, as
medicine understands it now, rarely causes immediate life threatening
consequences. It can claim lives when it results in bowel hemorrhage, scar
tissue of the lungs, intractable asthma, recurrent pneumonia, cancer of
the voice box, and more. Mostly GERD makes people miserable and adversely
effects the quality of life. It’s a chronic disease. Each day, people
awaken after being “under attack” by their own secretion, hydrochloric
acid. Some days are worse than others. Oftentimes, how miserable they are
depends on what happened in their esophagus the night before.
Sleep disturbances can cause GERD
and conversely GERD can also cause sleep disturbances. Beware that sleep
apnea associated with GERD, can be either a cause or a result. There
appears to be an unusually high incidence of gallbladder problems
associated with GERD. Gallbladder disease can cause GERD symptoms.
Likewise, the GERD mechanics can result in gallbladder disease.
GERD does not discriminate by age,
race, or gender. The youngest patients I have successfully treated are
around two years old and the oldest have been over one hundred.
Typical symptoms in some GERD
patients are complaints about the kind of mucous they make. It is so
sticky that they feel as if they have to reach into the back of their
throats and literally pull the mucous out. Some of this sensation is
caused by swelling of the throat tissues in conjunction with this special
thick, dense, sticky, adherent mucous.
If your mother didn’t tell you,
“nothing smaller than your elbow in your ear,” she should have. Cotton
swabs can easily damage the ear canal. GERD patients have an unusual
propensity to feel the necessity to aggressively clean their ears, often
with cotton swabs after they shower. This is strictly forbidden, instead
they might try a few drops of rubbing alcohol in the ear to evaporate the
water. In these individuals, the ear canal is already swollen and hence,
hypersensitive. They can’t stand anything (water) in the canal of the
ear so they “go after it”.
People who say, “I can’t swallow
pills. I’ll gag,” are almost always GERD patients. After a few days of
GERD therapy they often can swallow any size pill.
Halitosis in my patients is
exclusively related to GERD. Halitosis is not the result of poor oral
hygiene. It is a result of making excessive mucous which clings to the
teeth and hence allows bacteria to grow. Bacterial growth results in this
characteristic odor. The mucous is so adherent to the teeth that they are
unable to brush it away no matter how often and how hard they try. Only a
small minority of GERD patients have halitosis. Every halitosis patient I
have ever seen I believe had GERD. The same goes for that person at the
water cooler who always “sniffs” and clears their throat. They almost
always have GERD. I say that because they have usually been treated and on
their own have tried numerous remedies without relief.
If you are doing your own research,
key words are: acid reflux, laryngotracheal reflux, gastro-esophageal
reflux, gastric reflux, esophageal reflux, esophagitis, hiatal hernia,
GER, NERD, non-erosive reflux disorder, extra-esophageal manifestations of
GERD, atypical symptoms of GERD, silent GERD, and GERD.
Dr. Andrew Taylor Still, M.D. D.O.,
Civil War surgeon founded Osteopathy over 100 years ago on the belief that
the body can heal itself. I understand this concept more clearly since I
have seen spectacular outcomes from treating GERD. When wayward acid is
reduced or contained the body says, “Thank you for helping”. The
activated protective mechanisms are no longer engaged and a state of
health ensues. This quality of life can be truly remarkable. As a result
of moderating the stomach acid, I have had people comment, “This is the
best I have felt in 10, 15, 20 years or more.” There is more here
through GERD and the autonomic nervous system than just sinus and
respiratory problems. Many other troublesome symptoms (diarrhea,
constipation, rectal bleeding, fatigue, recurrent infections, joint pain,
and the list goes on) resolve; often for the first time in a person’s
memory, through the treatment of silent GERD.
The normal state of the body is a
state of health. Something about western civilization with industrialized
societies results in this phenomenon of acid related disorders (ARD). I
don’t know what initiates this process, but I certainly would like to
find out. Research on this topic through Michigan State University is
being assessed as we go to print. These ARD’s plague a huge number of
people as manifested by the first proton pump inhibitor, Prilosec, being
the number one prescribed medication in the United States. One capsule of
any strength proton pump inhibitor is usually enough to relieve heartburn.
There is more to the story than just heartburn. Remember that this most
common prescription medication in the United States is being used to
relieve heartburn. The majority of people that have this condition have
never had heartburn or never consider their heartburn serious enough to
treat. Heartburn IS NOT normal. Since it occurs so commonly, it appears to
be a consequence of life in our current environment. Even though millions
of people in the United States suffer from heartburn every day, it should
not be regarded as “just one of those things”. I would like to add
here that these medications, the proton pump inhibitors, are superb at
healing peptic ulcer disease. They are so effective, along with other
newer techniques (like eradicating Helicobactor-pylori bacteria with
antibiotics) that peptic ulcer disease is actually becoming rare. It will
soon be “retired” to take its place in the archives of medicine
alongside smallpox, diphtheria, and other infectious diseases.
A German philosopher once said
“The eyes only see what the mind knows”. I truly believe that the
future of improved health will be thru better understanding of
particularly silent, atypical, supra-esophageal manifestations of GERD
(NERD) or what we may end up someday calling SNERD (silent non-erosive
esophageal reflux disorder).
Sir William Osler, one of the
greatest physicians of all time, noted the relationship between ASTHMA and
a DISTENDED STOMACH over one hundred years ago! It’s high time we
followed up on his observations because within the body there lies a cure.
Are You Sick of Being Sick?.
Copyright © 2002 by Barrett Publishing and Dr. Kurt A. Barrett, D.O.
Excerpted by arrangement Dr. Kurt A. Barrett. $14.95. Available in local
bookstores or call 800-351-7828.