Acid Reflux and Gastro-Oesophageal Reflux

WHAT IS ACID REFLUX?

Acid reflux happens when stomach contents and gastric acid travel from the stomach back up into the oesophagus to cause discomfort and pain.  

Acid reflux is a major symptom of Gastro-Oesophageal Reflux Disease (GORD/GERD). Heartburn is a symptom of acid reflux. 

It is normal for some reflux to occur after meals, as the food and drink travel down the digestive tract but this doesn’t normally cause discomfort.

Chewing breaks down the food in the mouth into small pieces. It then travels down the oesophagus into the stomach.  The gastric juices in the stomach break the food down into smaller molecules and the resulting chyme enters the small intestine for further digestion and absorption before being passed into the colon. Disruptions to this flow causes reflux.

ACID REFLUX SYMPTOMS

Heartburn is the burning sensation in the middle of the chest and throat.  It is extremely common and affects up to 25% of adults in the UK.1

Other symptoms commonly associated with acid reflux, heartburn and GORD are regurgitation, difficulty swallowing (due to inflammation), feeling bloated, upper abdominal discomfort, nausea, burping, mucus, post-nasal drip and shortness of breath.

The reflux acid can often irritate the airways and make asthma and wheezing worse.

GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)

What is GORD?

Gastro-oesophageal reflux disease (GORD/GERD) is a chronic condition where the stomach contents reflux into the oesophagus regularly.

The gastric acid strips away at the lining of the oesophagus and causes it to become irritated and inflamed. If the inflammation is severe, it can lead to ulcers and other complications, such as oesophagitis, stricture formation and aspiration pneumonia, to name a few.2 .

The oesophagus can cope with a small amount of acid but the lining will get damaged with too much.  Some people are more sensitive to acid in their oesophagus than others.

Causes of reflux

The body has natural protective mechanisms in place to maintain a balanced state so that reflux doesn’t happen. These mechanisms include the lower oesophageal sphincter (LES), mucosal resistance and clearing the acid in the oesophagus. GORD develops when these protective mechanisms are overcome. This could be due to an impaired LES at rest or short term LES relaxations. It could be as a result of the acid in the oesophagus not being cleared properly and/or if the gastric contents are not emptied efficiently and in time.

Why does this happen?

As the food enters the oesophagus, the upper sphincter opens to let the food pass through and then closes. The oesophagus pushes the food down in waves.  At the lower end of the oesophagus, the lower sphincter (LES) opens to allow the food to pass into the stomach. The LES is a muscular ring which connects the oesophagus to the stomach and ensures that the food flows one way down into the stomach. 

The LES normally relaxes just before the oesophagus contracts and this allows food to pass from the oesophagus to the stomach.  At rest, the LES is normally of a higher pressure than in the stomach. For some patients with GORD they constantly have a weak, low pressure LES. This allows reflux every time the pressure in the stomach is higher.  Factors that decrease LES pressure include hormones, medications, specific foods (high fat-content meals, caffeine, alcohol) and smoking. Factors that increase the pressure in the stomach are ineffective digestion, absorption and emptying of the gastric contents, due to a non-optimal level of acid.

What is happening in the stomach?

Whether some substances are absorbed by the stomach or not depends on the pH level of the gastric contents.  At a low pH(acidic), substances are absorbed easily whereas at higher pH levels, absorption is slower. It is important that the pH level of the gastric juice remains at an optimal level for the digestive process to work properly.

Gastric juice is a mixture of water, acid, electrolytes (sodium, potassium, calcium, phosphate, sulphate and bicarbonate) and organic substances (mucus, pepsins and protein).  The content of the hydrochloric acid makes it highly acidic. Bicarbonate is produced when the acid passes from the stomach to the small intestine and this helps to immediately dilute and neutralise the acid which helps to protect the intestinal lining.

There are 6 different types of cells in the gastric mucosa which all play an important role in maintaining the pH level of the gastric juice. The cells do this by secreting essential substances such as mucus, bicarbonate, gastrin, histamine and hydrogen ions which are all needed for the process.

Of the 6 different types of cells, the most important ones are the parietal cells because of their acid secreting ability. Histamine is the primary modulator involved.  Histamine and parietal cells are essential in the regulation of acid secretion. Their ability to regulate and secrete acid plays an important role in acid reflux. Parietal cells respond to three stimulators for acid secretion and histamine is the primary one.

If the balance of chemicals is disrupted (due to foods, stress, illnesses or medication) then this can affect the pH levels. Any change in the pH affects how much acid is produced for digestion. For example, the pH level of the gastric juice will be affected by too much histamine and/or ammonia. The levels of histamine and ammonia can be the result of food, illnesses, medication, lifestyle and/or stress.

The composition of the meal also affects the rate at which the stomach empties.  Carbohydrates empty the fastest, then proteins, and fat is the slowest to empty. Some hormones, especially those released after digestion of fat, can also supress acid secretion. 

What else can help protect against GORD?

Fast and effective acid clearance in the oesophagus is an important protective mechanism against GORD.  Longer exposure to acid will injure the oesophagus more severely.

The oesophageal mucosa contains several components to help protect it from toxins. This includes the bicarbonate from saliva and secretions in the oesophagus and bicarbonate in the epithelium, which act as a buffer and help to protect.

High acid reflux, medication and certain foods can overwhelm the epithelial defence mechanism.

Acid Reflux, SIBO and H. pylori

Small Intestinal Bacterial Overgrowth (SIBO)

The small intestine only has a small number of bacteria. This small quantity must be maintained and kept low in order to avoid illnesses associated with an overgrowth.  Overgrowth of ‘bad’ bacteria in the small intestine causes irritation in the intestinal lining which affects the permeability of the intestinal wall. 

Stomach acid is produced to aid digestion and to kill pathogens before passing chyme through to the small intestine.  Low stomach acid prevents this and interferes with the gut microbiome by allowing pathogens through, which slows down digestion in the small intestine.  This results in the gastric contents being emptied more slowly which then affects the stomach acid and the vicious cycle carries on.

H. pylori Infection

According to Public Health England, one of the patient groups who should be tested for H. pylori are patients with dyspepsia.  Dyspepsia is a common group of symptoms associated with GORD.  Dyspepsia covers a range of symptoms which include upper abdominal pain/discomfort, heartburn, gastric reflux, nausea/vomiting.   

H.  pylori bacteria colonise in the stomach and increases inflammation.  It stimulates histamine producing cells and increases an enzyme that creates histamine.  In order to increase its survival rate in the stomach acid, H. pylori breaks down the urea in the stomach, into carbon dioxide and ammonia, which causes belching.  This increase of pressure in the stomach will affect the pressure balance between the stomach and oesophagus which then leads to reflux.  The H. pylori bacteria use the ammonium to survive in the gastric acid.  As the gastric juice must remain at an optimal level of acidic pH during digestion, any imbalances will have a negative impact on digestion and the balance of acid and will lead to reflux. An H. pylori infection (too acidic due to increased histamine or not acidic enough due to production of ammonium) will cause such an imbalance.

ACID REFLUX AND GORD/GERD SOLUTIONS

A change in diet and lifestyle can help. This includes avoiding trigger foods such as fried/fatty foods, chocolate, caffeine, alcohol, citrus, peppermint, carbonated drinks, tomatoes, garlic, onions) and eating smaller meal portions.  Avoid laying down soon after food, allowing 3 hours after food if possible.  Tight clothing and any pressure on the stomach can make reflux worse. To help with reflux in the night, go to bed with the upper body slightly raised.  Stress, smoking and certain medication can also cause reflux.  Regular exercise and reducing any excessive weight will also help.

Proton Pump Inhibitors (PPIs) and H2 blockers are often used to treat reflux.  They work by reducing the amount of acid produced in the stomach. Although they help with reflux, overuse results in reduction of stomach acid. This leads to pathogens being passed down the digestive tract and causes issues such as SIBO which in turn can affect reflux.

Excessive histamine and ammonia in the stomach affects the balance of chemicals in the gastric juice.  This leads to the inefficient production of acid and the ineffective digestion of food in the stomach. The result is reflux and other undesirable conditions and inflammation of the gut lining.

Removing excessive histamine and ammonium from the body will bring the pH of the gastric juice back to an optimal level and allow the body’s natural effective mechanisms of acid secretion to resume.

What role do MANC® particles play in helping with Acid Reflux?

MANC® (Modified Activated Natural Clinoptilolite) particles are the safest and most effective form of clinoptilolite zeolite which have the ability to bind to and eliminate histamine, ammonium and heavy metals from the body.

Toxaprevent Medi PLUS Sachets are specially formulated to target the upper digestive tract, including the oesophagus and stomach. The MANC® particles bind and remove excess histamine and ammonium, thereby optimising the pH levels of the gastric contents. The PLUS Sachets also contain calcium carbonate and magnesium carbonate which will help to relieve the symptoms of acid reflux more immediately with the soothing effect on the oesophagus and stomach.

For references and the full article, or for information on the applications of MANC® and how it could help you, please contact us on info@nhinnovations.com or on 02476 363873.