02/12/2023
SIBO is a risk factor for developing gastroesophageal reflux disease (GERD). Small intestinal bacterial overgrowth (SIBO) by-products (gases) can impact the lower esophageal sphincter (LES), the junction that separates the esophagus from the stomach, resulting in GERD symptoms. For example, increased gas pressure from the fermentation of foods by the overgrowth of bacteria in the small intestine leads to acid reflux due to the gas's pressure resulting in the LES's forced opening. The LES has to hold against this pressure. If the LES is too weak to maintain the pressure, it opens, resulting in reflux.
In addition, unnecessary treatment with proton pump inhibitors (PPIs) may predispose to developing SIBO. The duration of PPI use has been shown to significantly increase the risk of SIBO, highlighting the need for appropriate prescribing and scaling down of PPIs. In addition, PPIs can lead to a higher likelihood of developing food allergies in children, which may be avoidable if SIBO is ruled as a cause of GERD symptoms and treated accordingly. In a study of GERD patients receiving a PPI, SIBO was detected in 8.3% of cases (0-6 months of treatment), 21.7% (6-12 months of treatment), and 61.6% (over 12 months).
In another study, prolonged PPI treatment was proven to produce bowel symptoms and SIBO; therefore, PPI therapy should be carefully used and perhaps should be minimized in GERD.
Anyone suffering from GERD should always test for SIBO through a simple breath test. The eradication of SIBO will reduce pressure on the LES, significantly reducing the symptoms of GERD.
THE REAL DEAL ON GERD AND PPIs
Having tested many patients with acid reflux using the Heidelberg pH Diagnostic medical device, I have never encountered anyone who presented with hyperchlorhydria (too much stomach acid). Instead, they tested positive for hypochlorhydria (low stomach acid) and one patient with achlorhydria (no stomach acid). The problem with "heartburn" or acid reflux is not that there's too much acid in the stomach; the problem is the involuntary opening of the LES due to injury, scarring, or weakness. You're prescribed PPIs not to reduce high levels of stomach acid but to significantly lower the risk of having just one tiny drop of stomach acid getting into the esophagus where it isn't supposed to be. This is because the stomach lining is built for the acidity of hydrochloric acid, whereas the LES is not.
The importance of stomach acid cannot be overstated. When food is eaten, the secretion of stomach acid (HCL) triggers the production of pepsin. Pepsin is the enzyme required to digest protein. If HCL levels are insufficient, pepsin will not be activated to break down complex long-chained proteins. As a result, proteins don't get broken down into their component amino acids and peptides. This can lead to a deficiency of essential amino acids, leading to chronic depression, anxiety and insomnia. In addition, proteins that escape digestion by pepsin may end up in the bloodstream. The body reacts to these proteins as foreign invaders, causing allergic and autoimmune diseases.