Is GERD an Autoimmune Disease? | Chris Kresser

Is GERD an Autoimmune Disease?

by Chris Kresser

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Woman with heartburn
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GERD is an extremely common problem in the U.S. 44% of Americans suffer from it at least once a month, and 20% suffer from it weekly. (1) Drug companies make $7 billion a year selling acid suppressing drugs – primarily proton pump inhibitors (PPIs) like Prilosec and Aciphex.

The popularity of these drugs is predicated on the idea that GERD is caused by stomach acid burning the esophagus. This is known as the “chemical burn” theory. It holds that GERD develops from caustic, chemical injury that starts at the surface layers of the esophagus and progresses through the tissue to the deeper layers (the lamina propia and submucosa). (2)

Early animal research seemed to support this. Studies showed large quantities of stomach acid with a pH of less than 2 does damage the esophagus. (3) However, the concentrations of acid used in these studies are much higher than those normally found in human episodes of reflux. In fact, the vast majority of human reflux episodes have a pH of more than 2 and are incapable of causing esophageal damage. (4)

What If GERD Is Not Caused by Acid Burning the Esophagus?

In a 2009 study Souza and colleagues connected the esophagus directly to the duodenum (the upper part of the small intestine) in a group of rats, thus permitting acid to reflux freely into the esophagus. (5) To their surprise, it took 3 weeks for damage to the esophagus to occur. Commenting on the results, senior author Stuart Spechler said:

That doesn’t make sense if GERD is really the result of an acid burn, as we were all taught in medical school. Chemical injuries develop immediately. If you spill battery acid on your hand, you don’t have to wait a month to see the damage.

If acid itself caused the damage, we’d expect to see the damage start at the superficial layers of the esophageal tissue, and then progressively deepen. Instead, this study found the opposite. 3 days after the initial acid exposure, there was no surface damage – but inflammation had already begun to develop at the deepest layer of the tissue. This inflammation didn’t rise to the surface layers until about 3 weeks after the initial acid exposure.

This Suggests That GERD Is an Autoimmune Disease

Acid refluxing into the esophagus doesn’t damage the mucosal lining. Instead, it causes the esophagus to release inflammatory cytokines that attract inflammatory cells like interleukin-8, interleukin-6, and others. It’s not the initial exposure to stomach acid that causes the tissue damage characteristic of GERD; it’s this inflammatory process, which is characteristic of autoimmunity.

Do You Have GERD – or NERD?

The theory that GERD is not caused by chemical injury is supported by the fact that 70% of westerners diagnosed with GERD have no visible tissue damage.

In fact, these people don’t have GERD at all. They have NERD, or Non-Erosive Reflux Disease. Tissue biopsy of their esophagus shows inflammation developing at the base layers of the esophagus like GERD sufferers, but no damage to the surface layers as the conventional theory would predict. It’s unclear at this point why the tissue injury progresses to the superficial layers in GERD – but not NERD – sufferers, but this study suggests that the answer may be an autoimmune mechanism.

So What Does This Mean for You? How Do You Avoid GERD and NERD in the First Place?

Even if GERD is caused by an autoimmune process as this study suggests, the initial trigger seems to be acid inappropriately moving from the stomach to the esophagus. But that does not mean GERD & NERD are caused by too much stomach acid, as the common dogma holds.

In an earlier series of articles I presented evidence that acid reflux is caused not by too much stomach acid, but by not enough. I argued that low stomach acid causes bacterial overgrowth in the gut, which in turn produces gas that puts pressure on the lower esophageal sphincter, causing it to open and inappropriately allow acid into the esophagus.

I also offered a simple, 3-step protocol for treating reflux and GERD without drugs that thousands of people have now successfully used (check out the 190 comments) – including people that had been on acid suppressing drugs for 20 years or more. This is important because acid-suppressing drugs have numerous side effects and complications.

Why You Should Think Twice about Taking Acid-Suppressing Drugs.

Acid stopping drugs promote bacterial overgrowth, weaken our resistance to infection, reduce absorption of essential nutrients, and increase the likelihood of developing IBS, other digestive disorders, and cancer. The pharmaceutical companies have always been aware of these risks. When acid-stopping drugs were first introduced, it was recommended that they not be taken for more than six weeks. Clearly this prudent advice has been discarded, as it is not uncommon today to encounter people who have been on these drugs for decades – not weeks.

What’s more, a recent study showed that proton-pump inhibitors (PPIs) – the most popular class of acid-suppressing drugs – induce “rebound acid reflux” in healthy people.

The researchers took a group of people without any history of reflux and put them on PPIs for 8 weeks (where did they find these volunteers???) More than 40% of the healthy volunteers developed rebound acid-related symptoms like heartburn, acid regurgitation and dyspepsia once they stopped taking the drugs. (6) The authors of the study stated:

If rebound acid hypersecretion (RAHS) induces acid-related symptoms, this might lead to PPI dependency and thus have important implications.

I’d say!

If you suffer from acid reflux, make sure to read the entire series, and then follow the 3-step protocol I laid out. In a future article I’ll be covering some additional natural treatments that studies have shown to be just as effective as PPIs, with virtually no side effects or risks.

117 Comments

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  1. You have a lot of great info about acid reflux, but I haven’t seen anything about LPR (laryngopharyngeal reflux), which I’m almost certain is what I have. Do you have any suggestions for dealing with LPR? I’ve tried a few remedies that are known to work for acid reflux, but without results. I keep getting discernible vapor of stomach contents coming up into my throat, and I have a burning sensation in my throat much of the time. I’m a little alarmed because I’ve read that once the function of esophageal sphincters is lost, it can’t be regained. Although some people have reported great improvement with the condition from taking vitamin D3 supplements, which are thought to strengthen those muscles, so I’m still trying to figure things out. Thanks.

    • Hi tl,

      Actually, I have heard that they can do surgery to repair the flap that keeps acid in and tighten up the esophagus as well. Do you take any medications that may be causing it? See my story right below yours. If you drink coffee, give it up right now. That is the worst for causing reflux.

    • I would also like an explanation regarding how LPR differs from GERD. After eating, I also get the discernable vapor sensation working up into my throat and lungs. I frequently get horse, have post nasal drip and must use a asthma inhaler frequently. However, once I did the home test and confirmed I had low stomach acid I started taking the HCL/w/pepsin capsules working up to five capsules with larger meals and fewer with smaller meals. As long as I remember to take the capsules I remain symptom free. If I don’t take enough HCL I will get some minor symptoms, particularly the vapor creeping up feeling. What I do then is chew gum. The constant production of saliva seems to counteract the vapor. All that said I still would like to know why people with LPR do not get the same sternum burn as GERD sufferers

      • I am currently on a lowered fat and oil diet, it appears to help somewhat. At least I can sleep. I haven’t tried the HCl capsule yet. How does this low HCl test work you were talking about? I might buy one.

        • The formal test for low stomach acid is called the Heidleburg Test. It costs about $300. The problem is finding a provider. GI Docs don’t test for low stomach acid as there is no money in it for them by offering you supplemental hydrochloric acid with pepsin, a simple fix. Rather, they want to steer you to expensive tests and surgery, and yes, recurring office visits. The in home test is quite simple and safe. (Step 1) First thing in the morning before eating or drinking anything, mix a half teaspoon of baking soda in half a glass of lukewarm water and drink it. Set a timer for 5 minutes and simply go about your business. If you do not burp involuntarily within that 5 minutes, that is a sign you have low stomach acid; (Step 2) Purchase a bottle of Betaine HCL with Pepsin. I use the product from NOW Labs. Get in on Amazon or at a health food store. Take one capsule with a meal. If you experience no side effects such as bloating or a warm feeling, repeat the one capsule per meal for a couple of days. If you still have no adverse symptoms, up it to two capsules and repeat the process. Continue adding capsules until you get an adverse symptom. Once that happens, back off to the prior number of capsules. In other words, if you take 5 caps and have a reaction, dial back to 4 caps and remain on that level. Only take the HCL with full meals not snaks. You may also need to dial back the number of capsules if your meal is light or doesn’t contain any protein. When I started I was taking 5 caps per meal but after a couple of months I started to get bloated so dialed it back to 4. Now I take 3 with most meals and 4 when I have a large amount of protein. It is my understanding that after being on HCL for awhile, your stomach will start to produce more of its own acid. Hope this helps. There is plenty of information in the Internet regarding this home test. Just GOOGLE “self test for low stomach acid”

  2. I was diagnosed with GERD by a doctor who did NO tests. He just said, “Aha! You have a chronic cough and trouble breathing, it must be GERD! Take these super strong antacids.” Well, I knew that that wasn’t right, reasearched, and found that I had been most likely suffering for years from B12 deficiency. Well taking B12 helped many symptoms, but not the cough or the inability to breathe. I went to a pulmonologist who said I had asthma. He started me on the asthma drugs, which helped me not to drop dead, but did not really help. In the meantime, I stopped taking the Amlodipine and Hydrchlorothiazide I had been taking for High Blood Pressure — my cough stopped! Unfortunately, I still couldn’t breathe, and my pulmonologist sent me to an Endochrinologlist for thyroid (I had also started losing a lot of weight and food would get stuck in my throat). Am now on the meds for hyperactive thyroid, but still could not breathe so well. I discovered when I take 2 TURMERIC capsules, I have no problems breathing!

    Wait, I am getting to the GERD again.

    I also have had a history of severe headaches during the summer. I discovered Zyrtec, and my headaches were practically gone. I also found that after taking B12, B complex, D3, and B2, that my headaches have been seriously under control. Every year I start Zyrtec at the beginning of allergy season for fear the headaches might come back if I don’t. I have had that back-of-the-throat regurgitation during allergy season for about twenty years now, and assumed it was the allergies…until today, when it hit me that it was the Zyrtec. I looked it up, and there it was — GERD plus Zyrtec all over the internet. I have also noticed that suddenly my middle aged eyesight was a lot worse. That is on there too! So is the ringing in my ears! Son of a….they added a whole lot more side effects to the lists…well, better late than never.

    Now I don’t know what caused what. Looking back, I think it was really the B12 deficiency that started everything, but people, try other routes before you go the big pharma route, or at least look into more natural fixes that can help you eventually get off of your meds. Be very skeptical of their drugs. They are just too strong. I have been on the thyroid meds for about six months and feel a lot better, but I am looking into more natural fixes. Don’t worry, I look at tgem very carefully, too. The non-stop headaches were excrutiating, so I would probably still have taken the Zyrtec too, but I would have looked more into something different.

    My advice, just remember, it might not be a condition, it might be your meds.

    • Thanks AnnF!
      I tried a lot of medication too including antacids and metoclopramide. They helped to some degree, but they did not heal the disease. I still have acid regurgitation and I feel I cannot breath sometimes. I am not sure what triggers it, but sometimes for 2-3 weeks it is unbearable and sometimes it just stops for months, and I have no problem. It does not appear to depend on seasonal allergy, because it is always worse in autumn and winter. I guess cold triggers it somehow.
      I have been experimenting with meditation for a few years and I think I had a breakthrough last month, because since then I can ease the symptoms if I concentrate enough. I can sleep without pillows again, which is a relief, because I had lower back pain because of them. So things are getting better here. I think if you try hard enough you will find at least a partial solution too in you own way. Never give up! 🙂

  3. Hi there! I’ve been looking everywhere for solutions and help for GERD. I have chronic cough and wheezing – especially when I sleep. It’s terrible, I wake up tired with headaches from coughing all night. My husband is getting no sleep and i never hear the end of it!! We are all miserable!! I’m talking omeprazole 40 mg and although I do not have any issues or coughing all day, every night it never fails. I’m going crazy! ! Was tested for allergies and had no issues. Went super strict for a few weeks and nothing really helped. I didn’t give up wheat though. I feel like being on these pills for two months I should get some relief. Help! Any advice would be greatly appreciated. Thank you!

    • Hi,

      I was on PPIs (Prilosec specifically) for stomach ulcers / possible gastritis. After a couple days on it I felt too bloated and felt the need to stop. When I stopped I had really bad GERD and what really helped me was changing my diet for a couple days. I went gluten-free, no wheat, no dairy, and I noticed I no longer had GERD. It was surprising because I knew I wasn’t exactly Gluten-Intolerant but I knew if I ate too much wheat my stomach would get cramps. Well the gluten-free thing helped calm my stomach down A LOT and I would suspect that my body does not digest wheat very well. Anyways I slowly started eating wheat again lately or at least bread and my GERD isn’t too bad at all. I also took D-Limonene and it helps a lot though I would recommend trying the gluten-free thing and slowly reducing your current PPIs very slowly such as cutting it in half into 3rds into 4ths and then slowly stopping them. That’s the same advice I have been getting from everyone else on the forums. Hope that helps!

    • I have GERD too, tested for thyroid dysfunction, it was negative. Now testing for H. pylori infection, maybe that causes it.

      I started a diet, it is somewhat better with that. I drink a lot of warm tea, and eat soups and food reach in dietary fibers. That increases gut motility, which reduce the acid in my stomach.

      Currently sleep is my major problem, so you are not alone. I try not to eat anything after 8pm. This seems to help a little bit, but still I almost always wake up with sore throat and acid in my mouth… :S

    • Try elevating your bed. I purchased a wedge pillow which helps a little but not that great. It does help with my ears. If I sleep without a pillow I am more prone to balance issues. Sleep on your LEFT side. That helps to keep the contents of the stomach from trickling into the stomach. Don’t eat or drink after 7pm. I am suffering with ETD, and reflux. Checking into autoimmune disease presently. Take Care.

  4. It was interesting to read all these comments. Some of them were helpful for my condition. I have the autoimmune disease “CREST syndrome” and the e is esophageal dismotility (which causes acid reflux). So I was happy to see this article. I have been taking PPI for many years. I have also tried several times to stop taking it without success. I have been worried about shutting down the stomach acid and sending undigested food into the intestines. I came across Autoimmune paleo diet recently and got some relief from leaky gut but I was still taking the PPI which probably defeated the purpose. Two weeks ago I stopped them and I am suffering from reflux. Apple cider vinegar helped during the first few days (during rebound hyperacidity?) but not anymore. I am taking it day by day identifying foods that give me reflux. The autoimmune paleo diet is supposed to help so I will continue it.

    • I’d love to get off PPIs too, but I’m not sure it is a good idea for someone with CREST. Here is the standard rationale about GI problems and scleroderma.

      http://www.scleroderma.org/site/DocServer/digestive_system_article.pdf?docID=314

      A person with CREST needs to consider their quality of life, prevention of lung inflammation (you don’t want pulmonary hypertension), and strictures of the esophagus (fixed by dilating the esophagus. ouch). These are serious problems.

      I do wonder how much the PPIs contribute to osteoporosis, fecal incontinence, bacteria overgrowth, and the malabsorption issues associated with scleroderma. My uneducated guess is that it is a combination of both the disease and the PPIs.

      Even if these (downstream) problems are caused 100% by the PPIs, you still need to consider whether they are protecting you upsteam (fibrosis of lungs and esophagus) and which is more important.

      Just my 2 cents. If you are able to come off them, with no throat pain, let me know.

  5. If low stomach acid is the cause of GERD, why does the “rebound” of higher acid after being on a PPI not fix the problem?

  6. hi linda I know this was long ago but I really want to try what you have tried. is it really gone afterwards and what were your symptoms?? please reply x

  7. The possibility of a relationship between GERD (NERD) and secondary Raynoud’s disease is definitely worth investigating. I am not a doctor, but my daughter is completing her final year of specialization in Rheumatoid Arthritis. She is aware that I suffer from Raynoud’s disease (mildly) and suggested recently that it may be caused by an autoimmune disorder. She does not know that for about 2 years I have also been suffering from GERD. The possibility of an autoimmune disorder causing GERD, rather than acid reflux would fit perfectly with my age and symptoms and the occurrence of Raynoud’s disease – which has started about two years ago. It currently only affects the fingertips of my hand when I leave the house in temperatures below 10 degrees Celcius (even wearing gloves).
    Neither the manifestation of GERD (which occurs daily, after an evening meal) nor Raynoud’s disease are sufficiently serious to cause more than mild discomfort – at this stage.

  8. What we plan with thoughts and actions for our future so we can enjoy
    retirement/older age, right? Life can change drastically when a rare,
    incurable disease such as Systemic Scleroderma attacks our bodies without
    warning! My life started changing in Fall 07 in my hands, progressing fast
    to include weak/painful muscles, swelling, loss of range of motion and
    depression until 3/30/09 diagnosed with Systemic Diffuse Scleroderma which
    no one has ever heard of until diagnosed and adding insult to injury,
    neither have most doctors, leaving patients to fend for themselves on how
    to find treatment for symptoms because Scleroderma cannot be treated as
    yet. Most Scleroderma patients look normal in appearance but the damage is
    extensive on the inside of our bodies, stage 4 kidney disease, hiatal
    hernia, pulmonary fibrosis, aneurysm in heart, GI issues, skin changes and
    Raynaud’s in hands & feet are just a few of my Scleroderma challenges. I am
    one of the more functionable patients and grateful I have doctors who care
    and support from Sweetheart, family and friends. Some patients don’t have
    either doctors nor support and rely on facebook Scleroderma chat groups for
    advice, love and support from people who relate and understand what they
    are experiencing. My life has changed dramatically from 5 1/2 yrs ago and I
    am grateful for my Scleroderma journey because the more I reach out to
    others the more rewarding my life has become. I am a patient advocate
    helping to educate and promote public and medical awareness of the
    desperate need to recognise Scleroderma as the life threatening disease it
    is. Scleroderma was first documented 260 yrs. ago, now we want awareness to
    help alleviate the horrible suffering this disease causes physically,
    mentally and emotionally. Please help. EMILL:[email protected]

  9. I can now tell u all after trying everything, research etc raw food has finally been my best solution! It is not easy but totally worth it! Yes, I cheat at times but for the most part try to stick to raw!

      • Because raw food contains the enzymes within it, for its own digestion, this is why raw food goes off quickly. Cooked food has no enzymes so requires more stomach acid to digest.

  10. What we plan with thoughts and actions for our future so we can enjoy retirement/older age, right? Life can change drastically when a rare, incurable disease such as Systemic Scleroderma attacks our bodies without warning! My life started changing in Fall 07 in my hands, progressing fast to include weak/painful muscles, swelling, loss of range of motion and depression until 3/30/09 diagnosed with Systemic Diffuse Scleroderma which no one has ever heard of until diagnosed and adding insult to injury, neither have most doctors, leaving patients to fend for themselves on how to find treatment for symptoms because Scleroderma cannot be treated as yet. Most Scleroderma patients look normal in appearance but the damage is extensive on the inside of our bodies, stage 4 kidney disease, hiatal hernia, pulmonary fibrosis, aneurysm in heart, GI issues, skin changes and Raynaud’s in hands & feet are just a few of my Scleroderma challenges. I am one of the more functionable patients and grateful I have doctors who care and support from Sweetheart, family and friends. Some patients don’t have either doctors nor support and rely on facebook Scleroderma chat groups for advice, love and support from people who relate and understand what they are experiencing. My life has changed dramatically from 5 1/2 yrs ago and I am grateful for my Scleroderma journey because the more I reach out to others the more rewarding my life has become. I am a patient advocate helping to educate and promote public and medical awareness of the desperate need to recognise Scleroderma as the life threatening disease it is. Scleroderma was first documented 260 yrs. ago, now we want awareness to help alleviate the horrible suffering this disease causes physically, mentally and emotionally. Please help. EMILL:[email protected]

  11. Dear All,

    Greetings,

    I have a chronic condition and have been suffering from gastrointestinal problems as well as muscle and joint pain for over than 10 years. My ANA level was very high between 640 up to 1280, however all other tests were negative, so the doctor’s diagnosis was undifferentiated or unclassified autoimmune disease. Even my endoscopy and colonoscopy procedures were unable to pin point the problem.

    Since I am currently unable to visit USA, Could you kindly recommend functional or integrative medicine practitioners in Switzerland? Preferably in Zurich or Aarau or Basel or Bern.

    I will highly appreciate your advice.

    Thank you very much and looking forward for your reply.

    Kind regards,
    Essam

  12. I have a terrible smell from my mouth (told by dentist not my oral hygiene and not originating in the mouth) that my gastroenterologist feels is GERD. If I can get the GERD under control, will the odor also stop? This is ruining my life! I no longer have symptoms of GERD (was told I have “silent” GERD without symptoms), but the odor is still there. It can be smelled from 6-8 feet away from me and the odor can fill up a room. I’ve been told that stomach acid is so strong that a teaspoon of it can clear out an auditorium. Can it be the stomach acid that is causing my odor?

    • nmarshall:
      Have you considered that your stomach acid is too LOW? This is often the case with sufferers of acid reflux and it can cause a whole cascade of problems, often starting with misdiagnoses. Low stomach acid can cause food to remain in the stomach for too long, resulting in putrification of proteins, fermentation of carbohydrates and rancidity of fats. More: the low acid environment can allow your stomach, and eventually, your entire GI tract to be overrun by unwelcome little bugs such as h. pylori, and candida. PPIs, Hystamine blockers, and even plain old antacids can all contribute to this problem. I suggest seaking out the help of a Naturopathic Doctor or even well-trained nutritionist as allopathic MDs are generally wont to prescriping PPIs or H2 Antagonists rather than addressing the real problem. It is also important to note that most of these drugs are not meant to be used for more than 2 weeks, according to the manufacturers, yet MDs will prescribe them for years ongoing.

  13. I am in the process of stopping 8 years of taking Protonix (a PPI). The question I have is- if I have reflux because of lack of acid why then after stopping the PPI does it cause extreme reflux? Is it a fact that the acid is hyper as I have read? Or is there still not enough acid? I am confused about this as I was thinking of starting a low dose of an HCI. However, if I am in a state of hyperacidity that would not be a good idea. Right?

    • Hi Jim – I too am experiencing some strong rebound symptoms and pain as I taper off PPI’s. I was wondering how you are doing now?

      • I am doing great now. However, I was a bit confused at first about the lack of acid causing my reflux. I wasn’t sure if I didn’t have enough acid or if I had too acid after having come off a PPI (Protonix). I actually did have too much acid as my digestion had been shut off for such a long time. My digestive system did settle down and I was reflux free for about 6 months. Then I started to get a little burning again. As my stomach finally recovered from years of PPI’s, it turned out that I was now low on stomach acid. So having read Chris’s article on GERD, and other articles, I started Hydrochloric acid with Pepsin. That solved the problem. So I am GERD free. It was tough getting off PPI’s but wow was it worth it.

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