Is GERD an Autoimmune Disease? | Chris Kresser

Is GERD an Autoimmune Disease?

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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. I have a weakened lower esophageal sphincter (LES) due to long term side effects of radiation therapy decades ago. Consequentially, I developed GERD and strictures (scarring) causing difficulty swallowing. I’ve had two endoscopes to break up the strictures in my esophagus. I’ve been taking PPI for several years, and mostly keep my symptoms down to a minimum by eliminating trigger foods, etc. I tried stopping the PPI a few times, but my symptoms didn’t go away and my doctor said I could be damaging my esophagus further if I don’t take them. Thoughts?

  2. Hi,
    I am suffering from this GERD. Is the acid reflux and GERD is same and how to cure this? what should diet I can follow/ please help

  3. Great site and well written article as always Chris :).

    As a past sufferer of a myriad of digestive issues, i had always tried to tell these doctors that PPI drugs which inhibit stomach acid production, actually made my symptoms worse and things like traditional bitter herbs which increase the release of stomach acid, improved my “GERD”.

    Enjoying your site and information, keep up the good work.

    As to the last line, the re-bound heartburn symptoms from these drugs are likely caused because they neutralize stomach acid production, as you stated this is a terrible factor for not only digestion, but health overall. Mimics the same symptoms of “hyperchlorhydria” i.e excessive stomach acid, but literature doesn’t really support that this is common from what ive read.

    Hypochlorhydria i.e a lack of stomach acid is actually much more common i suspect.

    PPI’s and ant-acids are some of the most over-prescribed medications in my opinion.

  4. I am at a painful loss here. I was recently diagnosed gerd/hiatal hernia and Barretts esophogus. I had no pain until a slight sore throat which eventually turned to a scary difficulty swallowing, this was the reason for endoscopy and later diagnosis. I have been is so much lower throat discomfort. My dr wants me taking prilosec and my naturopath has me taking Dgl and gastro health but seeing no relief so I am ready to do prilosec. I am so worried about it developing to cancer. I am a young mother. Someone please help, I know this is old but please give me guidance/relief.

    • Here’s something you can try that worked for me. I had acid damaging my vocal chords and the ENT put me on acid blockers. I later saw an ND and he told me to stop the acid blockers and drink 1/4 of an undiluted fresh lemon after I ate. I can’t remember all the details of why it works but somehow it binds to receptors that tell the valve to close. It worked immediately for me.

      • I’m curious about the lemon cure. Do you just cut a lemon in quarters and squeeze into aglass without water to drink? I’ve been drinking lemon juice in my water but if this method is more effective I’m willing to try! I’ve just recently been diagnosed with Barrett’s Esophagus. I wasn’t having typical reflux symptoms. Instead I was having a stabbing pain that would come and go under my ribs (still there…just not as severe as it was a few months ago). I had numerous tests that included checking my gall bladder and pancreas. The elastase showed to be a bit low in my pancreas as well as low stomach acid (tests my functional dr did). Then my GI did an endoscopy and found the Barrett’s esophagus. I was prescribed the antiacid, Dexilant. My functional dr prescribed digestive enzymes as well as advising taking the antiacid med. 🙁 I’m so confused as to what to take now. The Dexilant seemed to help for a few days but now I’m getting a tightness in my chest. I have been following a Paleo diet for over 10 years now and baffled as to where this diagnosis came from! Now I’m seriously considering an AIP diet. I would really like to come of the antiacid but like the other user commented, I’m afraid of getting cancer! Has anyone had success on an AIP diet to cure this?

        • I’ll add that I’ve never smoked nor do I drink alchohol or caffeine and I’ve lost a disturbing amount of weight since this pain (I now weigh under 100 lbs and can’t seem to keep the weight on).

    • I had the same issues and the swallowing issues were scary. I cut out gluten and dairy. Within 3 weeks I dropped the prilosec with no issues. I had been taking Prilosec for over 2 years everyday and if I missed taking, I was sure to have acid reflux while sleeping that night. During the change in diet (Paleo – Jmainet/Kresser) I did take a teaspoon of Bragg Apple Cider vinegar before bed from time to time during the 3 weeks and have not had acid reflux since.

  5. Hi Chris,

    I’m a 26 year old male who has been suffering from moderate to severe acid reflux episodes for close to a year, I have been managing this with 40mg Nexium. I’d point out that prior to this I had no issues, my diet is balanced and has not changed, I’m not over weight, I do not drink alcohol or tea and coffee. I exercise regularly. An endoscopy revealed no mechanical faults in my digestive tract, simply some insignificant esophagal damage at this point. Naturally I do not wish for this to get worse, but I also do not wish to continue taking Nexium for the rest of my life. I’d like to know the following:

    a) Whether or not acid reflux is proven to both be potentially caused by excess OR not enough stomach acid.
    b) What possible cause the body might have for inexplicably deciding to suddenly change the amount of acid it produces.
    c) If discomfort in the stomach area itself, that later manifests itself further up the esophagus is caused by too much or not enough acid, intuitively I would have thought the former would have to be the case in order for the stomach to feel sore. But I would value your thoughts on this.

    Thanks
    Alex

    • Me myself personally I think it is chemicals in our food that is causing this problem cause to many of us or getting it and this way the government can sell their medication drugs cause I am 33 years of age I was diagnosed at 26 the condition never left yet it has gotten worse over the years I have tried to get off the medication an the condition is still here so im praying for a cure for this condition cause the condition can get bad just watch what food u buy watch what u eat that is the whole key to cure…..

  6. so what is the treatment –i was on prevacid for 10 plus yrs went off myself and have been suffering. Using home remedies / food ie apples various other natural –but I dont want medication ever again.

  7. I have what they call GERD, but I have no heartburn effect. I have what I feel is like a bubble in my throat. I had a throat scope done and the gastro dr said there is no damage to the esophagus but he did find a hernia. I also had my general dr just tell me I have a B-12 deficiency…is this caused from taking ZanTac 150 morning and night??? I’ve only been taking this for about 1 month. Does 1 tabelspoon of unfiltered apple cider vinegar work for acid reflux??

  8. Hi Chris and thank you so much for you wonderful website.

    I was wondering if you have the same recommendations for pregnant women. I’m 27 weeks pregnant and have just started developing heart burn. Not every day but almost. What does a moderate active pregnant women need to eat of carbohydrates?

    I would very much appreciate your answer.
    Allt the best and huge thanx!

  9. I just wanted to remind people that dealing with reflux by eliminating grains is a different situation than coming off PPI drugs. If you were taking a PPI you are going to have to go through that transitional period of rebound hyperactivity.

    When I uses to cycle back and forth between eating grains and then going off them for 2 weeks at a time, my GERD came back with the first slice of whole wheat bread or bowl of oatmeal. Once it was back all the rest of the foods that induce it in me aggravated it. The last time I tried grains was when I also went on the PPI and not only did the symptoms not go with removal of the foods, it took a month instead of a day or two. There is more to the action of those drugs that what just appears at first glance. If you take them, this will be a lot harder.

    I read that some people have good luck with aloe vera. If I put aloe in my skin I get blisters and an itchy rash. Granted, that was from the plant growing in my kitchen, not from a bottle. We used it on kids for sunburn but I always shied away from it after a bad reaction. If you are tempted to try it I recommend a skin test first.

    • Liane,

      I can respect your process but everyone reacts differently. I was on daily Prilosec for over 5 years. I went Paleo and my acid reflux was totally cleared in three weeks. I stopped taking Prilosec becuase I was feeling so good and I did not expereince any rebound effect whatsoever. I think I was having allergy issues with both dairy and gluten. I subsequently gave up Zyrtec which I was also taking on a daily basis as well. I also introduced Braggs ACV on a semi regular basis. Thanks for all the great info Chris.

  10. That’s very interesting. I have dysphagia; oftentimes, food gets stuck in my esophagus (and it hurts). I went to a GI doc who told me I might have GERD and then he gave me Prilosec to try. I didn’t take it because the label said not to swallow Prilosec if you have difficulty swallowing. (That would be me). 😉 And I remembered reading about the dangers of reducing acids in the body.

    I’m still waiting to find the right doc to give me an endoscopy, so I can perhaps find out more about my esophagus. I have done a little research and I might have a hard time swallowing due to a lot of factors. I’m even wondering if it might be happening because of stress.

    Thank you for all the information. I’m going to check out your 3-step cure to see if it might be applicable to me.

  11. I know this is an older post but hopefully someone can answer this question, hopefully Chris himself. In my medical nutrition therapy class at school, my professor taught us that increased pressure from the other side of the lower esophageal sphincter actually helps to keep the sphincter closed, and that a lack of pressure allows it to relax and allows reflux to occur. This seems to conflict with your idea that bacterial overgrowth leads to increased intra-abdominal pressure and causes reflux. So what is your opinion on that?

  12. Years ago Rod Burreson spoke about the dangers of proton pump inhibitors on his radio show, “The Truth About Nutrition”.

  13. I have had acid relux for 5 or so years….I decided to try Dr Mercola’s complete probiotics. Within a week I was off my medication and taking 2 probiotics a day….I haven’t had any problems since I started taking them.. See if it will work for you as well!!

  14. It is neither, at least doesn’t start out that way. I figured this out on my own by paying attention to my own body. It is caused by undigested fully food, thus giving off a gas that causes the acid reflux to occur. Think how food lying too long in a refrigerator, molding and how it gives off a gas, if in a container. Now think of that happening within the stomach/esophagus. I cured it quickly by just putting hot sauce liquid, 5-10 drops, in warm water [4 oz] and drinking it slowly, two times a day for a week. At the end of the week, no more acid reflux, even after eating spicy foods or pizza. A way to prevent it is, after each meal [not before], eat green salad…the greens have enzymes that digest the food. I have proved this over and over, when I go to a buffet restaurant, I eat my green salad for dessert. While others walk out complaining they ate too much, I eat all I want and then walk out feeling just comfortable and satisfied, not feeling stuffed.
    I wish the research scientists would do a study on what I have found.

    • @Linda, Pat & Linda C

      Thanks for your stories of success, but unfortunately it is not always quite so simple. In my case I went on a gluten/grain free paleo diet and after experiencing initial relief for 3 months my gerd returned. I then thought it might be food allergies since I had immediate reactions after eggs, but it didn’t end there. I then tried HCI, bitters, plant enzymes, taking care with chewing my food well etc. Some of my more unpleasant recent gerd attacks occurred after HCI or using plant enzymes. From reading a lot of comments on numerous paleo sites, I can see that there are many among us that may have to go through a lot of experimenting before final and complete relief is found. As far as I can tell, heart burn, gerd etc. is a symptom. The cause(s) might be varied for many people.

  15. My husband suffered from GERDS for years. He always had antacids with him where ever he went.
    When he stopped eating gluten all that discomfort stopped too and never returned.

  16. Four years ago, I was told I had celiac, and that I also had baretts. I started with gluten free diet, and the baretts is gone, and the heartburn is gone. I am not taking any meds, just follow the gluten free diet

  17. Chris, I’m a fairly recent follower of your blog. I sought it out after having recurring GERD nearly every day. For the last month I’ve strictly followed the Specific Carbohydrate Diet, drank my homemade Kefir, used bitters, etc. My naturopath recommended I avoid using HCl until after an upper endoscopy ruled out any problems (hernia, ulcers, etc.).

    After the procedure, the GI specialist said that my acidity level was pH 2.6, which is pretty normal. That would seem to contradict the low acidity component to the 3-R program, but I’m wondering if I should try to lower it more? The symptoms have been greatly reduced, but haven’t gone away completely.

    Still awaiting H. Pylori results…

  18. Has anyone ever heard of feeling “heartburn” symptoms in the arm? A friend of mine feels it in the tricep area of his right arm. His doctor doesn’t seem concerned and, of course, put him on a PPI med.

  19. Hi Chris,

    My 3-month old was diagnosed with GERD and perscribed acid-supressing drugs. Do you have any blog posts on GERD in infants???

    Thanks,
    Lindsay

  20. Hi Chris, I have a 5 week old breast fed baby showing all the signs of silent reflux. His main issue is a large amount of gas about 1 hour after feeding which is stopping him from having long and deep sleeps. He gets hiccups nearly twice a day. His mum had post labour complications (lost 2 liters of blood and was in an induced coma). We tried to get him as much colostrum as we could. As she was unwell he was bottle fed for the first week.. Breast feeding was eventually established.
    I hope I’ve provided enough info to give you a small window into his health.
    He’s in the 90th percentile for all his growth maps so he’s getting good feeds and is very regular with his bowel movements..

    Sorry my post is a little bit all over the place..

    Thanks again.

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