Note: this is the third article in a series about heartburn and GERD. If you haven’t done so already, you’ll want to read Part I and Part II before reading this article.
Right after publishing yesterday’s article (The hidden causes of heartburn and GERD), I came across a new research (PDF) study hot off the presses that adds support to the theory that GERD is caused in part by bacterial overgrowth. Before moving on to my next planned article in the series, I want to take some time to review this study and discuss its implications.
Malekzadeh & Moghaddam performed a retrospective study to investigate the prevalence of GERD in patients with IBS and vice versa. The data comes from a very large number of patients (6,476). To my knowledge it’s the largest data set that has been reported about the overlap between GERD and IBS.
The authors found that 64% of IBS subjects studied also had GERD, whereas 34% of the GERD patients also had IBS. They also found that the prevalence of all functional symptoms (such as nausea, changes in bowel movement, headache, etc.) was higher in overlapping GERD and IBS subjects than the prevalence in GERD subjects without IBS or IBS subjects without GERD.
Implications of the Connection between GERD and IBS
What this correspondence suggests, of course, is exactly what I argued in the last article: that IBS and GERD may very well share a common etiology and underlying mechanism. From the conclusion:
This finding shows that in overlapping GERD and IBS, other functional abnormalities of the GI tract are also highly prevalent, suggesting a common underlying dysfunction.
The authors even speculate that the underlying cause may be an overgrowth of bacteria. Specifically, they mention H. pylori as a possible culprit. I think they’re on to something!
Assessing the role of H. pylori infection in GERD and IBS patients could be a target of future research, as in the present study the prevalence of H. pylori infection in GERD patients was found to be greater than in non- GERD patients.
The Role of H. Pylori in GERD
I believe that H. pylori infection plays a significant role in the pathogenesis of GERD and other digestive disorders.
H. pylori is the most common chronic bacterial pathogen in humans. Statistics indicate that more than 50% of the world population is infected. Infection rates increase with age. In general, the prevalence of infection raises 1% with every year of life. So we can expect that approximately 80% of 80 year-olds are infected with H. pylori.
Second, we know that H. pylori suppresses stomach acid secretion. In fact, this is how it survives in the hostile acidic environment of the stomach, which would ordinarily kill all bacteria. Treating an asymptomatic H. pylori infection with antibiotics increases stomach acidity and eradicating H. pylori with antibiotics improves nearly all patients suffering from hypochlorhydria.
Although it is commonly assumed that stomach acid production declines with age, recent studies suggest that the secretion of stomach acid doesn’t decrease with age and that the trend is actually to increase, especially in men.
However, this tendency for acid secretion to increase with age is completely nullified by the corresponding increase in H. pylori infection. Since the incidence of H. pylori infection increases with age, it follows that hypochlorhydria also increases with age.
Like what you’re reading? Get my free newsletter, recipes, eBooks, product recommendations, and more!
Acid Suppressing Drugs Increase Risk of H. Pylori Infection
Perhaps most importantly for those taking acid suppressing drugs, researchers now believe that the initial infection with H. pylori can only take place when the acidity level in the stomach is decreased (albeit on a temporary basis). In two human inoculation experiments, infection could not be established unless the pH of the stomach was raised by use of histamine agonists. (1, 2)
A 1996 article published in the New England Journal of Medicine followed two groups of people who were being treated for reflux esophagitis for a period of five years. One group took Prilosec (20-40 mg/day) and the other underwent surgical repair of the LES. Among those who had documented H. pylori infections at the start of the study and who were treated with Prilosec, the rate of atrophic gastritis increased from 59 percent at the beginning of treatment to 81 percent by the end of the study. Among those who had no atrophic gastritis at the beginning of the study, 30 percent of those who took Prilosec later developed it. By contrast, just 4 percent of the surgically treated group developed atrophic gastritis.
Another Vicious Cycle You’d Be Smart to Avoid
The connection between low stomach acid, h. pylori and acid suppressing drugs kicks off another nasty vicious cycle, similar to the one we discussed in the previous article.
Low stomach acid >>> heartburn >>> acid suppressing drugs >>> H. pylori infection >>> further reduction of stomach acid >>> chronic heartburn & GERD
I’ll have more to say about this in the next article.
As I mentioned in the last article, fermentation of malabsorbed carbohydrates produces hydrogen gas in the intestines. Hydrogen gas is the preferred energy source for H. pylori. Elevated levels of hydrogen gas are also associated with other nasty bugs such as Salmonella, E. coli and Campylobacter jejuni, the leading cause of bacterial human diarrhea illnesses in the world.
Excessive fructose, certain types of fiber and starch, and particularly wheat increase hydrogen production, and thus increase the risk of infection by H. pylori and other pathogenic bacteria. If you’d like to avoid heartburn, GERD and the many other unpleasant symptoms associated with bacterial overgrowth, it follows that you should minimize your intake of sugars, starches and grains.
In the next article we’ll examine the many important roles of stomach acid and the significant risks of long term hypochlorhydria.
Better supplementation. Fewer supplements.
Close the nutrient gap to feel and perform your best.
A daily stack of supplements designed to meet your most critical needs.
Hi Chris
I was diagnosed with h. pyloi recently and I have constant flow of mucus from my throat to stomach that makes me nausated and suppresses my appetite. I dont have heartburn. Can this mucus from throat caused by H.Pylori infection o gastritis?
Thanks
Sam
Dont think so. Try to eliminate dairy.
I have tested negative to HP about 3 times but have the worst gut symptoms. It is so much more complicated. There are many other bacteria that probably cause these problems, as many quite happily live with HP in their guts around the world.
I am in Korea and was diagnosed with ‘superficial gastritis’ and ‘reflux esophagitis’ are these the same as GERD and could they also be caused from bacteria? I would be interested to know, the doctor didn’t really say anything and just gave me pills and said it’s not necessary when I asked for a H Pyroli test because I didn’t have and signs of ulcers.
Thanks -Dan
Chris,
I was just diagnosed through a blood test for H Pilori. Me being inexperienced I took the PrevPac and now proscribed Nexium. I do not want o take this but has a loud gurgling stomach with gas cramps(mostly at night) I have read you article and now am I am mission to surpress these symptoms. I have ditched the Nexium(only on it for 2 days) and working towards a low carb yogurt diet. I have been struggling with stomach issues since I have have 5 misdiagnosed with everything only to realize most of my early issues were due to lactose intolerance.
Please keep the info coming.
Fascinating series of articles!
I’m wondering, would you see any benefit in taking raw apple cider vinegar as a way to increase the acidity of the stomach, if low stomach acid is one of the issues leading to reflux? That is, before undergoing testing and antibiotic treatment for the bacteria?
Would probiotics be of any benefit to the situation?
Thank you so much for your help…
Sir, I am only 16 years old & I came across your article. Please help me. I drank a really strong coffee about a month ago & right after I started burping BADLY & I also diarrhead. I felt like throwing up but it was just bad burps. I had no pain anywhere, but I couldn’t stop burping. I went to my doctor & he said I was fine I just needed to let it pass. I trust him but I still burp to this day. It has subsided but could I possibly have this?
Hi Se
I have the bubble problem & difficulty burping for 3 years now. For me, while no Gastroenterologist can tell me with any certainty, was caused by a disruption of bowel flora & clostridia bacteria took over & paralysed my digestive system causing constipation, indigestion & reflux. I am on antibiotics which helps the constipation remarkedly, but doesn’t help the burping problem. I will have FMT eventually after being on the antibiotics long term.
What does help my stomach settle & be able to burp ( at least so I am comfortable. It by no means cures it) is not eating anything remotely acidic or spicy, no garlic, onion, vinegar, anything high residue. Also sugary foods are a no- no even too much watermelon. No tea, coffee or alcohol. I eat very little.
I hope for your sake, it will resolve for you. If it’s just happened & you don’t have a history of these symptoms then it probably will. I’d recommend you stay on th PPIs or a while so at least that will help your inflamed stomach heal.
I have been on nexium for years…before I realized the serious consequences of taking it. I never had heartburn, but did have some pain in my abdomen. Had an endoscopy and was told to just keep taking nexium. I have no idea if I still need it….ot if I ever really needed it. I would like to stop taking it, but have read that cold turkey is not the way to go. Is a low carb diet beneficial? I would appreciate any help anyone can give me.
Hi Chris,
I just found all these great articles you wrote. I am having tiny bubbles seeping up in my throat for 4 days now. It is not burning, nor i am burping them up they are just coming up like bubbles slowly. Especially at night whenI lay down. I feel my stomach is streching and bloated-not my bowels-, have nausea, cannot eat from it neither can sleep from the bubbles and feels like the is a hard candy stuck in my throat.. I was at the Dr ansdshe said i have a bit of sore throat but that is not where I feel the hard candy feelbut lower and have sligh fever too though I dont feel it but also my nose it a bit stuffy. She told me to take prilosec. I tried to eat sauerkraut and some soaked almonds also steamed aspargus. That is pretty much my daily meal cannkt even drink an herbal tea only in the morning but in the evening my stomach streches so much that I cannot. It feels when I had once food poisoning but i actually do not throw up. I was wondering since I do not eat meat only fish if that would be OK to eat that. Also I drink dairy like kefir normally but I was worried to do so. I also took acidophilus bifidus, drank baking soda-water-apple cider vinegar mix that helped to burp. I also took colloidal silvr drops and thinking if I could eat garlic maybe as a natural antibiotic. Also thinking of some rice noodles instead of wheat however today I ate a high-fiber wholewheat breakfast cookie I bake-not sweet as cookies are at all though. I do not know if I have GERD or a silent acid reflux as I have no burning feeling but looking around on the net too after talked to the Dr think I may do. Please be kind to send me an email and sorry for the bother and thank you kindly in advance!!! :):)
Hi Chris
Do you know of any good Chinese acupuncturist in the Boston Mass area . Thank you
.
Thank you for these amazing, informative articles!
I was just re-reading them and wondered about something after this paragraph (from article III) –
“As I mentioned in the last article, fermentation of malabsorbed carbohydrates produces hydrogen gas in the intestines. Hydrogen gas is the preferred energy source for H. pylori. Elevated levels of hydrogen gas are also associated with other nasty bugs such as Salmonella, E. coli and Campylobacter jejuni, the leading cause of bacterial human diarrhea illnesses in the world.” Could this be a reason [or contributing factor] for some of the E. coli and Salmonella contaminated meat recalls of the grain-fed meat animals?
Another association I thought of after reading the articles is that horses often get colic after eating an excessive amounts of grain. The excess grains, due to improper digestion , ferment causing intense pain (and other complications). Part of the recovery treatment is to stop the grains and feed only grass hay which helps to rest/heal the digestive tract!
I’m seeing grains and excessive carbohydrate consumption in a whole new light!
Thanks, again, for sharing your knowledge thoughtful study.
I love how you are finding the cause, and not supressing the symptoms. However, one of the causes of bacterial overgrowth in our gut is antibiotics! And that is what you are suggesting to treat the H Pylori. Antibiotics wipe out the 2-5 pounds of bacteria in our gut which keeps it healthy–like a good lawn, it keeps the weeds from taking over. Wipe out the lawn, and the weeds are free to grow, well, like weeds! It was probably antibiotic use which caused the problem in the first place. If you have to take antibiotics, and I believer there are few times when you really need to, then you should take a good probiotic to replenish your gut flora.
I’m kind of blown away by the fact that you’ve apparently missed ALL of his comments about avoiding antibiotics for the exact reason you seem to think you are “teaching him”.
Well done. But not really.
I meant “hypchlorhydria” . Sorry about that,
John,
Chris doesn’t contradict himself because in the following paragraph he explains that H pylori infections increase in older adults. If stomach acid increases with age, then there would be a decrease in H Pylori infections given that stomach acid kills bad bugs like H Pylori, so this supports that it is more likely that hypochloridia is more prevalent in older adults.
Your first article uses a chart showing mean stomach acid secretion decreasing overtime and this is a large part of your argument. Yet in this article you wrote, “recent studies suggest that the secretion of stomach acid doesn’t decrease with age and that the trend is actually to increase.” Doesn’t this completely go against what you’re saying in part 1? You’re trying to show that if acid secretion decreases overtime and incidences of heartburn and GERD increase over time that low acid is a cause, but now you say that acid secretion actually increases with age.
Before receiving FMT treatment you are prescribed antibiotic treatment for 6 months to rid the body of as much of the bacteria as possible.This is the protocol. There are more bacteria than Heliocabacter Pylori that cause reflux see under “constipation” at http://www.cdd.com.au…and probably so many more bacteria that we know of yet.
you have not answered the discrepency in the 3rd article that stated that we produce more acid as we ge especially men, I am completely at a loss on this as everything else you say says that we decrease acid
Hi. Many thanks for interesting info. I had a question about a coinciidence of symptoms that I thought was curious. I take Prevacid for a persistent Acid Reflux? ie burning in my esophagus and up to my throat. When I developed a streptococcal inflection in my throat and sinuses, the acid burning stopped, either when I first had it or when I was treated with an antibioti. Is the connection the antibiotic or could the strep overcome the stomach helico bactor pylori? My doctor simply dismissed it….
Is this just as silly as increasing the acid level of the stomach by having a teaspoonful of apple vinegar?
Hi Chris,
I would tend to disagree with your assertion about the H. Pylori or at least it appears not to be the case for me. I am 47 and i hardly ever can remember having acid problem. When I was a kid, every year I would get a pneumonia, and had it 11 times. Every time, I was treated with a course of antibiotics. By the time I was 12-13 years old, I was diagnosed with gastritis and excessive acid production. I remember suffering from acute bouts of abdominal pain until I was 18-19 years old. At that time, my last pneumonia was when I was 11 years old, and at 19, despite me starting drinking and smoking, my gastritis had subsided and gone, and same happened with excessive acid production. I never went to the doctor up until I was 45, when I got another pneumonia. I was put Avalox, which almost killed me, and then on another antibiotic, I think Erithromicyn or something like this. Upon curing my pneumonia, I started having periodic problems with bloated feeling in my stomach. I went to the doctor, who did the tests and found that I have H.Pylori. Put me on the 2 week course of antibiotics, which eradicated it. Ever since then I suffer daily from GERD, which is how I ran into your article, I know link my condition to the fact of taking antibiotics, which kill certain types of bacteria including H. Pylori, and causing overgrowth of other bacteria with all leading consequences. I suspect that H. Pylori by itself may not be the menace as long as there is a correct balance of beneficial bacteria. Antibiotics start this cycle by killing certain bacteria and ruining the balance. It eventually may correct itself over the course of years, as long as you don’t take any medications that affect the bacteria. However, depending on the type of bacterial overgrowth, it may also lead to more problems. Bottom line, my idea is that while you are healthy you should be tested for types of bacteria you have in your stomach. Should you require to take antibiotics that will dis-balance your bacteria, you should then be tested again, compare the results and introduce missing bacteria back into your stomach.
Hi Chris!
Thanks so much for sharing your learnings with us!
I’m completely baffled by what I think is my GERD. I have never experienced heartburn, but I frequently hiccup and burp, and often throughout the day and night I get a sour/bitter taste all over my mouth and my tongue. These symptoms became noticeable about two months ago after I took some Chinese herbal supplements and made the mistake of drinking the medicine cold, but not sure if there was another cause as well.
I took prescription-strength Prilosec for two weeks with no relief (didn’t get worse either though), so I stopped it (because I’m afraid of osteoporosis). Just a few days ago I got a urea breath test to measure my gastric H. pylori level, and it came out normal (low end of normal, even). Might it still be that my stomach is under-secreting acid? I’m wondering: what have you learned (from research or personal practice) about GERD conditions without heartburn? I’m at a loss for finding info online. But after reading your articles about GERD, I plan to cut my carb intake and eat more yogurt!
Thanks!