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More Evidence to Support the Theory That GERD Is Caused by Bacterial Overgrowth


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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.

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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)

If low stomach acid is a prerequisite to H. pylori infection, we might expect acid suppressing drugs to worsen current H. pylori infections and increase rates of infection. That’s exactly what studies suggest. Prilosec and other acid suppressing drugs increase gastritis (inflammation of the stomach) and epithelial lesions in the corpus of the stomach in people infected with H. pylori.

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

The increased risk of H. pylori infection caused by acid suppressing drugs is especially significant because H. pylori infection is associated with a small but significant increase in the risk of stomach cancer.

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.

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Join the conversation

  1. Thank you for the above article. I am a 28 year old male and had been suffering from worsening GERD since the age of 20. I fell into the above mentioned cycle; temporary relief from pH raising antacids, only to be followed by more and more incidents of acid reflux or heart burn. An endoscopy finally revealed the present of high levels of H.pylori. Since taking the antibiotic, I have not had any feelings of GERD and have found overall energy level and mood have been vastly improved.
    The science makes sense: I grew up in Seattle and had lots of issue with post-nasal drip (H.pylori lives in mucus). I moved to drier climates at 22 and started to have more frequent issues with heart burn. Over the counter remedies and dietary experimentation did not work until I found Picot, a Hispanic marketed antacid (Sodium bicarbonate and citric acid). It was a miracle drug; suppressing heartburn nearly every time. However, the continual change to the PH levels likely gave the bacteria more strength to resistant. After a year of using Picot, heart burn became more and more frequency.

    Be aware of the cycle, and talk to your medical provider about this article.

  2. Try one or two teaspoons of apple cider vinegar in a little water. It should stop the symptoms quickly.

    • Cheri D, I agree, unfiltered apple cider vinegar has helped me tremendously. I wish I had started eating raw honey sooner in addition. In my case, the cider vinegar has not been enough, but it has certainly helped my health and will be a part of my healing regimen!

  3. You should reasearch and look i to serrapeptase enzymes.. they are good for the body. Europe and asia are using them now in clinical settings. I think the bottle is like 50 dollars but so worth it.. i have sudden onset of acid reflux at night and not sure how or why its coming but having hp test done weds and a gi appt jan 13.. ive tried omeprazole but to no avail and am on zantac right now its also doing nothing.. hoping they figure it out soon as before this i was a healthy 35 yr old

  4. I have suffered with GERD for near 43 years and have always reached for bicarbonate sodas, Mylanta and more recently Pariet. Certain foods I have learnt to avoid – cold meats, wine, bread etc. time has taught me to drink lots of water and eat natural foods. No longer require medication . My body soon tells me if I lapse and don’t drink enough water each day.

  5. Like previous comments, I am interested in the question of getting off Nexium (12+ years) having Barrett’s diagnosed plus a hiatial hernia (no H.pylori). Strangely I find that fats seem to trigger more GERD. I am worried about the long-term side effects of low acid and want a protocol to get off Nexium. I heard that PPI’s are now the top selling drug above all else – which means there will be no incentive to promote or test ways of stopping them. I am down to 20mg once per day, but if I take it even 4 hours later than normal the acid rebound (even on an empty stomach) is unbearable. Thanks for your comments.

    • I recently found this information: http://www.endfatigue.com/tools-support/How-To-Get-Off-Acid-Blockers—Naturally(dot)html I have been taking Mastic Gum for about a week and a half now and can already feel a difference. I’m a big fan of natural remedies now after successfully treating my allergy symptoms with Stinging Nettle! Most doctors just want to give you a pill for everything now, and I don’t like taking a bunch of chemicals if I don’t have to. Mine told me to take Omeprazole which worked temporarily, but I didn’t want to get hooked on that. Natural herbs are worth a try. I think diet is also important. You can’t eat unhealthy food all the time and expect to feel good.

      I find it rather disappointing that the medical community is aware of the research cited in these articles and yet they continue to recommend acid blocking drugs. The Internet provides us all with a great tool to advocate for our own health rather than just taking whatever drugs are offered to us. I am thankful for people who take the time to post informative articles like this.

      • Hi was reading ur comment… fighting hpylori at the moment..took mastic gum for the first time this morning after reading up on hpylori..it felt like fire after I took the capsules burned so bad…is this normal with the mastic gum at first??? Sorry I’m so desperate to cure this bacteria that I will take the mastic gum again..just wanted to knw if the burning is common??

        • No, it is not normal. You probably have an acute gastritis right now. You need to put this fire down before you start working on pylori and it is going to be a long battle. Douglas lab or other reputable brand DGL will do the work. Also seabuckthorn oil from the bottle,not capsule. These two will do the work! Then you start working on h.pylori. I posted a lot of info on earthclinic site. Mustic gum is just one of the ingredients that may work.did not work for me. In fact,you just have to keep h.p. under control, I don’t think you can eradicate it. Uncontrolled h.p. can lead to loss of gastric intrinsic factor,b12 deficiency,autoimmune anemias and god knows what else,including heart problems.so read info on earthclinic site. Good luck.

      • One great supplement overlooked by many is Quercetin. Especially for allergy or any kinds of conditions with histamine release. Some POTS people have mastic cell disease,undiagnosed, and this supplement might help.

  6. I don’t have GERD. I have LPR or silent reflux. Never get heartburn. Well, that’s what we think I have. If you think I’m going to take that sadistic 24-hr. test they give to find out, forget it. I have every symptom. But every time I stop eating healthy food and go back to a SAD cheat day or two, it goes away. Is that strange or what? Either my system is so messed up (don’t think so) or eating what I want, when I want relieves stress. That’s my theory. Junk food is a stress reducer for me. Now over time, it’s very intrusive but in the short term I get pretty relaxed from it. GERD and LPR is worsened with stress and can even be caused from it. Ulcers are known to occur from stress and it’s all related. Strange and SAD 🙂

  7. Can anyone help me out?
    I was first diagnosed with GERD in May 2014 and I’ve been on Prilosec for just over two months now. I was negative when my primary care provider had me go through a lab test for H. pylori.

    I’ve been cutting back on wheat, simple carb foods, fat, dairy – except for lactose-free milik, and any kind of meat completely since I started taking Prilosec and I’m actually eating more healthy now but I’m still suffering from acid reflux symptoms (heartburn, dull/burning pain in upper stomach, acid reflux when lying down in bed at night even after 3hrs of eating) EVERYDAY.

    If H. pylori causes GERD, why am I still having these reflux symptoms with being negative for H. pylori?

    • GERD is also caused by other issues like poor digestive motility, a weakened LES sphincter, and low stomach acid. Dr. Wright, author of Why Stomach Acid is Good For You, found that in a majority of his patients that suffered heartburn, there was too little acid in the stomach. The problem in most cases, is not that there is too much acid, but that acid is in the wrong place, the esophagus. Prilosec and other drugs that suppress or neutralize stomach acid make the problem worse in the long run. While it may provide temporary relief, it is creating a very unhealthy digestive system, allowing pathogenic bacteria, yeast, and viruses to grow, and also lead to peripheral health problems like allergies and depression.

  8. Thanks Chris, great info. I have been using inhibitors for years starting with 10 mg Losec up to a 40 mg dosage of Nexium. Obviously its time to break the cycle. Please let me know when the last of the series is published.

  9. I’m a little confused with a statement in Part I and Part III.

    Part I states –

    But there’s a big problem with this theory: the incidence of heartburn and GERD increases with age, while stomach acid levels generally decline with age (Fig 1).

    Numerous studies have shown that stomach acid secretion declines with age. In one study researchers found that over 30 percent of men and women past the age of 60 suffer from atrophic gastritis, a condition marked by little to no acid secretion. Another study found that 40% of women over the age of 80 produce no stomach acid at all. 1

    Part III states –

    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.

    Am I misreading this or is it contradictory? It states that recent studies suggest that stomach acid increases with age (Part III), was there a long time lapse between the publication of Part I and III?

    • I noticed this as well– Could the author clarify? Are the referenced publications contradictory?

  10. Hi chris….i started on my gym diet and due to over eating i got bloating symptoms frequntly…..i dnt know whether it is sibo or anything else….slowly my symptoms turned into reflux disease…..but i dont have classical burning except for the regurtitation….and very frequent yawning…..i feel like my stomach is bloated and adherent to me diapragm…i couldnt breathe nrmally ….i need to yawn frequntly now….my diet if included with fats and spicy fud it aggravetes the problem…not even with anykind of food iam havng these symptoms….dont whether it is due to sibo or hypochlorhydria dats causing my gerd…..help me with these symptoms …i couldnt concentrate on my studiess…i couldnt sleep with it…..plzzz

  11. About 10 years ago acid reflux propped into my life never had it before but I was having it 24/7. I did have a lot of stress in my life at that time. But the reflux was messing me up. Took a little bit but my dr ran a blood test and that was when I met pylori it’s nasty. Anyway I did the antibiotics it took a year for the symptoms to fully go away. now here I am 10 yrs later I was just under a lot of stress and reflux is here again and other problems like low thyroid, uti, major distention, diabetes wow this threw me it was like all these things just showed up at once. Funny thing is my dr did a test for pylori blood and stool and no pylori. I was shocked. Right now I am left with not many answers but try to make positive diet changes and keep excercising sometimes I feel so bad in my gut but I don’t trust that my own dr can help me. What a mess.

    • Same situation. It feels so hopeless, sometimes it seems as though we are in a ‘dark-ages’ of medicine. Doctor’s don’t really understand the body and they cannot help. There are a lot of people out there (us) who desperately need real help and a real solution. Sometimes I wish an advanced alien race would come and save us from all this misery — healing us all instantly from all maladies and sending the gazillion-dollar ‘medical industry’ into a tailspin..

  12. Chris, First time to your site. Wow, I am impressed, as an allopathic doc (albeit a dumb orthopod). I admit I did not read all the comments, but your commentary and interpretation of the allopathic literature is impressive, clear and concise.

    I wish you would have more positive reviews of allopathic medicine in your bio, because you are using the existing medical literature appropriately to glean helpful information for many people. I really appreciate your physiologic detective work–I think you are synthesizing the medical literature in a clear and appropriate way that is physiologically, medically, and holistically sound.

    I think that many times medical “band-aids” can be applied that just treat symptoms, and not the source. That being said, the allopathic research is very helpful and can be a very positive influence on people, even if they are only interested in holistic/herbal/naturopathic applications of the allopathic literature findings. But obviously I am biased. Thanks for your good work!

  13. i have hpylori cant take antibiotics only make me worse,so have stopped all wheat, dairy and sugar but amm still plagued with terrible heartburn am desperate

  14. I wonder if anyone can offer me some advice on my own experience. For more than five years I suffered from a persistent cough and acid reflux. I had numerous medical tests but no explanation could be given for the cough beyond the obvious, that I am a former smoker so there is obviously some lung damage. As for the acid reflux, that was old age and weakening throat muscles. I was prescribed Nexium (Australia), an acid suppressing drug, and it worked but it is very expensive.

    I couple of months ago I developed a persistent cold and finally decided to treat it with an antibiotic, something that I am usually reluctant to do. Well the cold went, but so did the coughing and the acid reflux. Since that five-day course of an antibiotic, I have never had another attack of acid reflux and I wonder now why no medical practitioner ever suggested it as something at least worth trying for the treatment of acid reflux since the success was instantaneous. Whether it will be long-term though is something I don’t know.

  15. I normally don’t comment on posts, but I had to share my experience with you and your readers. I do believe you are completely correct, H. pylori infection is the main culprit when it comes to GERD. In my recent research, I found that there is a connection between preeclampsia and H. pylori infection. I don’t suffer with any IBS symptoms, but in my last 2 weeks of pregnancy I got preeclampsia. I believe I passed on the H. pylori infection to my daughter at that time. My daughter who is now 8, suffered with Gerd since she was very little. As soon as she started speaking well (about 2), she would say “Mommy, I just threw up in my mouth a little.”) This went on for quite a while and I just kind of hoped it would go away because I didn’t want to give her harmful medicines. Then when she was 7 it got really bad. Lots of stomach pain, burning her throat, difficulty swallowing, major migraines, and terrible mood swings. It got so bad at one point that she was having trouble breathing. I searched the internet like a mad women and after a month or so of searching, I decided that Weston A. Price had the answers. I started fermented all my breads and buying grass fed everything. I quickly noticed improvement. The acid reflux stopped, but the migraines and irritibility continued continued off and on- up until 2 weeks ago. I tried magnesium oil spray on her and it has made a world of difference! She is like a brand new kid. Anyone who has acid reflux should totally try magnesium and try a Weston A. Price diet (maybe a low carb traditional diet for some). It’s a life saver.

  16. I just got an endoscopy last week and the doctor didn’t even do a test for H. pylori! I was floored. He prescribed Prilosec 40 mg 1x a day. It isn’t working. I still feel like I’m trying to choke down a kids building block and it’s stuck around my voicebox.
    I’ve had acid problems most of my life and in 2007 put on aciphex for a while until it all healed. Things have been great for years until just after spinal surgery March 6th. As soon as I woke up I complained of my old arch nemesis heartburn. They gave me Tums (I wonder how much those cost at their pricess!). I don’t eat too many carbs (but I’m not tracking), never did like spicy foods, haven’t had a glass of orange juice in 10 years or so, rarely eat chocolate now, don’t usually consume alcohol, and refuse to give up my couple cups of java in the morning. Strangely enough coffee alleviates the lump pain at my voicebox area, but does create mild Tums manageable acid that I can feel further down.
    Insurance won’t probably pay for another endoscopy with twilight sedation so soon so…what are my test options again? This blog is looooooong so apologies for asking again when I know it’s probably been asked 100 times.
    Wishing good and better digestive health to you all….

  17. Thank you very much for this great article. I’ve been struggling with stomach problems for many years as far as I can remember. In addition to strong heart burns, if left without antiacids, I throw up even on an empty stomach. the vomit is always highly acidic. I also suffer from bloating. a couple of years back I also had chronic diarreah.
    in my research i’m a bit confused as to whether H.Pylori increases or decreases acid. the research i did was partially saying that it reduces acid to survive but other research says it secrets gastin which increases acid. I do know though that my vomit is very acidic and without acid blockers I suffer deeply. I was wondering what type of treatment you recommend so I can live a pain free life. Thank you for making the world a better place

  18. Hello All
    I just had an endoscopy yesterday for killer upper chest pain after eating, or when my stomach was empty. It started immediately following spinal fusion surgery on March 6th, ’14. I figure I either got a food borne infection or something went wonky when I was intubated. (When I woke up in recovery I had a huge fat upper lip on the right side..hmmmm).

    The gastro doc isn’t the one from the group he’s in that I used 7 years ago to detect a handful of ulcers but he was the only one I could get in to see on ‘short’ notice. I actually had to wait three weeks in ungawdly pain to see even him!

    So the test was done, and no ulcers. OK…good news right?…wrong. At least when I was found to have “10+” ulcers in 2007 the treatment process was clearcut and resulted in healing/cure. Now I have no idea what is causing this and the doctor didn’t do a biopsy or test for H. Pylori! I wasn’t happy about that and am STILL not happy about it. He pooh pooh’d my concerns and blew off my questions.
    The last thing I needed whike recovering from surgery was more problems and especially to get an arrogant know-it-all doctor; the type that’s almost always associated with unnecessary testing, procedures, harmful medications, and in worst case scenarios, a cocky SOB that misses serious diagnosis that lead to death like a good friend of mine who died from stomach cancer several years ago.

    I intend to ask my new GP for the pylori breath test or whatever test he thinks is next best to a biopsy. A biopsy test however is so much more definitive for many digestive maladies and not having a biopsy means I’ll be subjected to more tests and costs at a time when I can’t afford either.

    I just wanted to rant and vent a but but also let this serve as a message to others to take control of their doctors. If they won’t spend any time with you to answer questions before any procedures are performed…dump ’em and find another.

    Wishing you all good/better health


    • YES! Take control of your health. I had what was thought to be ulcers for 2 years until 3 months ago I went to a GI doc that the first thing he said was “We need to do an edoscopy and take a biopsy to see what may be causing this.” That is the answer… find the route cause for everything. And YES I had h-pylori and now (knock on wood) I feel great.

      • Hi Sofia
        What treatment route did you take? Was a triple antibiotic part of it?

        While waiting to get in for the endo test I had bought omeprazole but it seemed to make things worse so only took 2 doses. Guess what I was prescribed after the doctor did the endoscope? heh heh Yup…same stuff just prescription.

        I need to call to see if a digital copy was made of the scope video and have another doctor look at it. There’s
        no way this is going on for months or years.

        I’m glad you’re feeling better!

  19. I have h-pylori infection gastric and inflammation but I stop taking my anti biotic because they made my stomach upset but one of my co work tough me about mastic gum and I’m taking it until now but soddenly when I do my vowel movement it turn to black I mean the last few weeks my vowel movement color was fine..is it possible that mastic gum can change you stool color??

  20. This article was an excellent read! My 7 month old has been battling GERD and the medicine pediatricians have put her on (Axid, Prevacid) have only made the issue worse.
    I recently stopped the medicines because I’ve had enough! I went to a chiropractor who did muscle testing for food allergies and found out that the meds in deed were half of the problem. He told me to use Bacteria-chord (a homeopathic remedy) which I bought at his office. He feels she has a bacterial infection, and I completely agree. So I am looking forward to seeing this homeopathic remedy work!