Approach to reflux

The stomach needs acid to facilitate the breakdown of food, but also to provide protection for the rest of the digestive system by destroying harmful bacteria/yeast/parasites that are swallowed. Taking a proton pump inhibitor (ie. Nexium, Prevacid) for a long-time robs the digestive system of this and has been shown to increase the risk of fractures, B vitamin/magnesium/iron deficiency, colon infection, and leaky gut. The other problem with proton pump inhibitors (PPIs) is that the stomach never really stops wanting to make acid, so upon stopping the drug, there is an increased risk of high acid output. This acid output combined with the fact that proton pump inhibitors may weaken the lower esophageal sphincter (LES) is a recipe for heartburn and the feeling that the patient "needs" to restart the medication.

PPIs were developed for acute ulcer or gastritis: Take the medication for 4-6 weeks while implementing the lifestyle strategies that rid the root cause of the reflux: Food sensitivity, LES weakeners: nicotine, caffeine, peppermint, high fat, carbonation. Not likely spicy food. Also smaller meals, not eating before lying down). Then one stops the PPI and all is well. Unfortunately, we rarely focus on the root causes and implementing change and people stay on these drugs forever at the risk of complications.

For new cases, I rarely find a need to use PPIs if a focus on root causes is done. Treatment, if needed involves any one or combination of: Iberogast, probiotics, melatonin (good evidence, as it seems to stimulate closure of the LES at night-time), turmeric (good evidence for treating gastritis, if this seems to be present), working up or considering the elimination of food sensitivities (start with gluten and dairy) and adding digestive enzymes.

For those currently on PPIs for some time, it's often hard to stop cold turkey and sometimes hard to slowly wean. I typically discuss the root causes and how the digestive system works and explain this can be a long, but necessary process to get off PPIs. I usually start people on probiotics (20 billion colonies daily), melatonin (2.5 mg at bedtime, may need to increase especially if waking up with heartburn), Iberogast, and if sometimes additionally something with aloe, licorice and L-glutamine for digestive lining support and protection. I also consider food sensitivity elimination (if no testing, typically start with gluten for sure and often dairy, especially milk and ice cream). After 10 days I have them cut their PPI in half or take it every other day. Most are able to do this without symptoms. Over time, maybe every 1-2 weeks we try and space it out by a day more, eventually using it only as needed. Don't forget head position while sleeping, smaller meals, and avoidance of LES weakening foods and drugs.

Contributed by:

Dr. Jeffrey Gladd


Dr. Jeffrey Gladd graduated from Indiana University School of Medicine in 2001. He then went on to train in family medicine...

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Dr. Jeffrey Gladd
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