November 2004

Gastroesophageal reflux disease

by Dr. Howard Loomis

The sale of antacids and proton pump inhibitors now exceeds $12.9 billion dollars a year. Television advertising continually warns us of the danger of excess stomach acid eroding the mucous lining of the stomach and possibly leading to cancer.

A fairly significant portion of your patients have problems associated with diet, digestion, and bowel function.

Chiropractors should be aware that they are uniquely suited to specialize in diagnosing potential problems in these areas and preventing the catastrophic problems pharmaceutical companies are advertising to scare Americans into using drugs. These drugs retard digestion and do nothing to correct dysfunction and restore normal function.

The problem

There is a fundamental problem with labeling digestive symptoms as a disease. First, symptoms do not make a disease. As I will discuss below, indigestion is a syndrome or collection of symptoms for which prescription drugs are routinely prescribed without objective verification that an actual pathological condition exists. This presents a significant problem for you and your patients because normal function cannot be maintained or restored with drugs, regardless if they are recreational, prescription, or over‑the‑counter.

Gastroesophageal reflux disease (GERD) is a structural problem that allows stomach contents to back up through the cardiac valve that separates the esophagus and the stomach. Obviously, the problem can be localized to the lower esophageal sphincter (LES), but dysfunction here can represent several different structural problems as well as biochemical deficiencies. For chiropractors, several different subluxation patterns may be presented by patients suffering from identical symptom patterns.

In coming columns, I will:

‑‑ assert that the concept of excess stomach acid is not physiologically possible, and it has been abundantly documented that patients suffering from indigestion are actually stomach acid deficient.

‑‑ discuss treatment and make several common‑sense suggestions for restoring normal digestive and elimination functions and dietary recommendations.

Throughout this series on nutrition and digestion, I'm going to suggest chiropractors consider specializing in this condition and preventing the potential disease component of the syndrome. In addition to recognizing the common symptoms associated with this syndrome, DCs are uniquely qualified to find the actual cause of the problem (and there are several). As I've written in the past, once the cause of a condition is recognized, the needed treatment becomes obvious.

The symptoms

Symptoms of indigestion are very common. Only recently have the pharmaceutical companies been allowed to call these symptoms a disease. Yet, there's no known single cause of GERD nor does any one symptom identify the actual cause of the problem. Symptoms of GERD vary from one person to another.

According to the International Foundation for Functional Gastrointestinal Disorders "the majority of people have mild symptoms with no visible evidence of tissue damage and little risk of developing complications!" That seems to contradict the ever‑present radio, TV, newspaper, and magazine advertisements for acid blockers and antacids, ad nauseum (pun intended).

Supposedly, GERD only occurs when the mucosal lining of the esophageal is damaged by acidic contents that back up into the esophagus. Isn't that a contradiction? The mucosal lining of the stomach and esophagus protects the epithelial wall of those structures from digestive activity. Physiology textbooks state that secretions from the esophagus are entirely mucoid in nature and provide two important functions:

1. Simple mucoid glands provide lubrication for swallowing.

2. Compound mucoid glands protect the esophageal wall from damage by the gastric juices.

In other words, if a problem develops in the esophagus from damage by digestive juices, the problem lies with the secretion of adequate mucus and not with the secretion of excess stomach acid. Even a small amount of stomach acid with a pH somewhere between 2.0 and 5.0 will damage unprotected epithelial tissue. There is no need for an excessive amount.

Symptoms associated with GERD

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach and is often accompanied by persistent or chronic heartburn. But not all symptoms of indigestion and heartburn are related to actual tissue damage within the esophagus.

Only when tissue damage is present can the patient be said to have esophagitis or GERD. In other words, the epithelial structures of the esophagus must be examined and tissue damage demonstrated before the diagnosis of GERD should be made. However, tests for this damage are not routinely performed. Rather, the prescription of an antacid or proton pump inhibitor to prevent the formation of stomach acid (even up to 24 hours) is routinely made for any symptom of indigestion.

Differentiating dyspepsia from GERD

Authorities state that periodic heartburn is a symptom that many people experience. If it occurs just after a meal or only occasionally, it is likely a "benign" problem. Only when the condition has occurred more than once a week, or for five years or more, or when the indigestion awakens the patient while they sleep is the patient considered to be at risk for GERD and its potentially harmful complications.

Conclusion

Considering the information presented here, it should be obvious that chiropractors can determine the cause of symptoms associated with dyspepsia and restore normal function before actual damage to the esophageal wall occurs. I believe prevention of disease falls well within scope of a chiropractic practice regardless of philosophical orientation.

(Dr. Loomis welcomes input on the subjects covered in this column. To make a comment or ask a question, or to request a free copy of his video titled, "Using Enzymes in Clinical Practice: The Loomis System," call 800‑662‑2630, or write to him at 6421 Enterprise Lane, Madison, WI 53719. Visit www.loomisenzymes.com online for information on upcoming Loomis Institute seminars.)