Low Stomach Acid

I believe I suffer from this syndrome. Can you please explain about why one feels GERD like symptoms if there is too LOW a stomach acid? Please give your thoughts on HCL Pepsin therapy as well as dietary modifications. I've suffered from IBS for years, and it always feels like the food is just fermenting in the small intestine.

Thanks,
Joseph

[Joseph Sclafani, M.D.]

Hello,

Thank you for your question. Gastroesophageal reflux (GER; when gastric contents move from the stomach to the esophagus) is not a disease. It occurs normally. GER DISEASE or GERD, has a wide spectrum of disease, and is probably one of the most common diseases of mankind.
In regards to your first question, I would wonder why you believe you have too "low of stomach acid"? Do you mean too low of stomach pH (which actually means more acid)? Regardless, the amount of acid is not the issue. GERD occurs when there is a failure to the normal anti-reflux mechanisms, which doesn't only rely on how much acid, but on other factors like the pressures of the lower esophageal sphincter and other anatomical factors ("the way the parts are built").

There are 3 major defenses against acid damage. The first is a complex region involved the lower esophageal sphincte (LES) (opening between esophagus, a part of the diaphragm, and some ligaments, and another part of the LES). The second is the ability of the esophagus to clear the acid that refluxes. The last defense is the stomach's role, which relates to your question. This is the actual amount of acid secreted. However, it has been proven that gastric (stomach) acid secretion is NORMAL in patients with GERD.

Pepsin AC (famotodine) is an H2 blocker. I generally recommend H2 blockers and antacids (like Gaviscon, others) for the patient with mild or intermittent symptoms. If they get symptoms like heartburn 2 or more days per week, I recommend over the counter (OTC) omeprazole (trade name Prilosec) instead for 14 days (every day, even when they don't have the symptoms). I tell them to take it 1 hour before their AM or lunch meal. If that fails  to relieve their symptoms I either intensify their therapy with twice daily treatment or refer them for an upper endoscopy to look for complications of GERD or for an alternative diagnosis like an ulcer. However, there are variations on this that I individualize for the patient, but this is my general approach.

Lifestyle and food choices are key. Elevate the head of the bed while sleeping, avoid lying flat for 3 hours after meals, sleep with the left side of your body down. Also avoid large fatty meals. Avoid foods that trigger GERD like onions, garlic, alcohol, chocolate, etc).

Thank you,
Dr. S

[Duece36]

what can be done about difficulty swallowing with GERD??? Boyfriend having a hard time swallowing anything... and it is really concerning me. Had him at the hospital and they gave him a cocktail and it helped him, then they sent him home with the same medicine, but in pill form.. what can he do to help this symptom?

[kevieb]

is he having trouble moving the food down his esophagus, or is he getting food stuck in his esophagus/  I have had severe reflux for almost 22 years.  I have had to have my esophagus dilated 4 different times.  3 times I have had what is called a shatzky's ring, which is a narrowing band in the esophagus that must be fractured or stretched to widen it.

I also have developed a condition called eosinophilic esophagitis, which is an infiltration of allergic cells in my esophagus.  It can cause difficulty in swallowing---sometimes food will just kind of feel like it is dragging it's way down.

He sounds like he needs to have a endoscopy done to see what is going on---and make sure he has it done by a GI and not a surgeon.