SIBO and Reflux

What to do about reflux?

Most people have heard of Prilosec, Nexium, and Prevacid. These medications are known as proton pump inhibitors (PPIs) or acid blockers and are often prescribed for symptoms of heartburn, as they are designed to decrease acid production in the stomach. What many don’t realize, however, is that gastric acid is one of the first-lines of defense to prevent gastrointestinal bacterial overgrowth. This means that when gastric acid is consistently supressed for treating heartburn or stomach pain, it can create an ideal environment in the gut for bacteria to overgrow, including pathogenic bacteria such as Clostridia Difficile (C. Diff). This dysbiosis in the gut can lead to a host of symptoms and health conditions, including gastrointestinal issues and SIBO. In order to address these issues, we must look at the medications you take or have taken in the past and look more deeply into why you are suffering from reflux in the first place.

Root Causes of Reflux:

Anything that irritates your esophageal sphincter can cause reflux. The esophageal sphincter is a band of muscles located at the end of the esophagus at the entry to the stomach. It is responsible for keeping the contents of the stomach from going back into the esophagus. Once the sphincter becomes irritated, the muscles can’t do their job as effectively, allowing stomach acid and partially digested food to go back into the esophagus.

The following can irritate the esophageal sphincter and create an environment for reflux.

  • SIBO (small intestinal bacterial overgrowth) causes intra abdominal pressure from gas, both methane and hydrogen. This puts pressure can cause the esophageal sphincter open up when it is not suppose to.

  • Food Sensitivities – Consuming foods you have an immune reaction to can irritate the espohgeal sphincter.

  • Low Gastric Acid/Low Digestive Enzymes – Not enough stomach acid and/or digestive enzymes makes it hard for the body to break down food. This leaves food in the stomach for longer and allows for fermentation of carbohydrates by intestinal bacteria. This fermentation creates gas that results in increased intra-abdominal pressure on the lower esophageal sphincter, resulting in reflux.

  • Acidic foods– If you have reflux, you know staying away from acidic foods like citrus and tomatoes helps.

  • Anything that causes increased intra abdominal pressure, including any other condition that may result in gas and/or  bloating.

Talking with a doctor can help you determine your next steps based on your personal situation. Two of the options you might look at with your doctor is an HCl Challenge and-or a SIBO test. The HCl challenge looks at finding your personal dosing for additional stomach acid. You start with a small amount and increase your dosing until you find relief from your reflux symptoms. This is done under the supervision of a doctor. The SIBO test is a breath test done at home over 3 hours. This test can measure the levels of both hydrogen and methane producing bacteria in your small intestine.

Do you have additional questions about what might be causing your reflux or ways you can start finding relief? Reach out to our office to speak with one of our doctors. Dr. Spencer has experience treating SIBO and has various ways to address SIBO based on the results of your test. Both Dr. Spencer and Dr. Riggs have experience using the HCl Challenge to help patients find relief from their reflux. They can help determine the right next step for you with reflux.

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