Are you considering hiatal hernia surgery? 
Did you know that acid reflux can come back even after surgery?

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The official medical guidelines for surgery specifically state that a small, sliding hiatal hernia (95% of them are sliding) is NOT an indication for surgery. Surgery is typically reserved for large, paraesophageal hernias, those with severe esophagitis, Barrett's disease and strictures.

It is also considered as an option when there is refractory relux - meaning you are taking medication (typically PPIs) and it isn't working to suppress your symptoms. It is this point I wish to address.

A critical point that's missed is that PPIs suppress acid, they don't prevent reflux. Read that sentence again. So reflux is still happening, it's just not very acidic. Now we need to ask what could continue to cause symptoms if it wasn't acid? Bile. Bile reflux can cause similar symptoms to acid reflux in how you feel, even though it's not acid causing it.

As a 2025 study that I list below stated: "consider bile reflux, don't just keep giving more PPIs". 

A 2024 study stated that up to 38% of refractory reflux is due to bile reflux. If you add in acid plus bile, the total is 64%. 

Let's look at another point. How well does hiatal hernia surgery do in eradicating reflux? It's not great. After 5 years, 44% of patients were again long-term PPI users. Another study found that recurrent heartburn post-surgery had an occurrence rate of 10 to 62% and was considered a post-operative complication.

This data is to give you knowledge that I find many patients considering surgery haven't been made aware of. Conservative measures are always preferred over surgery. Every surgeon would agree, barring obvious emergencies.

Finding a clinician who can address the often missed bile reflux and get to the root cause of what's causing it and acid reflux, could be of great benefit in improving your health.

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.

References:
Monaco L, Balletta A, Mazzarella G, et al. Combined pH and bilirubin monitoring of the esophagus improves the diagnostic yield of reflux disease in patients non-responsive to proton pump inhibitors. Scand J Gastroenterol. 2009;44(5):565-571.

Sugimoto M, Nishino S, Nishizawa T, et al. Importance of bile reflux in proton pump inhibitor-refractory gastroesophageal reflux disease. Digestive Endoscopy. 2024;36(3):390-399.

Armstrong D, Wong RKH, et al. Management of refractory reflux-like symptoms. Aliment Pharmacol Ther. 2025;61(7):505-522.

Naik RD, Vaezi MF. Treatment of refractory gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2020;18(2):343-351.

Wetscher GJ, Schwab G, Pointner R, et al. Long-term outcome after laparoscopic Nissen fundoplication: a systematic review and meta-analysis. Langenbecks Arch Surg. 2024;409(2):199-211.

Oor JE, Roks DJ, Broeders JA, et al. Reflux control 5 years after laparoscopic Nissen fundoplication: a prospective long-term study. World J Surg. 2025;49(4):1020-1029.

Engström C, Jamieson GG, Devitt PG, et al. Ten- to fifteen-year outcome of laparoscopic Nissen vs. Toupet fundoplication: a randomized trial. JAMA Surg. 2022;157(7):623-631.

Lundell L, Miettinen P, et al. Long-term outcome of antireflux surgery in randomized clinical trials: results at 20 years follow-up. Surg Endosc. 2024;38(1):112-120.

Broeders JA, Rijnhart-de Jong HG, Draaisma WA, et al. Ten-year outcome of laparoscopic and conventional Nissen fundoplication: randomized clinical trial. Ann Surg. 2013;258(5):870-877.

#hiatalhernia #acidreflux #r

Why can doctors miss the presence of Hiatal Hernia Syndrome. It's sheet number of symptoms is one problem.

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The symptoms are acid reflux, bloat, abdominal discomfort, heart palpitations, shortness of breath, anxiety and panic attacks, trouble swallowing, hoarseness - to list just a few. There are up to 20.

You can see that these symptoms cover many organ systems of your body: heart, lungs, stomach, digestion, and brain. It's no wonder that what you receive from specialists, who are not communicating with one another, is a palliative drug that can improve your symptoms but does not address the root cause.

And, unfortunately, in the case of PPIs and psychiatric medication, is known to worsen the root cause through its effect on your microbiome.

It's not that your doctors don't care; they are constrained by our medical model to make a diagnosis and then provide the appropriate care, typically a drug, that is approved. 

What the research below does confirm is that the root cause of the problem involves physical/mechanical changes within the digestive tract along with neurological effects (primarily the vagus nerve) which explain what people suffering with this syndrome experience.

How to fix it? One has to establish the causative agents that have created the increased inta-abdominal pressure within the body. Finding a clinician who understands the full depth and breadth of these interactions and how to identify the "why" can really open the door to improvement.

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.

References:
1. Kahrilas PJ, Pandolfino JE. Hiatus hernia. Nat Rev Dis Primers. 2021;7(1):1. doi:10.1038/s41572-020-00241-1

2. Schlottmann F, et al. Hiatal hernia: a review on diagnosis and treatment. J Thorac Dis. 2017;9(Suppl 12):S1108–S1117. doi:10.21037/jtd.2017.06.120

3. Roman S, Kahrilas PJ. Challenges in the diagnosis of gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2012;10(9):864–871. doi:10.1016/j.cgh.2012.02.018

4. Tutuian R, Castell DO. Management of atypical manifestations of GERD. Am J Gastroenterol. 2006;101(8 Suppl):S38–S44. doi:10.1111/j.1572-0241.2006.00657.x

5. Vaezi MF, et al. Proton pump inhibitors and risk of adverse events: a critical appraisal of current evidence. Gastroenterology. 2017;153(1):35–48. doi:10.1053/j.gastro.2017.04.047

6. Moayyedi P, et al. Long-term proton pump inhibitor use and safety: a review of evidence and position statement by the American Gastroenterological Association. Gastroenterology. 2017;152(4):706–715. doi:10.1053/j.gastro.2017.01.031

7. Mittal RK, Balaban DH. The esophagogastric junction. N Engl J Med. 1997;336(13):924–932. doi:10.1056/NEJM199703273361306

8. Bredenoord AJ, Pandolfino JE, Smout AJ. Gastro-oesophageal reflux disease. Lancet. 2013;381(9881):1933–1942. doi:10.1016/S0140-6736(12)62171-0

9. Farré R, et al. Mechanisms of gastroesophageal reflux disease: lessons from animal models. Am J Physiol Gastrointest Liver Physiol. 2017;312(1):G1–G15.

#guthealth #hiatalhernia #rootcausemedicine 

Disclaimer: The information provided in this video is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding your health, medical condition, or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have seen or heard in this video.
The views expressed are based on my clinical experience and

There are places in your body where bacteria normally reside. But what happens when they move to a different location?

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In a recent study looking at 13 different trials the researach observes to hwat degree PPI medication altered gut bacteria. What they found was concerning.

Oral bacteria normally confined to the mouth moved (translocated) and proliferated further down the GI tract. As an example, Strep, proliferated in just 7 days of using a PPI.

Esophagus bacteria shifted too, causing refllux symptoms even without excess acid.

These shifts explain why PPI meds can increase infections, SIBO, system inflammation and overall dysbiosis. 

One infection, C diff (Clostridium difficile) is one of the best known connections to PPIs - proven to double the risk. It causes colitis with severe diarrhea and can become life threatening. 

Why does this happen? When you take a PPI you raise the pH in your stomach and you lose good bacteria while allowing bad bacteria to multiply. There also an issue with bile not being converted properly which allows this bacteria (and other bad bacteria) to multiply.

SIBO symptoms include gas, bloating, constipation or diarrhea, rosacea, osteoporosis, generalized malabsorption, along with creating a deficiency of fat soluble vitamins - A, D, E, and K.

Causing systemic inflammation factually increases your risk for obesity, a weakened immune system, diabetes, IBS, heart disease, autoimmune diseases, certain cancers, anxiety and cognitive decline. 

To summate, here's what the authors of the study said: PPI use may be one of the strongest factors shaping dysbiosis in populations. 

Finding a clinician to help you get to the root cause of your reflux so that you can wean down or off your PPI could make a big impact on your health.

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.

Reference
Fossmark & Olaisen (2024) Microorganisms. “Changes in the Gastrointestinal Microbiota Induced by Proton Pump Inhibitors — A Review of Findings from Experimental Trials” 

#guthealth #acidreflux #rootcausemedicine 

Disclaimer: The information provided in this video is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding your health, medical condition, or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have seen or heard in this video.
The views expressed are based on my clinical experience and current scientific understanding as of the date of publication. Individual results may vary.

A hiatal hernia attack can involve up to 20 different symptoms that seem unrelated to one another. 

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You can feel acid reflux, bloating, gas, pressure in your abdomen or chest, but you can also feel short of breath, have heart palpitations, feel anxious or have a panic attack. 

It this hits you suddenly or in the middle of the night it's pretty terrifying. You definitely want to rule out heart disease due to the symptoms of heart palpitations, shortness of breath and chest pain or pressure. But once you've done that and you continue to suffer, you're left perplexed with what's really going on.

A hiatal hernia, even if small, can cause a cascade of symptoms that begin with the stomach getting compressed, bringing acid up into your esophagus (tube that connects your mouth to your stomach) and the subsequent irritation/spasming of your diaphragm and irritation to your heart that sits directly above your diaphragm. This can cause shortness of breath and heart palpitations along with anxiety symptoms.

It's important to realize that these 3 organs (stomach, diaphragm, and heart) sit very close to one another anatomically and it's well researched that they can influence one another's function when a hiatal hernia or acid reflux occurs.

It's worth mentioning that 95% of hiatal hernias are sliding which means the symptoms can come and go, which can also be confusing because you're not sure what you're doing to cause it. 

At the root is increase intra-abdominal pressure which can worsen lying down at night to sleep as well as when bending over. This is why you can awaken in the middle of the night with a hiatal hernia attack, that is quite frightening.

Half of all reflux is silent, meaning it presents with symptoms that are less obvious than the "classic" heartburn. In silent relux the symptoms are more in the upper chest and throat such as trouble swallowing, having the feeling of a lump in your throat, hoarseness, a cough, or bitter taste in your mouth. You can still have the rest of the symptoms mentioned previously without the signs of heartburn and reflux.

The root of this problem is digestive in nature, with the rest of the symptoms occurring secondarily due to a cascade of effects.

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.

References:
Kahrilas PJ, et al. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22(4):601-616.

Schlottmann F, Patti MG. Hiatal hernia: a review on diagnosis and treatment. World J Surg. 2017;41(7):1626-1633.

Mittal RK, Balaban DH. The esophagogastric junction. N Engl J Med. 1997;336:924-932.

Roman S, et al. Gastroesophageal reflux disease: from pathophysiology to treatment. World J Gastroenterol. 2014;20(14):5275-5294.

Gyawali CP, Kahrilas PJ, Savarino E, et al. Modern diagnosis of GERD: the Lyon Consensus. Gut. 2018;67:1351-1362.

Disclaimer: The information provided in this video is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding your health, medical condition, or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have seen or heard in this video.
The views expressed are based on my clinical experience and current scientific understanding as of the date of publication. Individual results may vary.

A new study reveals a surprising link with acid reflux and your overall health and disease risk.

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Acid reflux is linked to a host of degenerative diseases such as obesity, diabetes, heart disease, autoimmune diseases, certain cancers and cognitive decline.

Don't get depressed; there's good news.

First the mechanisms:
The researchers discovered that when comparing healthy patients to those suffering with acid reflux, Barrett's esophagus or esophagitis, there was a shift in the bacteria population when the reflux was present.

The good bacteria within the esophagus shifted to bad, "gram-negative" bacteria that inflammed the cells of the esophagus triggering not only a leaky esophagus but downstream inflammation throughout the gut. The leaky esophagus created an environment for systemic, body-wide, inflammation.

The bad bacteria affect motility, decreasing it, which increased the frequency of reflux, thereby compounding the problem.

The increased numbers of bad bacteria alter how bile from your gallbladder is broken down, resulting in bile that is more toxic, increasing bile reflux and further damaging the esophagus.

It's quite a vicious cycle.

The protective effects from good bacteria which support an overall healthy microbiome, prevent leaky gut, are anti-inflammatory, enhance proper motility and bile acid metabolism (breakdown) are all lost due to this imbalance.

I promised good news and here it is: improving reflux and thereby healing the esophagus can allow the bacteria to shift back towards a healthy bacteria balance - reversible dysbiosis!

This is great and now you need to find someone who can address how to naturally get to the root cause of your refllux. It's not difficult, but the solution is not a PPI, which factually worsens this very imbalance. [Note: I've recently done some videos on the PPI link to dysbiosis and the research supporting it.]

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.

Reference
Guan et al., Frontiers in Immunology (2025). "The role of the esophageal and intestinal microbiome in gastroesophageal reflux disease: past, present and future"

#guthealth #acidreflux #rootcausemedicine 

Disclaimer: The information provided in this video is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding your health, medical condition, or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have seen or heard in this video.
The views expressed are based on my clinical experience and current scientific understanding as of the date of publication. Individual results may vary.

A new type of reflux has been discovered. If you suffer with heartburn but testing doesn't really show it, this is for you. Similarly, if antacids aren't providing much relief, you could fall into this category.

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If you go to your doctor with classic heartburn symptoms, the first treatment offered to you is antacids, typically a PPI medication. [Note: this is the WORST thing you can do with this condition!]
 
If that isn't providing relief you may be scheduled for an endoscopy. Not everyone can avail themselves of this testing, but if you do and the test doesn't really show a reason for your symptoms, it can be quite perplexing.

A new study revealed that an abundance of a certain type of bacteria, Gram negative, may be present in your esophagus. Bacteria such as Klebisella and Pseudomonas fall into this category. these bacteria trigger inflammatory chemicals which in turn create a "leaky esophagus" which can result in heartburn symptoms, even with minimal acid reflux. 

What are the causes?
1. Low stomach acid - this is why a PPI or any acid reducing medication would in fact worsen this condition. Stomach acid is needed to keep bacterial overgrowth from occurring.

2. Poor oral hygiene - periodontal disease or mouth breathing. Mouth breathing, especially at night, allows bad bacteria to multiply, you swallow them with your saliva and they propagate in your esophagus.

3. A diet high in saturated fat and low fiber also fosters growth of these bacteria.

4. Poor motility of stasis with the esophagus and gut from a hiatal hernia or vagus nerve dysfunction also allows these bacteria to colonize.

Treatment
1. Restore hydrochloric acid in the stomach. Work with a clinician to determine the best approach for you.
2. Supplements such as green tea catechins, resveratrol, curcumin and oregano oil can help reduce the population of these bacteria. Again, work with a clinician to determine best protocols.
3. Add polyphenols to your diet - dark berries, apples, broccoli, cumin asparagus, flax, chai, almonds and walnuts, to name just a few.
4. Foster nasal breathing - try mouth tape at night.
5. See your dentist to address any periodontal disease.
6. Don't eat late at night to allow your body's normal cleansing process to occur during a 12 to 14 hour fast overnight.
7. Get help to naturally treat your hiatal hernia, vagus nerve imbalance.

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.

Reference:
Chen S, Journal of Translational Medicine, 2024: Esophageal dysbiosis → barrier injury via LPS-TLR2-IL-6-claudin-1.

#guthealth #hiatalhernia #rootcausemedicine

Disclaimer: The information provided in this video is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding your health, medical condition, or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have seen or heard in this video. The views expressed are based on my clinical experience and current scientific understanding as of the date of publication. Individual results may vary.

Do you suffer with acid reflux or hiatal hernia? Do you also suffer with irregular heartbeats like atrial fibrillation (A fib)? Have you wondered if they were connected?

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If so, you're correct. Before we jump into the results of a brand new study confirming the link, I want to note that symptoms associated with your heart should always be checked out first by a cardiologist. This video is directed towards those individuals who do NOT have heart disease but still suffer with cardiac symptoms.

Atrial fibrillation occur due to an irregular rhythm in the upper chambers of your heart called the atria. The heart's electrical system becomes irregular. 

Symptoms include heart palpitations, a racing heart, fatigue, shortness of breath or dizziness.

This new research, corroborated by several other studies which I include below, cite that acid reflux treatment could influence the prevention or progression of A fib. And the acid reflux (GERD) mangement could potentially modify A fib risk. This is exciting.

When heart disease isn't driving A fib, how does acid reflux cause it? There are 2 key mechanisms:

1. Vagus nerve involvement - it's called vagally -mediated A fib and the clue to its presence is A fib that occurs after meals, when you're overly full, it occurs when lying down or during reflux. Reflux and hiatal hernia causes irritation that can overstimulate the vagus and thereby trigger A fib or heart palpitations.

2. Inflammation due to acid exposure - acid and bile reflux causes inflammation of the esophagus. Anatomically the esophagus is very close to the atria of your heart. Inflammatory chemicals, created by reflux set off changes in the cells of the atria that alter how electrical impulses are generated, causing electrical instability.

The solution for this type of atrial fibrillation is to get the reflux under control naturally. I say naturally because PPI medication has multiple side effects, one of which is a risk of heart attack and stroke.

It's not difficult to identify the root cause of acid or bile reflux and to get the hiatal hernia symptoms under control.

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.

#acidreflux #hiatalhernia #rootcausemedicine 

1. Sinha T, Joshi HM, Patel B, Stanikzai H, Hussaini H, Chaudhari SS, Habib I, Hirani S. The Association Between Gastroesophageal Reflux Disease and Atrial Fibrillation: A Systematic Review and Meta-Analysis. Cureus. 2025;17(2):e78356.

2. Xu L, Zhang Y, Xie J, Liu Y, Xu L. Association between gastroesophageal reflux disease and atrial fibrillation: a systematic review and meta-analysis. Rev Esp Enferm Dig. 2019 Nov;111(11):874-879. 
PubMed

3. Huang C-C, Chan W-L, Luo J-C, Chen Y-C, Chen T-J, Chung C-M, et al. Gastroesophageal Reflux Disease and Atrial Fibrillation: A Nationwide Population-Based Study. PLoS ONE. 2012;7(10):e47575.

4. Frontiers in Cardiovascular Medicine. “Gastroesophageal reflux disease may causally associate with increased AF incidence: Mendelian randomization study.” 2024.

Disclaimer: The information provided in this video is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding your health, medical condition, or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have seen or heard in this video.
The views expressed are based on my clinical experience and current scientific understanding as o

If you've been suffering with acid reflux or hiatal hernia, you've already been told what NOT to eat: avoid tomatoes, onions, garlic, coffee, mint, citrus and spicy foods. 

But what SHOULD you eat?

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Adding the right goods can help heal, soothe and prevent reflux.

1. Soothing, Alkaline Promoting Foods  
Melons and bananas are naturally low-acid; they coat and soothe the esophagus.

Oats, quinoa and brown rice absorb stomach acid and can reduce reflux episodes.

2. Mucosal Healing Foods 
Aloe vera juice (inner fillet, no aloin) has been demonstrated to reduce esophageal irritation.

Slipper elm or marshmallow root tests are demulcents (a substance that forms a protective film over inflamed mucous membranes) that coat the esophagus and stomach.

Cabbage juice is rich in glutamine and supports mucosal healing.

Prokinetic (Motility) Supporting Foods 
Ginger, start with small amounts to imrove stomach emptying.

Bitter greens such as arugula, dandelion and endive, stimulate bile production and motility.

Anti-Inflammatory Foods
Berries and high polyphenol foods (olive oil, flax, walnuts, Brussels sprouts) lower inflammation.

Omega-3 rich foods such as wild salmon, chia and flax recude esophagus inflammation.

Gut-Balance Foods
Soluble fiber has been show to increase the positive presure of the esophagus to thereby prevent reflux.
Fermented foods - start with samll amounts of sauerkraut, kefir, miso, support the microbiome.

High fiber vegetables such as steamed brocoli, zucchini, sweet potatoes, help stool transit time and reduce the intra-abdominal pressure that can drive hiatal hernia and reflux.

Eating Habits
Adopt small meal size to lower intra-abdominal pressure
Timing: finish eating 3 hours before bed.

Posture - avoid slumping after meals, take a gentle walk to facilitate digestion.

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.
#guthealth #hiatalhernia #rootcausemedicine 

References
Panahi, Y., et al. (2015). Phytotherapy Research. Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial.

Morozov, S., et al. (2018). Journal of Clinical Gastroenterology. Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease (NERD).

Komolafe, K., et al. (2025). Foods. Natural Products in the Management of Gastroesophageal Reflux Disease: Mechanisms, Efficacy, and Future Directions.

Panahi, Y., et al. (2016). Pharmacological Sciences. Effect of Aloe vera and Pantoprazole on Gastroesophageal Reflux Symptoms in Mustard Gas-Exposed Subjects: A Randomized Controlled Trial.

Andrews, W. G., et al. (2021). AEG/AME Groups, specialized GI journal. The relationship of hiatal hernia and gastroesophageal reflux.

Kahrilas, P. J., Shi, G., et al., 2000. Gastroenterology. Increased frequency of transient lower esophageal sphincter relaxation induced by gastric distention in reflux patients with hiatal hernia 

 Hyun, J. J., et al. (2011). Gut and Liver. Clinical Significance of Hiatal Hernia.

Disclaimer: The information provided in this video is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding your health, medical condition, or treatment options. Never disregard professional medical advice

Barrett's esophagus is typically "blamed" on acid reflux and the solution offered is to take PPI medication. But that's not the whole story. 

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Bile reflux can be more damaging to your esophagus, proven by research.

Some basic information before we dive in: Barrett's esophagus occurs after many years of reflux, acid and/or bile. It is diagnosed when the lower esophageal lining changes from its normal type of cells (squamous epithelium) to the types of cells seen in your stomach (columnar epithelium). 

The  concern is that these cells can become pre-cancerous and then cancerous and esophageal cancer is an awful cancer to have.

The earlier you begin with reflux in life raises your risk for developing Barrett's. Additional risk factors are: reflux, obesity, smoking, male, caucasian, age and having a hiatal hernia. But bile reflux is one of the strongest independent factors, therefore the reason for this video.

Symptoms of Barrett's includes: heartburn, regurgitation, chest pain, difficulty swallowing, or no symptoms.

It's typically diagnosed during an endoscopy.

Traditional treatment is PPIs, weight loss, smoking cessation and surgery.

While a scary proposition to contemplate, the risk of esophageal cancer is about 5% but it is higher once the cells have become pre-cancerous. At the pre-cancerous stage there is a successful ablation surgery but the recurrence rate is about 10% per year so it's still advantageous to be addressing root cause issues.

The exciting prospects for this condition is research that if the cause of reflux is addressed, healing/stabilizing and a potential for reverting to normal tissue can occur.

That's certainly something we see often with hiatal hernia and reflux. When you get to the root cause of what's causing the reflux, the esophagus has the potential to heal. 

Solutions
Address "drivers" of bile and acid reflux including hiatal hernia, weight reduction, neutralizing bile acids (alginates are helpful), shift bill acid composition to a less toxic state with things such as taurine/glycine, milk thistle. Note: I am not diagnosing nor treating you. You will need to find a  clinician to work with you.

For hiatal hernia utiizing diaphragmatic breathing and stabilizing the vagus nerve are important while normalizing microbiome diversity.

Protect the esophagus and stomach lining with natural agents such as DGL, aloe vera and zinc. 

Avoid late night eating, ultra-processed foods, sugar and alcohol.

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.

#guthealth #acidreflux #hiatalhernia  
References:
Katerina Dvorak, et al., "Bile acids in combination with low pH induce oxidative stress and oxidative DNA damage: relevance to the pathogenesis of Barrett’s oesophagus"  Gut 2007

Bhaskar Banerjee, et al. "Clinical study of ursodeoxycholic acid in Barrett’s esophagus patients". Cancer Prevention Research
2016 (July issue)

Shaheen NJ et al. ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus. Am J Gastroenterol. 2022.

Andrici J, Eslick GD. Hiatal hernia and the risk of Barrett’s esophagus. J Gastroenterol Hepatol. 2013. Wiley Online Library

Eusebi LH et al. Risk factors for Barrett’s oesophagus in individuals with reflux symptoms. Aliment Pharmacol Ther. 2021. White Rose Research Online

Orman ES, Shaheen NJ. Efficacy and durability of radiofrequency ablation for Barrett’s esophagus. Clin Gastroenterol Hepatol. 2013. mgh-ita.org

Wani S et al. Recurrence after complete eradication peaks around 18 months. Clin Gastroente

If you're one of the millions of people taking a PPI, this is data you'll want to know.

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You're told that you have acid reflux and you have to decrease your acid with a drug. Sounds reasonable until you find out that your reflux is not associated with excess acid, but rather inappropriate pressure on your stomach. 

Further, the acid that's being blamed, once reduced by the drug, is causing the exact problem that's creating the acid reflux. It's not helping your underlying condition, it's perpetuating it.

I know that's frustrating but there are solutions.

First let's look at the various mechanisms occurring.
When you reduce stomach acid it allows both oral and environmental (from your food) bacteria to pass into your intestines. PPI uders have greater oral bacteria like Streptococcus in their gut than non-PPI users.

Bacteria such as E. Coli and C. difficile (which can result in life-threatening diarrhea) are linked to infection and overgrow in PPI users. There is also less diversity of good bacteria in the gut making you less resilient against infectious organisms.

Bile acids are also affected. You need good gut bacteria to break apart bile acids so they can be recycled. With less good bacteria present that doesn't occur and even more infectious, pathogenic bacteria survive, further worsening the gut microbiome.

When the pH is raised in the stomach, bacteria colonize in the small intestine promoting SIBO and causing bloat, gas, diarrhea and malabsorption.

The imbalance of the colon weakens the gut lining causing leaky gut and promoting body-wide (systemic) inflammation. This not only increases infection risk but also leads to metabolic changes leading to heart disease, type 2 diabetes, obesity, cancer, autoimmune diseases and dementia.

What can you do? It's not about abruptly stopping your PPI, especially if you've been taking it for more than a few months. You need to find a clinician who can evaluate and help you treat the root causes which include:
Infections
SIBO
Poor diet
Toxins
Weight loss - visceral fat particularly
Food sensitivities
Vagus nerve imbalance
and more.

It's not difficult when you know how to determine what the causative agents are. The program is natural and drug-free.

If you'd like help we're here for you. The best next step is to contact us for a consultation and then we can determine if what we do is a good fit for you. Call 727-335-0400.

References
1. Imhann, F., et al. (2016). Proton pump inhibitors affect the gut microbiome. Gut, 65(5), 740-748.

2. Seto, C. T., et al. (2014). Prolonged use of a proton pump inhibitor reduces microbial diversity: implications for Clostridium difficile susceptibility. Microbiome, 2, 42.

3. “Passing the ‘Acid Test’: Do Proton Pump Inhibitors Affect the Microbiome?” – T. Dong, E. Forslund, et al. (2018). Annual Review of Microbiology. PMC

4. Zhang, J., et al. (2023). Meta-analysis of the effects of proton pump inhibitors on the gut microbiota. BMC Microbiology, 23, 2895.

5. Khurmatullina, A. R., et al. (2025). The Duration of Proton Pump Inhibitor Therapy and the Risk of Small Intestinal Bacterial Overgrowth: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 14(13): 4702.

6.Fossmark, R., et al. (2024). Changes in the Gastrointestinal Microbiota Induced by Proton Pump Inhibitor Treatment. Frontiers / PMC paper.

7. Zhang, X., Li, Y., Huang, C., et al. (2024). Proton Pump Inhibitors and Oral–Gut Microbiota. Biomedicines, 12(10), 2271.

8. Kiecka, A., et al. (2023). Proton pump inhibitor-induced gut dysbiosis and digestive disorders: what is the link? Pharmacological Reports.

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