Erosive Gastritis: Low or High Stomach Acid

its another one of those topics like chronic lyme that has split the medical community

mainstream docs will say GERD is caused by too much stomach acid - and will prescribe antacids and Proton pump inhibitors to reduce it

more integrative docs will say its actually caused by something else all together - ie SIBO - and that might have originated because there is too little stomach acid ( not too much) - allowing SIBO to develop - which causes gasses to push acid back up past the valve at the top of the stomach and into the oesophagus - causing discomfort and eventually damage.

i am leaning towards the second theory being nearer the truth

partly because - at least it offers an explanation for why acid might suddenly make its way past the valve at the top of the stomach designed specifically to keep it in

also - looking around in the world its clear that there are massive incentives for interested parties to keep pushing the former theory - namely antacids and PPI's being big sellers ( i read that they are in the top 5 most commonly prescribed drugs in the west - so sales will be in the billions of dollars per year and companies will not want to give up on those ).
whenever we see these large commercial incentives at play we often see they are continuing down this path despite newer science which casts doubt on the approach. Chronic Lyme, thyroid treatment, etc are all cases in point

but also because everyone i know who takes antacids and PPI's long term doesn't seem to ever get better - just kind of manage symptoms a bit better - and often have long term side effects.

i don't think its easy to break the cycle though - and the temptation when you are in discomfort is always going to be to reach for the short term symptom relief - whereas the long term fix might be taxing, take longer and require some experimentation - which is i think why so many people seem to get stuck in the loop.

astro had some posts in the past - i think his approach involved talking SIBO and using D-lemonine to help heal the oesophagus - but that's not doing it justice

Bartonella wrecked my stomach, but it was mostly pain and diarrhea.

The stomach acid problem was not due to bartonella, but to dysregulation of calcium and vitamin D. This was mostly due to borrelia. Specifically, stomach acid production is regulated via a calcium-dependent mechanism, and when this is affected it causes excessive or inadequate stomach acid production. Insulin release is regulated via a similar calcium-dependent mechanism and this whacked my blood sugar too. Be careful with vitamin D supplements.

Also I found that clindamycin caused esophageal reflux, so be careful with that.

SIBO was mostly due to gastric motility issues, caused by dysregulation of the hypothalamic-pituitary-adrenal axis. I was able to treat this with hydrocortisone and LDN.

ref biopsy negative

i definitively had bartonella - and we know bartonella infects the entire lining of the gut including the stomach - from which they took 6 biopsies during my gastroscopy
they recorded mild-moderate gastritis on my gastroscopy report - but found no h-pylori

ref Burrascano's and his 2008 guidelines - gastritis is often caused by bartonella - and is the most common cause in the absence of h-pylori - so very likely my gastritis was caused by bartonella.

yet the histology report from the hospital on the biopsies taken said "no infectious agents found"

i tried to get to the bottom of exactly what they are testing for via histology of the biopsiesand what infections can in fact be found that way and ruled out
i was unable to get any clear convincing answers -

however, we know that bartonella does not stain at all with most histology staining techniques - and is also extremely small compared to most other bacteria - too small to see directly with light microscopes used for histology

so my conclusion is that Bart is simply not diagnosable via regular histology -
so the report will simply record inflammation with no known cause - as mine did - and the doctors will just go back to their "its just something that happens to some people" lame explanation
whereas - in reality all illness have a cause - an in this case they just don't understand what it is

ref stomach acid testing - if a test for levels of could be done reliably then that would be great

but i suspect its not straightforward - and would be wary of similar issues to teh above case being in the mix
how to test reliably? - maybe aspiration is the only way to really measure it....
and then - since its a dynamic system - when to test? - versus when food is taken - and what kind of food etc - all these factors may all have a bearing - and in reality you may have to test many times to get a useful average.

( i have not dug into testing of this in any detail, so this is more a list of things i would be seeking answers to if i was going into testing of it - based on my experiences with other type of testing)

also - if SIBO was initiated at some previous time - it may have been caused or exacerbated by low stomach acid - but that could have improved since - and so again it may not be definitive either way as normal levels of stomach acid will still damage the oesophagus as they should not be there

may be more effective to take a more pragmatic view and do some experimentation

Several years ago, I had the following Heidelberg Gastrogram Study

https://www.phcapsule.com/patients/heidelberg-ph-test

According to the results, my stomach acid was allegedly low. My doctor's advice was for me to take "Betaine HCl with Pepsin" capsules with each meal containing 20+ grams of protein.

Dosing was to start with one capsule per meal and titrate up every few days, until a burning sensation was achieved. At that point, I would reduce the dose by one capsule per meal until the burning sensation resolved. I was then to remain at that dose until the burning sensation returned, reduce the dose by another capsule, and keep repeating until no capsules were needed. In theory, I would then be producing sufficient stomach acid.

However...

I managed to get to five capsules per meal with no burning sensation and I was concerned about continuing to take more, based on the instructions on the supplement bottle and what I had read online (the latter always being suspect). So, I notified my doctor and asked for guidance. His advice: Ah, it's okay, you can stop taking them.

That's it? Just stop taking them? No further questions or investigation, after dropping a few hundred dollars on the test?!?

Of course, that made me wonder how much he really valued the pH test, given how quickly and easily he abandoned the treatment plan based on it. He referred me to another clinic for the pH test, so maybe he received a referral fee from them. This was just another in a series of interactions where I felt fleeced.

Years later, I then ran across the following article:

The HCL Challenge: Why The Conventional Test Is DEAD Wrong
https://metabolichealing.com/the-hcl-challenge-why-the-conventional-test-is-dead-wrong

"...if a small dose of HCL produces burning, it is not because you have adequate HCL at all. If HCL supplements produce burning it indicates rather that your mucosal barrier is damaged! The HCL is producing burning because the acid is burning exposed tissues.

Under normal, healthy circumstances, a person should be able to tolerate a lot of Betaine HCL. HCL only contains about 2-3% hydrogen. The clinical response that occurs with Betaine HCL supplementation is more due to the Betaine than from HCL! If you are experiencing burning with only 500-3,500 mg of HCL, your gastro intestinal mucosal barrier is in a state of distress. Many researchers believe that a person with a healthy mucosal barrier should be able to tolerate upto 26 capsules of Betaine HCL!"

Perhaps this is why I wasn't bothered by so many HCl/Pepsin capsules.

He goes on to write that "The Heidelberg pH test is probably the most accurate way to gauge HCL insufficiency," but he also claims that blood tests and hair mineral analysis may also be acceptable substitutes.

If you're interested in the pH Capsule test, you can learn more about it here:

Heidelberg Medical - Gastric pH Diagnostic System and pH Capsule
https://www.phcapsule.com

Using their lookup tool, the following clinic is located in Dunwoody:

Progressive Medical Center - Dunwoody, GA
https://www.progressivemedicalcenter.com/conditions/digestive-disorders

Though I can't recall for sure, I think I paid somewhere around $350 or more for the test. But, that was several years ago and may vary by clinic.

Finally, because I cannot seem to stop offering ideas, the following person may have some other useful information. I've cobbled-together a few disparate resources about some of his approach to digestive issues:

How To Stop Acid Reflux - Without Drugs
https://youtu.be/3tajuzdt0bg

How To Fix LPR (Silent Reflux) - LPR Diet that Stops Reflux
https://youtu.be/khrm_qf9mai

Fast Tract Diet
https://digestivehealthinstitute.org/fast-tract-diet

Fast Tract Diet Food List: What to Eat and Avoid for Better Digestion
https://naomedical.com/blog/fast-tract-diet-food-list-nao-medical

Fast Tract Diet with Dr Norm Robillard | Ep 18
https://youtu.be/0kzrmia4m88

Good luck, running wild.

Sincerely,
The Loquacious Dude

Thank you both for tremendous thoughts and information. And Dude, ALL your thoughts and information are appreciated. No need to be concerned about too much. No such thing. And I need to email you. Will do so when I get laptop back and don’t have to use this phone. Mother board went down.

Rainy - Great thought about the candida. Good news is it doesn’t play off as autoimmune related.

Chances of gastro buying into to anything but too much stomach acid are remote. Very closed minded, and I’ll probably piss him off with my questions Tuesday.