Defining and classifying reflux, and the importance of this

I have a tendency to be pragmatic and perhaps sometimes cynical, and apply logic in my approach to analysis and problem-solving.   The heading of this HealingWell messageboard is “GERD – Heartburn”, but I feel there is a need to define and clarify those terms.   I realize that both the symptoms and diagnosis of this condition(s) is not always black-and-white, but for those new to the discovery that they have to begin making lifestyle adjustments to find some comfort, I think it’s important for some things to be understood.   Even with the advances today in medicine, a lot is not understood about reflux and its causes.   The following is an incomplete list of possible/theoretical causes:   ·        weakness of lower esophageal sphincter (LES), upper esophageal sphincter (UES), or both. ·        paraesophageal hernia ·        hormonal imbalances resulting in nausea/regurgitation ·        gastritis/ulcers ·        reactive stomach to certain foods, or perhaps food allergies ·        poor stomach emptying ·        excessive gas from lower GI tract “backing up” ·        anxiety ·        obesity   Only the first item on this list (and perhaps the second, if you allow the impact it has upon the LES), that of mechanical, physiological problems with the esophagus leading to reflux, is classified as GERD.   The symptoms one may experience in whatever category he/she belongs to may be the same, but the classification is not.   Reflux regurgitation can occur even if the LES is structurally OK, and, within limits, can be normal.   Chronic reflux may very well be GERD, but again, it may not.   The importance of this fact is in the treatment of symptoms.   If you belong to one of the other categories, there are a multitude of possibilities in terms of treating or alleviating symptoms.   Some on this messageboard have reported success with diet, or herbal supplements.   The confusion results when these people call their condition “GERD” when they have never been officially diagnosed with this disease.   Perhaps they have been to a doctor who used an empirical methodology with his diagnosis, and prescribed PPIs for treatment.   But this still does not represent an official diagnosis, only an “observational” one.   The only way GERD can be accurately diagnosed is through pH testing, and sometimes manometry, although this is often inconclusive.   Even an EGD/endoscopy can not be relied upon for a diagnosis.   Dr. Jamie Koufman has had some success treating her reflux patients with diet, although she recognizes that not all respond to this approach.   In my opinion, she has success with those patients who belong to other categories of reflux, but not GERD patients.   It’s also possible that for those who have reflux as a result of poor diet choices (trigger foods, eating before bed, etc.), improvements may be found from more dietary discipline.   If you have GERD, however, your options are less for relief than those whose reflux has another cause.   Dr. Koufman coined the term, LPR, and some of her patients experience relief from these symptoms…which is interesting…but I’m not sure that one can draw any significant conclusions from these successes without more information.   Lately, it seems I am seeing more and more posts from folks claiming that they have “cured their GERD” through supplements and/or diet, and are giving advice to others who come to this forum.   These newer members may not be knowledgeable with what they (or their children) are dealing with, and are perhaps somewhat vulnerable.   If you are fearful of doctors and the unknown, do not have insurance or don’t have the money to spend on testing and treatments, you can be reluctant to see a doctor, and may be more willing to experiment with herbal/dietary suggestions.   This was the position I was in several years ago as I struggled with advancing symptoms of GERD.   I had the misfortune of going to doctors who didn’t know how to help me, or sent me down blind alleys, and I wasted months and dollars experimenting with “internet cures”.     To those who claim a cure for reflux, I would like to see a scientific methodology applied to their claims.   How long have they experienced freedom from symptoms?   Can this resolution be attributed to a single supplement, or was the individual taking several?   Is the cure absolutely confirmed from a single supplement, or is it possible they have experienced a spontaneous physiological remission due to some other factor?   Has the reflux stopped, or are they just having success in masking symptoms?   Do you see where I’m going with this?   A “cure” has to withstand vigorous scientific methodology, be able to be independently verified, and duplicated.   I would hope that those with some experience with this condition carefully consider how they classify themselves when posting, as well as dispensing advice.   I would also caution new members to read and weigh carefully the content of what they see here, and while doctors may not always provide satisfactory treatments, don’t avoid medical opinions as a result of something you saw on this messageboard.

Awesome post, and very well said! As I have stated in my post, my barretts are gone and my LES is some what improved due to what I feel has helped this happen. I being said, I have also stated that none of the "things" I have done cured my gerd.

Doggbones

A lot of difficulty in classifying one's own symptoms, which as you say may overlap with other people's symptoms and yet have a different origin, is that the medical investigations and treatment deal more with what it ISN'T than what it is. For example, one could summarise my experience thus:-

- you don't have an ulcer
- you don't have Helicobacter
- you have mild gastritiis and oesophagitis
- you don't have cancer
- congratulations
- goodbye

I'm certainly not going for further tests just so I can determine how best to declare my symptoms or disease label on this forum!

I for one appreciate hearing about people's experiments with diets and supplements as for me, like many, there are no other options currently available to us. Mock Turtle would agree with me if he were able to be here :-(

People generally prefer to live with a little hope and I think we need to tread very carefully so as not to take that away.

MMM

MMM,

Have I missed something? Where is Mock Turtle? Now that you mention it I haven't seen any post from MT for awhile.

Doggbones

Bruce,
I think many of us come here looking for hope. We have usually heard that we have a life-long condition, but we won't give up until we try all alternatives that make sense to us. Because many of us are so different, sometimes the path we try may be successful, though it wasn't for you, and won't be for many. I only ask that you don't take away that hope.

PS: Mock T has taken a sabbatical due to a different health problem. I hope he's doing OK.

MMM

Good Morning Everyone,

First of all thank you for posting your thoughts and feelings, Bruce.  Your opinion is respected. 

On HealingWell we strive to seek a balance between alternative and traditional approaches.  I feel strongly, both approaches have value for anyone seeking healing.

Disussions, however, should be balanced and suggestions concerning the scientific validity of such remedies are open for dicussion also.  We are all entitle to our opinion and when those differ from one another, we can show respect even if we disagree.

I am going to post from our Forum rules and guidelines this reminder:

4. Use good judgement. NEVER rely on information or opinions exchanged to replace necessary, personal consultation(s) with qualified health or medical professionals to meet your individual health or medical needs. Remember that what's right or has worked for one person may not be what's right for you. 

I think, as moderators, we are wary of the hyping of "natural supplements" in the forums because often times they are posts by someone seeking to sell the product in the forums. If the post is spam it is removed.  Otherwise there is no rule against discussing an alternative remedy.

Kindly,

Kitt