‘Common Knowledge’ About GERD Cause & Treatment – Wrong? Damage is Immune Related, Research Suggests

Contrary to current thinking, a condition called gastroesophageal reflux disease (GERD) might not develop as a direct result of acidic digestive juices burning the esophagus, University of Texas Southwestern Medical Center researchers have found in an animal study.

Rather, gastroesophageal reflux spurs the esophageal cells to release chemicals called cytokines, which attract inflammatory cells to the esophagus. It is those inflammatory cells, drawn to the esophagus by cytokines, that cause the esophageal damage that is characteristic of GERD. The condition is manifested by symptoms such as heartburn and chest pain.

“Currently, we treat GERD by giving medications to prevent the stomach from making acid,” said Dr. Rhonda Souza, associate professor of internal medicine at UT Southwestern and lead author of the study appearing in the November issue of Gastroenterology.(1)

“But if GERD is really an immune-mediated injury, maybe we should create medications that would prevent these cytokines from attracting inflammatory cells to the esophagus and starting the injury in the first place.”

In the study, researchers created GERD in rats by connecting the duodenum to the esophagus. This operation allows stomach acid and bile to enter the esophagus. Researchers were surprised to learn that esophagitis didn’t develop for a number of weeks after the operation.

“That doesn’t make sense if GERD is really the result of an acid burn, as we all were taught in medical school,” said Dr. Stuart Spechler, professor of internal medicine at UT Southwestern and senior author of the study. “Chemical injuries develop immediately. If you spill battery acid on your hand, you don’t have to wait a month to see the damage.”

About 40% of Americans suffer symptoms of GERD at some point, and 20% percent on a weekly basis, Dr. Souza said. Over the long term, GERD could eventually lead to esophageal cancer.

Previous studies had shown that if an animal esophagus is perfused with highly concentrated acid, esophageal damage develops quickly. In humans, however, the large majority of reflux episodes do not contain such highly concentrated acid, Dr. Souza said.

“In animal models of reflux esophagitis designed to mimic the human disease, researchers hadn’t looked at the early events in the development of esophageal injury,” Dr. Souza noted. “Most of those investigators have been interested in the long-term consequences of GERD, and we found virtually no published data about what happens later that induces gastroesophageal reflux.”

Dr. Souza, who is also a staff physician at the Dallas Veterans Affairs Medical Center and part of the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern, and Dr. Spechler, chief of gastroenterology at the Dallas VA, said the method they used to produce GERD in rats is a reasonable representation of how GERD develops in humans – acidic digestive juices from the stomach surge into the esophagus.

• Soon after the operation, they expected to see the death of surface cells of the esophagus, and they expected to see the injury progress later to the deeper layers.

• Instead, they found the opposite.

Three days after the surgery, there was no damage to surface cells, but the researchers did find inflammatory cells in the deeper layers of the esophagus. Those inflammatory cells didn’t rise to the surface layer until three weeks after the initial acid exposure.

The next step for researchers is to conduct additional studies in humans…

The study was supported by the Dallas VA Medical Center and the National Institutes of Health.
Visit www.utsouthwestern.org/digestive to learn about UT Southwestern’s clinical services for digestive disorders.
1. Citation: “Gastroesophageal Reflux Might Cause Esophagitis through a Cytokine-Mediated Mechanism Rather Than Caustic Acid Injury,” Souza RF, et al. Gastroenterology,” Nov 2009

Source: UT Southwestern Medical School news release, Nov 19, 2009

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One thought on “‘Common Knowledge’ About GERD Cause & Treatment – Wrong? Damage is Immune Related, Research Suggests”

  1. Sandy10m says:

    I am a physicist with health problems, so I tackle my health problems as a scientist. I had GERD and researched why my stomach would have such problems, then tried multiple treatment options. Over time, I came to realize that a proper diagnosis of reflux and heartburn and other symptoms depended greatly upon WHEN they occurred. In my case, the reflux came 3-4 hours AFTER a meal. I would drink some water, and the reflux would start. First, the food should NEVER have been in my stomach that late (normally takes 1-2 hours). Normal digestion needs acid from the stomach and enzymes from the pancreas. Without both, you do not digest your food properly. Then, when the food is digested, your system produces alkaline substances to neutralize the acid so it can now safely enter your intestines. Without all 3, the food will remain in your stomach and ferment, causing reflux. I ended up supplementing all 3 items: adding acid when I started eating, along with enzymes. Then 3 hours later I would take Alkalime (an alkaline substance) to kill the acid, and the food would move out. The cause for my problems came from a chronic stress scenario, but not from my lifestyle as doctors always assume. It turns out that I have Positional Cervical Cord Compression (PC3). The tube formed by my spine is smaller than normal (plus damaged by my military service as a pilot), and the spinal cord is being pressed on by the surrounding bones. This causes my body to think it’s in Fight or Flight mode all the time 24/7 (like being chased by a lion). Thus, it shuts down digestion (I’m running for my life, I don’t need to digest my food, right?), including the production of acid, enzymes, and alkaline at the right times. I am now in the process of figuring out the PC3 treatment to stop this stress response once and for all. So, this article is only part of the whole story. Good luck to you all.

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