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ACID Reflux or GERD and acid reducing medication.

Many people with reflux assume that they are over producing Hydrochloric acid (HCL). Gastric fluids with or without the presence of HCL are very bitter to the taste. The symptoms associated with the over production of HCL and the under production are identical. The over production of HCL is called Hyperchlorhydria. The under production of HCL is called Hypochlorhydria. Both of these conditions will cause belching, reflux, gas, bloating, nausea, abdominal pain,diarrhea and or constipation. Unfortunately many doctors, when reviewing the patients symptoms, make the same assumption that the patient is over producing acid. In many cases the diagnosis is incorrect and this usually leads to the doctor prescribing a Proton Pump Inhibitor or acid reducing medication. Patients that are not producing enough HCL that are placed on Proton Pump Inhibitors will become Achlorhydric (no acid production). If your doctor has prescribed an acid reducing medication, without first doing a pH diagnostic test, he is doing you a great disservice. A person that is not producing enough HCL, looses the benefit of complete sterilization and conversion of the nutrients consumed. Loss of sterilization and conversion will result in food allergies, bacterial infection and a host of other disorders. Have your doctor give you a pH diagnostic test before he prescribes an acid reducing medication.
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First Helper User Profile robichris

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replied November 14th, 2014
Experienced User
Whilst what you say is absolutely correct, over-production of acid is far more common than under-production.

Although testing for pH (using 24hr pH manometry or the Bravo 48 hr capsule would be an idyll, with 60% of the population presenting with acid reflux symptoms at some time, it would not be practical.

Similarly, an EGD for everyone presenting with symptoms of acid reflux would be even more desirable, to ensure metaplasia (Barrett's Esophagus) hasn't occurred, or it's possible fatal progression into esophageal adenocarcinoma.

The best instant advice doctors can give patients presenting with these symptoms is to try Acid Suppressant Medication (eg PPI or H2RA) for a period and monitor the outcomes.
If ASMs are discovered to be ineffective after a couple of weeks, or if the condition appears to have been exacerbated, then it is feasible the patient may be naturally hypochlorhydric.

But reflux is the main issue, be it acidic or Non-Erosive Reflux.

Reflux of acid and bile can cause the development of intestinal metaplasia (Barrett's - as aforementioned). To minimize risks of progression to EAC (already the 4th most common cancer killer in US and rising), at least one of those 3 elements must be eliminated or considerably produced. The easiest, for the medic, is to reduce the acid. Although this may induce hypochlorhydria in patients, with the possible consequence (if high dosed for long periods) of poor mineral and vitamin absorption and reduced protection against bacterial infections, these "side effects" may be addressed with supplementation.

NER also causes problems. Aspiration of extra-esophageal reflux (sometimes referred to as LPR) can cause pneumonia and bronchiectasis as well as a host of other unpleasant symptoms. (I recently wrote a paper on this but this site's linking policy prevents me from providing that link.)

Elimination of reflux is a better solution. In many cases this should be achievable with lifestyle changes which, unfortunately, too many patients find difficult to embrace.
Losing weight is the biggest single factor that can reduce reflux. Two thirds of the American population are considered to be obese or overweight.
Eating less, making healthier food choices and exercising more, results in a healthier population.
Unfortunately, too many people like driving to the mall and over-feeding on processed meats in a bread bun containing corn syrup accompanied by fries containing saturated fats and washed down with soda containing corn syrup.

But there are patients for whom lifestyle changes, with or without ASMs, doesn't work. They may have conditions beyond their control affecting the operation of the lower esophageal sphincter.
For them surgical intervention may be required.
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