As gastroesophageal reflux disease (GERD) soars globally, alternatives to traditional therapies are welcomed. An excellent review — described below — looked at the ability of probiotics to alleviate symptoms in GERD.
GERD, a little background
Gastroesophageal reflux disease commonly known as GERD affects an estimated one billion people worldwide with large variations between regions and countries.
The World Gastroenterology Organization defines GERD as ‘troublesome symptoms sufficient to impair an individual’s quality of life, or injury or complications that result from the retrograde flow of gastric contents into the esophagus, oropharynx, and/or respiratory tract.’
In addition to these undesirable health effects, GERD levies both a heavy economic (including drugs, tests, and surgeries) and societal (lost productivity) toll.
Though some of those suffering from GERD may blame pepperoni pizza, the pathogenesis is more complex including but not limited to motor dysfunction, hiatal hernia, and impaired mucosal resistance.
First line treatment usually begins with diet and lifestyle changes:
Eat smaller meals, slowly and at least two hours before sleep; lose weight if needed; avoid nicotine and alcohol; avoid possible triggers including peppermint, chocolate, caffeine, citrus fruits, tomatoes, and high fat foods.
Medications are frequently recommended. Antacids and H2 blockers are used to deplete acids. Proton pump inhibitors (PPIs) block certain acidifying protons and may also heal damaged stomach lining.
Unfortunately, PPIs are linked with increased risk of other adverse effects: osteoporotic-related fractures, Clostridium difficile infection, community-acquired pneumonia, vitamin B12 deficiency, kidney disease, and dementia. While PPI use has soared —often taken long-term — researchers are asking about alternatives.
Role for probiotics in GERD?
Probiotics are well documented for promoting lower gastrointestinal homeostasis and stimulate the growth of beneficial indigenous gut microbes in dysbiosis. However, activity of probiotics in upper gastrointestinal health is less clear.
Researchers have noted that probiotics may be relevant to changes seen in GERD:
- Specific probiotics accelerate gastric emptying by interacting with stomach mucosal receptors. Transient lower esophageal sphincter relaxation is often triggered in GERD.
- Specific Lactobacillus and Bifidobacterium are linked with alterations in the immune response and antagonistic activity toward potential pathogens through the production of short-chain fatty acids, such as lactic acid.
- Intestinal motility and immunity can be impacted by small intestinal bacterial overgrowth (SIBO) in which probiotics can be beneficial.
A recent review examined the efficacy of probiotics in alleviating the frequency and severity of symptoms in GERD in the general adult population. Gastroesophageal Reflux Disease and Probiotics: A Systematic Review by Jing Cheng and Arthur C. Ouwehand appeared in Nutrients journal in January 2020.
PubMed and Web of Science databases were searched for prospective studies on GERD and also (due to difficulty in differentiating) heartburn, regurgitation, and dyspepsia.
Thirteen prospective clinical studies, comprising 14 comparisons, were reviewed. A total of 951 healthy adults were analyzed with even distribution of gender in most studies. This table from the review details the types of probiotics or synbiotics studied as well as doses, delivery formats, additional ingredients and treatment durations.
Of the 14 comparisons included, 11 (79%) reported positive benefits of probiotics in symptoms of GERD.
Among these 11, probiotic showed benefit on specific symptoms:
- Reflux: 5 studies
- Regurgitation: 3 studies
- Heartburn or reflux: I study
- Dyspepsia: 5 studies
- Nausea: 3 studies
- Abdominal pain: 5 studies
- Gas-related symptoms (belching, gurgling): 4 studies
The authors concluded, “Probiotic use can be beneficial for GERD symptoms, such as regurgitation and heartburn.”
However, they added that “the heterogeneity in endpoints also made it impossible to quantitively evaluate the results…properly designed, randomized, double-blind, placebo-controlled studies with a sufficient number of participants and well-defined endpoints are needed.”
Stomach acids have important functions but occasionally rise up to irritate us. Follow diet and lifestyle tips for lessening reflux and your symptoms may be alleviated without medication. Probiotics may be beneficial for some of these symptoms.
Cheng, Jing, and Arthur C Ouwehand. “Gastroesophageal Reflux Disease and Probiotics: A Systematic Review.” Nutrients vol. 12,1 132. 2 Jan. 2020, doi: 10.3390/nu12010132
Gyawali, C Prakash et al. “Modern diagnosis of GERD: the Lyon Consensus.” Gut vol. 67,7 (2018): 1351-1362. doi:10.1136/gutjnl-2017-314722
Nirwan, Jorabar Singh et al. “Global Prevalence and Risk Factors of Gastro-oesophageal Reflux Disease (GORD): Systematic Review with Meta-analysis.” Scientific reports vol. 10,1 5814. 2 Apr. 2020, doi:10.1038/s41598-020-62795-1