The true cause of Gastroesophageal Reflux Disease (GERD) has been turned upside down. For the past eight decades scientists have believed GERD was due to the backflow of stomach acid into the esophagus causing chemical burns along the lining of its unprotected surface. But a recent study appearing in the Journal of the American Medical Association challenges this notion.
What is GERD
Whenever we eat and chew food up swallowing it, the food passes from the throat to the stomach through the esophagus. The esophagus is a hollow muscular tube whose purpose is to allow the transport of food, saliva and liquids to pass from the throat to the stomach.
At the bottom of the esophagus, where it connects with the stomach, there is a ring of muscle fibers that close very tightly preventing food that has entered the stomach to go back up into the esophagus. The muscle fibers are called the lower esophageal sphincter (LES). Sometimes the LES may not close as tightly as it should. When this happens, acidic contents of the stomach can leak back into the esophagus. This is called reflux or gastroesophageal reflux. The harsh stomach acids can cause damage to the lining of the esophagus.
Study on actual cause of GERD
The research conducted at UT Southwestern Medical Center and Dallas VA Medical Center, has discovered that damage in patients with GERD is actually due to an inflammatory response prompted by the secretion of proteins called cytokines and not from acid backflow from the stomach.
This small study of 12 patients with severe reflux esophagitis, were chosen to research to see if GERD would redevelop if proton pump inhibitors (PPIs) were stopped allowing the researchers to watch for early changes of GERD. The PPIs had been successful for the 12 patients in the past but by stopping the medication, the scientists could see if it was acid reflux from the stomach contents that would reignite the awakening of GERD again.
What was discovered was that 11 out of the 12 patients did have changes to the esophagus reoccur when the PPIs were discontinued. But to the scientists’ surprise, the changes were not consistent with chemical burns like what would be expected from acid reflux. What was found instead was the refluxed acid from the stomach stimulated the esophagus to produce cytokines starting the process of inflammation. Therefore, acid is not the direct cause of damage to the esophagus as it once was thought to be.
This inflammation is what can lead to bleeding ulcers in the esophagus and is associated with a dangerous condition called Barrett’s esophagus, which increases the risk of esophageal cancer. GERD affects 20 percent of the adult Americans making it a very common disorder.
Take away message
For now, the information gathered from this study most likely will not drastically change how GERD is currently treated.
Senior author Dr. Stuart Spechler stated, “Although this radical change in the concept of how acid reflux damages the esophagus of GERD patients will not change our approach to its treatment with acid-suppressing medications in the near future, it could have substantial long-term implications.”
As more information is gathered and research conducted, it most likely will have far-reaching ramifications as to how GERD is approached and treated in the future.
Co-senior author Dr. Rhonda Souza reiterated this by stating, “Someday we might treat GERD with medications that target the cytokines or inflammatory cells that really cause the damage to the esophagus.”