Medication or Surgery for GERD, or Maybe Neither?

I was a little unsettled by an article published in JAMA recently.   The study presents two options for gastroesophageal reflux disease (GERD) as if there are only two options: surgery (Laparoscopic anti-reflux surgery or LARS), or medication in the form of an acid-blocking drug, esomeprazole (Nexium, the purple pill).  The results of the study at 5 years showed 92% remission in the esomeprazole group and 85% remission in the LARS group.  Then they report the prevalence and severity of symptoms with either treatment: 8-16% for continued heartburn, 2-13% for acid regurgitation, 5-11% for dysphagia.   OK, pretty good but wait: 28-40% for bloating and 40-57% for flatulence, which by the way are symptoms of LOW acid in the stomach, and 4 deaths in the esomeprazole group and 1 death in the LARS group.  Serious adverse events occurred at a rate of 24-28% in both groups.  They conclude “patients with GERD who are initially responsive to PPIs achieve and remain in remission at 5 years…using either LARS or esomeprazole…”

This seems to me a very high price to pay for a, granted uncomfortable, but certainly not life threatening condition, which is primarily the result of our highly processed Standard American Diet (SAD), and a lifestyle that may include smoking and alcohol.  The symptoms of GERD may actually be due to LOW acid as the symptoms are similar.  Low acid is associated with hypothyroidism and autoimmune disease, radiation therapy to the stomach, and gastric bypass procedures.  GERD can be effectively treated with avoidance of common food allergens such as gluten, dairy, soy, corn, peanuts, and processed foods, perhaps a few digestive enzymes, and probiotics.  Since many people with GERD actually have low acid, they frequently respond to acid supplementation.

The stomach is acid for a reason and lack of acid leads to protein deficiency, and vitamin (C, K,, and B complex) and mineral (magnesium and zinc) deficiencies as well.  LOW stomach acid can lead to abnormal bacterial overgrowth, which can lead to further malabsorption of vital nutrients. Normal stomach acid serves to keep the appropriate bacterial flora of the gut and respiratory system in balance.

An article from JAMA in 2009 found an increased risk for pneumonia in hospitalized patients, who are given PPIs routinely on admission to prevent stress induced compromise (ulcers and inflammation) of the GI mucosa. 

“Assuming that 50% of hospitalized patients are prescribed acid-suppressing drugs, Herzig and colleagues estimate that 180,000 cases of hospital-acquired pneumonia and 33,000 deaths each year may be due to their use.”

I think we should think twice before committing a person to long-term acid blocking drugs, which can have serious long-term consequences.

The study was sponsored by Astra Zenega,, makers of Nexium.  

Still think food doesn’t matter?  Watch this video:

Marsha Nunley MD
Marsha Nunley MD
I am an internist, trained and experienced in Western Medicine, who believes that illness and disease are best treated by working to discover their underlying causes. Come to me for bioidentical hormones, advice on healthy aging, and whole-body medicine.