Over the years, a considerable number of people have contacted me asking for help to manage their acid reflux. Very often, they ask if they can stop taking their proton pump medication (PPIs – strong antacids) and take something more natural. Having heard of the side effects linked to taking PPIs, they hope that they can switch to something that will bring them the relief they seek, but without the worry of impacting their health in other ways.
I have helped many people to manage their acid reflux without needing PPIs, but if someone contacts me and tells me they have Barrett’s Oesophagus (BA), this is one instance where I do not recommend coming off the PPI. If you do, you risk acid-drenched food migrating out of the valve at the top of the stomach into the oesophagus and burning it, increasing the risk of developing oesophageal cancer.
Likewise, if you’ve been diagnosed with erosive oesophagitis, usually caused by the oesophagus being exposed to prolonged acid exposure, you must discuss your concerns around long-term use of PPIs with your GP.
Yes, there are side effects with long-term use of PPIs, but a natural health therapist, experienced in digestive and gut health healing protocols can help you with mitigating any effects of taking PPIs through dietary intervention and targeted supplements.
Barrett’s Oesophagus is a condition in which the cells lining the lower oesophagus (food pipe) change to resemble those of the stomach and intestines. The cells lining the food pipe are normally flat. In BA, however, they change into a type more like the columnar cells in the lining of the small and large bowel. These cellular changes can be caused by ongoing exposure to stomach acid.
What is Barrett’s Oesophagus?
Once the tissue has changed, you are more at risk of developing a rare type of cancer, called oesophageal adenocarcinoma. However, most people with BA never get oesophageal cancer, and those who do may live with BA many years before cancerous cells appear.
BA is most often found in people who have had gastro-oesophageal reflux disease (GORD) for a long time. Over time, the acid coming up from your stomach irritates the tissue in your oesophagus and causes the changes in cells. Although many people don’t have any symptoms from the change in tissue, they are likely to experience the classic symptoms of GORD, notably acid reflux.
In addition to regular check-ups to look for cancerous cells, treatment for BA aims to manage your GORD and remove cancerous or pre-cancerous cells. Thankfully, you can also get relief from GORD symptoms by making changes to your diet.
The changes in oesophageal tissue caused by BA do not always cause symptoms and may go unnoticed. You may not know you have the condition unless a doctor looks into your oesophagus with a camera or takes a biopsy. However, the disease often presents in people with GORD, which does cause symptoms and may even lead to BA so if you do have GORD, it’s something to be aware of.
Diagnosis of Barrett’s Oesophagus
Barrett’s Oesophagus is usually diagnosed during an endoscopy. You may be referred by your GP to have an endoscopy because you have symptoms of GORD, or for another reason.
- An endoscopy will be performed with a small tube and camera that goes down your oesophagus. Your oesophagus tissue will look bright red and inflamed if you have the condition, instead of pink and shiny like normal oesophageal tissue.
- Your doctor will remove tissue (via biopsy) from your oesophagus. The biopsied tissue can be examined to determine the degree of change.
The sample will be examined to determine if there is dysplasia (abnormal cell growth) present in the lining of your oesophagus.
The stages of BA are:
- Normal, healthy oesophagus
- Oesophagus damaged by prolonged acid exposure
- Barrett’s oesophagus tissue
- Dysplastic Barrett’s oesophagus (pre-cancerous cells present)
- Oesophageal adenocarcinoma (invasive cancer)
A diagnosis of BA means you are more likely to get a rare form of oesophageal cancer. However, even with Barrett’s disease, your risk of getting that cancer is very low.
BA symptoms (if you have any) may just be symptoms of GORD. These may include:
- A burning sensation in your chest – usually worse after food and at night
- Trouble swallowing when you eat
- Sensation of a lump in your throat
- Regurgitation of food or sour liquid
- Chest pain (rare)
BA cancer symptoms
If the condition does lead to cancer, symptoms may include:
- Pain or difficulty swallowing
- Unintended weight loss
- Hoarse voice
- A cough that doesn’t go away
- Feeling tired
- Vomiting red blood or what looks like coffee grounds
- Bloody or black, tarry stools
Seek medical care immediately if you have bloody or black vomit or stools.
Causes and Risk Factors
The exact cause of BA is unknown. However, there are several known risk factors that increase your chance of developing it.
Risk factors for BA include:
- Gastro- oesophageal reflux disease (GORD):the long-term flow of stomach acid into your food pipe irritates the tissue. Over time, that damages the oesophageal cells and, in some people, the body turns them into cells like those of the intestines. This happens in 10 to 15 per cent of people who have GORD. Conventional treatment, therefore, focuses on reducing acid production with medication, but this does not necessarily deal with the root cause.
- Large amounts of abdominal fat increase your risk of developing BA
- Smoking or being a former smoker
- Being over the age of 50
- Genetics, or a family history of BA or oesophageal cancer
- Being male
- Being Caucasian
Treating Barrett’s Oesophagus
Conventional management options include:
- Monitoring your condition (also called surveillance), including regular endoscopies
- Medication to stop stomach acid – PPIs like omeprazole or lansoprazole
- Surgery to strengthen the food pipe valve – this operation is called fundoplication
- removing the affected area through an endoscope (known as endoscopic mucosal resection or EMR)
- Destroying the affected area using radio frequency ablation (RFA)
- Surgery to remove the area containing the affected cells
- Other treatments to destroy abnormal cells, such as light therapy (photodynamic therapy) or freezing treatment (cryotherapy)
Working in conjunction with an individual’s GP, my nutritional therapy team can often help people withdraw from taking PPIs, with a combination of dietary and supplementation advice. However, this is not case for BA. As mentioned earlier, if someone has BA, it’s imperative they remain on the PPI.
Getting to the root cause of reflux
In Functional Medicine, we always look for the root cause of the problem, and how to correct it. For reflux, the root cause is sometimes very straightforward – it may be a case of what we are eating. Some common dietary triggers of reflux include:
- Fried foods
- Spicy foods
- Citrus foods
- Tomato-based foods
- Processed foods
Other root causes for reflux include:
- Eating right before bed
- Eating with an already full stomach – which can cause the food to come back up. This may be the case if you are constipated.
- Being overweight, particularly around your middle – this can put pressure on your stomach, causing reflux.
- A hiatus hernia – this is where part of the stomach pushes up through the diaphragm. It increases the risk of reflux as the hernia allows food and acid to back up into the oesophagus. Excessive abdominal gases and bloating can increase the risk of developing a hiatus hernia.
- Chronic stress – this affects the nerves in your stomach, making it impossible to process the food properly. This will cause food to go up instead of down. In fact, in order to digest your food well, you have to relax. So, breathing before eating is very important.
- Lack of magnesium – this is also caused by stress. Magnesium is needed to relax the sphincter at the bottom of your stomach that lets the food go down. When you don’t have enough magnesium, the food can build up and start to be regurgitated.
- Food sensitivities that may not be diagnosed by your GP, including gluten and dairy.
- A bacterial or yeast overgrowth in your stomach or SIBO. If you have been on a lot of antibiotics, or hormones, if you eat a lot of sugar and processed food, you could have gut dysbiosis which causes fermentation, increased abdominal pressure and reflux.
- Helicobacter Pylori – a bacterium that affects a number of people in our population, and can often be linked to reflux.
Healing reflux naturally
- Get tested
- Test for H. Pylori
- Check for coeliac and gluten sensitivity
- Check for food sensitivities
- Test your gut microbiome for parasites, yeast overgrowth, and bacterial overgrowth
- Test your small intestine for SIBO
- Try specific natural supplements to help – these include probiotics, digestive enzymes, essential fatty acids from Omega 3s, DGL, aloe, glutamine, magnesium. Please consult a Nutritional Therapy Practitioner before embarking on a supplement regime for reflux. They will be able to provide a proper protocol for you and check for any drug-nutrient interactions based on your own root causes.
- Manage stress levels – especially before eating meals.
- Consider food allergens – you should work with a Nutritional Therapist to guide you through this. Gluten and dairy can be the most common culprits.
- Remove the triggers – try for 4 weeks, abstaining from alcohol, caffeine, nicotine, spicy food etc.
- Consider lifestyle changes such as:
- Changing your evening mealtime to no later than 6pm and take a Digestive Enzyme tablet before the meal
- Sleeping with your head slightly more raised, either with pillows or raise the bed head
- Relaxation techniques
- Mindful eating
- Losing weight if you are overweight
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