Bioidentical Hormones 101 
The Book, by Jeffrey Dach MD

Chapter 36. Heartburn, GE Reflux (GERD), and Acid Blocker Drugs

GE Reflux Heartburn PPI acid blocker drugs jeffrey dach mdChapter 36. Heartburn, GE Reflux (GERD), and Acid Blocker Drugs

A July 2009 study of Acid Blocker Drugs shocked the medical community, reporting the drugs actually caused the symptoms they are supposed to treat.(1)  The study recruited normal healthy volunteers who had no symptoms.  These volunteers were then given Acid Blocker drugs for a few weeks, and then stopped the drug.  Upon stopping the Acid Blocker drug, more than 40% of the volunteers reported heartburn and acid regurgitation, symptoms they never had until after they stopped the Acid Blocker drug. (These drugs are Prolisec™, Nexium™ Aciphex™, Protonix™, and are also called PPI's for Proton Pump Inhibitors).  Dr. Christine Reimer the author, said her study revealed "unrecognized aspects of Acid Blocker - PPI drug withdrawal with acid rebound".   Above Left image: No Flame Schematic Diagram, courtesy of Wikimedia Commons.

The Acid Blocker Drug Merry-Go-Round

For the typical heartburn relieved with acid blocker drugs, symptoms return with a vengeance when the drug is stopped. This withdrawal effect is the hallmark of an addictive drug, in this case caused by "rebound acid hyper secretion" with increased gastric acid production. The worsening heartburn pain forces the victim to immediately go back on the PPI acid blocker drug, and continue indefinitely into the future. (3-6)

Windfall Profits from An Addictive Drug

With 5% of the population taking acid blocker PPI drugs, this represents a blockbuster profit for the drug companies.   Ask any street corner drug dealer, and they will tell you the best business is the addictive drug business, the clients always return for more.

PPI's Are As Safe As Placebo

Your doctor probably tells you acid blocker drugs are safe, with no adverse effects.   An article in a mainstream medical journal (AAFP) says," The frequency of adverse effects associated with PPIs is similar to that of placebo".  (50)This is not exactly true as you will see below.

Adverse Effects of PPI Acid Blocker Usage

The adverse effects of Acid Blocker Drugs are related to the profound reduction in gastric acid.  They really do their job well, reducing stomach acid to virtually nothing.   Most of the adverse effects of PPI's are related to the fact that stomach acid is needed for digestion and absorption of key nutrients such as vitamin B12, calcium, iron and the amino acids.  Long term use of PPI drugs is associated with increased risk for hip fracture (7), B12 deficiency (8), amino acid deficiency, and iron deficiency anemia.  One study showed reduced cognition from PPI's.(12)  Secondly, Gastric Acid serves as a defensive barrier to invading bacterial organisms and kills any ingested bacteria, before it can overwhelm the body's defenses.  With stomach acid turned off by the PPI drug, these bacteria are free to invade the GI tract and body.  This results in increased incidence of pneumonia, as well as Clostridia Difficile Entero-Colitis in patients on PPI's.(9-10)

PPI Drugs Cause Gastric Polyps, Paralysis of the Stomach and Gut Dysmotility

Dr A Breck McKay, in a letter to the British Medical Journal, said : “long term use of PPIs cause gastroparesis, delayed total gut dysmotility and bloating" .(14)

Patients suffer acute, explosive, exacerbation of their gastritis and reflux, on attempted cessation of the PPIs. While the PPI drugs block acid production, these drugs actually stimulate hormones like gastrin, cholecystokinin, and glucagon, which in turn stimulate growth of acid producing cells to massively increase and thus, are able to produce large quantities of acid, suddenly, when inhibition from the acid blocker PPI drug stops.(18)  Nonetheless, PPI drugs are handed out freely, like candy. Dr. Yeomans advised physicians not to "over-react" to concerns about the biological effects of inhibiting acid secretion with proton pump inhibitors. (19)

Warning – PPI drugs

Anti-Acid drugs known as proton pump inhibitors (PPI’s) may produce worsening symptoms of heart burn, and increased acid production as a rebound phenomenon upon discontinuing the drug.  Chronic use of PPI drugs can lead to B12 deficiency, osteoporosis, and immune dysfunction with increased incidence of  pneumonia and Clostridia Enterocolitis.



What Causes GE Reflux and Acid Heartburn?

The cause of reflux is well known. Firstly, there is a mechanical problem with the lower esophageal sphincter (valve) which allows gastric contents to go back up into the lower esophagus, causing irritation, damage and heartburn pain.  Turning off gastric acid with a blocker drug will relieve the symptoms, but does not address the underlying mechanical problems.

As a radiologist for 30 years, a large part of my job was taking pictures of GE reflux with barium X-rays.  I never saw reflux when the patient was standing up.  We were able to induce GE reflux before our eyes merely by placing the patient down in the supine position with the motorized table controls.  Now, with the patient in the supine position (lying down) turned back and forth on the table, we then see the reflux on the x-ray fluoroscopic screen, with the barium contrast spilling up from the stomach into the esophagus. 

Stay Standing Up or Sitting Up For Three Hours After a Meal.

Whenever I saw the GE reflux, I would then inform the patient they have reflux, and that it is important to stay standing up or sitting up for three hours after they eat a meal.  GE reflux cannot occur in the standing or sitting position.  After three hours, the stomach should be empty, so it should be safe sleep for the night.

Eradicate the Helicobacter Pylori

Secondly, there may be a co-existing bacterial infection in the stomach called H. Pylori.(41-42)  This may be detected with testing.   We routinely use the H Pylori breath test which is a sophisticated way to non-invasively make the diagnosis of H Pylori infection.(46)  Eradiction of the  H Pylori infection with antibiotics is an important step to ending the heartburn/reflux and getting off the PPI Merry Go Round. Thirdly, lifestyle and dietary modifications are essential to ending the heartburn.  Avoid spicy foods, eat smaller meals, do not lie down after meals, and stay standing or sitting up for three hours after a meal.

Mastic Gum - an Ancient Remedy - Kills H. Pylori

Mastic Gum is an old remedy used for centuries as a chewable gum effective against H Pylori. This is readily available at the health food store.  An excellent article on Gum Mastic by Karina L. Gordin appears in the October issue of the Townsend Letter.  She interviewed Dr Leo Galland who recommended Mastic Gum in capsule form (1000 mg twice a day) to a patient with gastritis.  Not only did the gastritis clear up, underlying ulcerative colitis also went into full remission. A 1998 landmark article in the New England Journal of Medicine on Mastic Gum, showing activity against H Pylori, is largely responsive for renewed interest in this old remedy. (58-62)

The H. Pylori Story, The Nobel Prize and The Eradication of Gastric Ulcers

The 2005 Nobel prize for Medicine was awarded to two Australian pathologists, Barry J. Marshall and J. Robin Warren for the recognition of H. Pylori infection as the causative agent in gastric and duodenal ulcers.(45)  With this great discovery, medical science could now cure gastric and duodenal ulcers by eradicating the H Pylori bacterial infection.  This is done with "Triple Therapy" consisting of two antibiotics and a PPI acid blocker drug.(42-44)  Once the ulcer is cured, treatment is discontinued.

Changes During My Radiology Career 

When I started out as at the beginning of my career as a radiologist in 1976, Gastric and Duodenal ulcers were quite common, and a large part of my job was using X-ray imaging to make the diagnosis, and I found many of these ulcers back in the old days using the barium Upper GI. This is no longer the case.  Triple therapy for H. Pylori has made gastric and duodenal ulcers ancient history, these are now quite rare, an ancient relic of the past, destined for the medical museum.

For more information on the importance of stomach acid, see the book by Jonathan Wright, “Why Stomach Acid is Good for You: Natural Relief from Heartburn, Indigestion, Reflux and GERD”.(27)  Dr. Wright pioneered the routine clinical measurement  of stomach acid using the Heidelberg capsule, and has written extensively on the clinical syndrome of low gastric acid (21-27) For references and links, see my web site:

Articles with Related Interest:

Hair Loss From Low Stomach Acid

References for Chapter 36. Heartburn and Acid Blockers, Getting Off the Merry Go Round

Gasteroenterology, Vol 137, Issue 1, P 80-87 (July 2009).  Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy,  Christina Reimer et al.

Evidence That Proton-Pump Inhibitor Therapy Induces the Symptoms it Is Used to Treat , 01 June 2009 Kenneth E.L. McColl, Derek Gillen Gastroenterology July 2009 (Vol. 137, Issue 1, Pages 20-22)

Aliment Pharmacol Ther. 2000 Jun;14(6):651-68. Potential Gastrointestinal Effects of Long-term Acid Suppression with Proton Pump Inhibitors. Laine L, Ahnen D, McClain C, Solcia E, Walsh JH.

Science News- Acid-Reducing Medicines May Lead to Dependency. Data suggests proton pump inhibitors can induce acid-related symptoms in healthy adults

PPIs May Induce Reflux Symptoms & Become Addictive -Wednesday July 1, 2009

Study: Acid Reflux Drugs Cause Rebound Symptoms

(7) Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture. Yu-Xiao Yang et al. JAMA. 2006;296:2947-2953.

Omeprazole Therapy Causes Malabsorption of Cyanocobalamin (Vitamin B12) Stefan P. Marcuard; Lisa Albernaz; and Prabhaker G. Khazanie - Annals of Internal Med February 1994, Volume 120. Issue 3, Pages 211-215

(9)  Gulmez SE, Holm A, Frederiksen H, Jensen TG, Pedersen C, Hallas J. Use of proton pump inhibitors and the risk of community-acquired pneumonia: a population-based case-control study. Arch Intern Med 2007;167:950-5.

(10) Proton pump inhibitors and Clostridium difficile. R Cunningham et al. Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea. Journal of Hospital Infection 2003 54: 243-245.

Shoshana J. Herzig et al. Acid-Suppressive Medication Use and the Risk for Hospital-Acquired Pneumonia . JAMA 301 (20): 2120–2128.

Boustani, M. The Association Between Cognition and Histamine-2 Receptor Antagonists in African Americans. Journal of the American Geriatrics Society, August 2007; Vol 55: pp. 1248

BMJ  2008;336:2-3 (5 January), Overprescribing proton pump inhibitors - Is expensive and not evidence based.

Letters to BMJ. side effects with  long term use of the proton pump inhibitors (PPIs). Dr A Breck McKay

Images of gastric ulcers.

BMC Gastroenterol. 2009; 9: 25. Published 2009 April 20. Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974–2002. Michael Hermansson et al.

Arthritis Res Ther. 2007; 9(3): R52. 2007 May 23.  Vonkeman et al.;  Proton-pump inhibitors are associated with a reduced risk for bleeding and perforated gastroduodenal ulcers attributable to non-steroidal anti-inflammatory drugs: a nested case-control study. Harald E Vonkeman et al.

(18) Expert Opin Drug Saf. 2002 May;1(1):29-38. Long-term safety of proton pump inhibitors: risks of gastric neoplasia and infections.Waldum HL, Brenna E, Sandvik AK.

(19) Aliment Pharmacol Ther. 2000 Mar;14(3):267-71.
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(20)  Basic Clin Pharmacol Toxicol. 2006 Jan;98(1):4-19. Consequences of long-term proton pump blockade: insights from studies of patients with gastrinomas. Jensen RT.

(21) Can Med Assoc J. 1970 May 23; 102(10): 1087–1089.  Tubeless gastric analysis with a radiotelemetering pill (Heidelberg capsule).M. R. Andres, Jr and J. R. Bingham

(22)  The Heidelberg pH Diagnostic System is a State-of-the-Art Diagnostic Tool for Measuring the pH Levels in the Digestive Tract.

Why Stomach Acid is Good For You  (The Gray Man)  By Jonathan Wright, MD, and Lane Lenard, PhD, Book published by M. Evans and Company, Inc. (November 25, 2001)

(24) Jonathan Wright on Stomach Acid, Tahoma Clinic.

(25) Age and Antacids: A Double Whammy Against Your Body's Optimal Health . This article was published in the March, 2007 issue of the Dr. Jonathan V. Wright's Clinical Nutrition & Healing newsletter.

Stomach Trouble: Too Little Acid?  Are Antacids and acid blockers curing—or causing—stomach troubles? Book by Jonathan Wright MD .

Why Stomach Acid is Good for You: Natural Relief from Heartburn, Indigestion, Reflux and GERD by Jonathan Wright , M. Evans and Company, Inc. (November 25, 2001)

Stomaching Stomach Acid: A Simple Solution. One simple trick is taking a half teaspoon of organic apple cider vinegar in half a cup of water before meals to stop acid reflux.

Gastroenterology. 1981 Dec;81(6):1068-71. Role of gastric acid in food iron absorption. Skikne BS, Lynch SR, Cook JD.

Omeprazole Therapy Causes Malabsorption of Cyanocobalamin (Vitamin B12) Stefan P. Marcuard; Lisa Albernaz; and Prabhaker G. Khazanie Annal of Internal Med February 1994 Volume 120 Issue 3 Pages 211-215

CMAJ, February 15, 2005; 172 (4). Cobalamin deficiency in elderly patients - Jonathan E. Prousky
Associate Dean of Clinical Education, Chief Naturopathic Medical Officer, The Canadian College of Naturopathic Medicine, Toronto, Ont.

(34) of the American College of Nutrition, Vol 13, Issue 6 584-591, 1994 by American College of Nutrition CLINICAL TRIAL. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption J. R. Saltzman et al.

Gastric Hypochlorhydria and Achlorhydria in Older Adults-Reply Aryeh Hurwitz, MD; Constance Ruhl, MD, MPH University of Kansas Medical Center Kansas City  JAMA. 1997;278(20):1659-1660.

A J Gastro (2001) 96, 1014–1018; Helicobacter pylori infection and serum ferritin: a population-based study among 1806 adults in Germany. Gabriele Berg et al.

Eur J Pediatr. 2003 Mar;162(3):177-9. Refractory iron-deficiency anaemia due to silent Helicobacter pylori gastritis in children.Kostaki M, Fessatou S, Karpathios T.

(38) The unseen epidemic: the linked syndromes of achlorhydria and atrophic gastritis. Townsend Letter for Doctors and Patients, July, 2004 by Nigel Plummer

(39)  Encephale. 2003 Nov-Dec;29(6):560-5.
Psychiatric manifestations of vitamin B12 deficiency: a case report] Antibodies to parietal cells were positive in the serum and antibodies to intrinsic factor were negative.

(40) N Engl J Med. 1996 Apr 18;334(16):1018-22.  Atrophic gastritis and Helicobacter pylori infection in patients with reflux esophagitis treated with omeprazole or fundoplication. Kuipers EJ et al.

Gut. 2004 January; 53(1): 12–20.  Cure of Helicobacter pylori infection in patients with reflux oesophagitis treated with long term omeprazole reverses gastritis without exacerbation of reflux disease: results of a randomised controlled trial. E J Kuipers et al.

(42) Gerontology. 2006;52(2):99-106.
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Aliment Pharmacol Ther. 2002 Feb;16(2):167-80. Current concepts in the management of Helicobacter pylori infection--the Maastricht 2-2000 Consensus Report. Malfertheiner P et al.

The Nobel Prize in Physiology or Medicine 2005  to  Barry J. Marshall, J. Robin Warren for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.

Med J Aust. 1989 Oct 16;151(8):435-9.  The 14C-urea breath-test for the detection of gastric Campylobacter pylori infection. Surveyor I et al.

(47)  Gastrointest Endosc. 2000 Jul;52(1):20-6
Noninvasive tests as a substitute for histology in the diagnosis of Helicobacter pylori infection.
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(48) BMJ Letter. H pylori infection and reflux oesophagitis - Jannis Kountouras, 

J Clin Biochem Nutr. 2008 March; 42(2): 71–75. Proton Pump Inhibitors and Gastritis- Masayuki Suzuki et al.

(50)  Proton Pump Inhibitors: An Update 2002 by the American Academy of Family Physicians.  Bruce T. Vanderhoff et al.

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(53) World J Gastroenterol  2007 October 28; 13(40): 5380-5383  Effects of H pylori therapy on erythrocytic and iron parameters in iron deficiency anemia patients with H pylori-positive chronic gastristis  Lun-Hua Chen, He-Sheng Luo

(54)  Dig Dis Sci. 2007 Feb;52(2):405-10. Ferritin, vitamin B(12), folate, and zinc levels in children infected with Helicobacter pylori.  Akcam M et al.

(55)  J Pediatr Gastroenterol Nutr. 2003 Jul;37(1):53-62. Correlation between Helicobacter pylori infection and vitamin C levels in whole blood, plasma, and gastric juice, and the pH of gastric juice in Korean children. Park JH, Kim SY, Kim DW, Lee WG, Rhee KH, Youn HS. Department of Pediatrics

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(57) European Journal of Dermatology. Volume 19, Numéro 5, 431-44, September-October 2009, Review article  Ana C Hernando-Harder, Nina Booken, Sergij Goerdt, Manfred V Singer, Hermann Harder 

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NEJM Volume 339:1946  December 24, 1998  Number 26 Mastic Gum Kills Helicobacter pylori

Helicobacter pylori Eradication: Are there Alternatives to Antibiotics? Alan R. Gaby, MD

Korean J Gastroenterol. 2003 Apr;41(4):277-283. Korean. The Effect of Mastic Gum on Helicobacter pylori-infected Gastritis.  Roe IH, Nam SW, Myung NH, Kim JT, Shin JH. , Korea.

(63) Antimicrobial Agents and Chemotherapy, February 2007, p. 551-559, Vol. 51, No. 2 In Vitro and In Vivo Activities of Chios Mastic Gum Extracts and Constituents against Helicobacter pylori  Sotirios Paraschos et al.

(64) Three simple steps to eliminate heart burn and acid reflux by Mark Hyman MD, UltraWellness.

(65) // Three Simple Steps to Eliminate Heartburn and Acid Reflux by Mark Hyman MD, Video on You Tube. UltraWellness blog.

Jeffrey Dach MD
7450 Griffin Road Suite 190
Davie, Florida 33314

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