Gastritis is a relatively common inflammatory condition affecting the gut lining resulting from a slew of offending agents. The most common cause of chronic gastritis worldwide is an underlying H. Pylori infection. However, multiple other reasons range from additional offending pathogens to non-microbial systemic contributors.
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CC: Chronic Gastritis, GERD, Generalized Anxiety Disorder, Fatigue
Anna was a 40-year-old female when she first presented with chronic symptoms of substernal and upper abdominal burning, abdominal bloating, flatulence, and long-term acid reflux symptoms. She had done a great deal of work over the years to tailor her diet to manage her acid reflux symptoms; however, with a recent job loss and subsequent high-stress level, her symptoms had increased in intensity and frequency. She has been dealing with these symptoms for 30 years, with multiple endoscopies confirming gastroesophageal reflux without eosinophilic influence.
One year prior, she had a positive h. Pylori breath test and was treated with two consecutive rounds of multiple antibiotics, which left her feeling fatigued, nauseous, and overall awful.
Additional History
The patient recalled a long childhood of gastrointestinal issues, frequently resulting in hospitalization due to severe abdominal cramping, diarrhea, and vomiting. At age 12, she began removing wheat, gluten, and dairy from her diet and found immense improvement in her symptoms.
She was tested multiple times for celiac disease, which was consistently ruled out. The patient also suffered a very traumatic childhood and had been consistently in therapy for the last ten years to help manage her PTSD and generalized anxiety disorder. When she began therapy, she noticed an improvement in her persistent bloating and abdominal pain; however never found full resolution.
Anna was a dental hygienist who had regular dental visits and exceptional dental care. Her diet consisted of a modified paleo, where she allowed occasional potatoes and gluten-free grains but maintained avoidance of gluten and dairy.
She was very diligent about consuming fermented foods daily, eating organic produce and meat, avoiding processed foods in favor of all home-cooked, and limiting/avoiding foods high in acidity like coffee, tomatoes, and citrus.
She had a sweet tooth and would indulge on weekends in homemade treats; however, she always noticed increased symptoms after eating. She has lived in a newly built home with her husband and daughter for the last eight years, having moved here from Poland by herself at age 24.
Lab Work
Comprehensive Stool Test Results:
- Pancreatic Elastase Low
- Products of Protein Breakdown (Total*) High at 8.9 (1.8-9.9 micromol/g)
- Eosinophil Protein X (EPX) <detectable level (<=2.7 mcg/g)
- Fecal secretory IgA Normal at 444 mcg/mL (<=2,040 mcg/mL)
- Short-Chain Fatty Acids (SCFA) (Total*) Low at 13.5 (>=23.3 micromol/g)
- n-Butyrate Concentration Low at 2.1 (>=3.6 micromol/g)
- Acetate, n-Butyrate, Propionate % all within normal limits
Overall, the microbiota is healthy with no pathogenic or dysbiotic overgrowth. She also had high levels of beneficial bacteria: Akkermansia muciniphila, Collinsella aerofaciens, Ruminococcus spp, Lactobacillus spp., and Faecalibacterium prausnitzii.
Lab Analysis
Anna's lab work points to three core issues that are contributing to her chronic gastritis and GERD.
- High morning salivary cortisol and DHEA indicate adrenal dysfunction with high morning cortisol output
- Positive h. Pylori breath test
- Low pancreatic elastase and increased number of products of protein breakdown
Overall the patient's significant lab findings are consistent with her presentation; high stress and anxiety contribute to elevated DHEA and cortisol output. The link between high cortisol output and decreased stomach acid is highly relevant to the patient's case. Low stomach acid is likely contributing to slow gastric breakdown, clearance, and acid reflux symptoms. The low acid also leads to high protein in the stool, as seen in the comprehensive stool panel, and low pancreatic output due to a lack of pH chemical signaling. Low stomach acid will also lead to intestinal bacterial overgrowth over time and a higher propensity for gastric helicobacter overgrowth and its associated symptoms.
Interventions
Nutrition
- Daily: foods known to limit h. Pylori growth: fennel, lavender, chamomile, turmeric, peppermint, ginger.
- Daily prebiotic foods to support microbiota growth: Cooked and cooled: white rice/potatoes, sweet potatoes, oats, beans, legumes, whole grains, green bananas, potato starch, and green banana flour.
- Daily high short-chain fatty acid (SCFA) foods: organic ghee, onions, chicory, bananas, artichokes, asparagus, garlic, leeks, broccoli, pistachios
- Stick to 3 meals daily and no snacking between meals to avoid blood sugar spikes
H. Pylori Supplemental Support
- Biofilm Defense (Douglas Labs): 1 cap daily on an empty stomach for 60 days, then stop---- Start with this for 2 weeks with GastroMend and DGL plus.
- GastroMend-HP (Designs for Health): 2 caps, three times a day, with meals
- DGL Plus (Pure Encapsulations): 2 caps with morning meal, 2 caps with evening meal
- Annatto Tocotrienols with Black Cumin Seed Oil (Designs for Health): 2 caps, twice daily, with any 2 meals
Support High Cortisol Output
- Adren-All (ortho Molecular): 2 caps in the morning upon waking, 1 capsule around 2 pm.
- daily meditation/yoga/gentle walk outside for 45 minutes
- Regular sleep/wake cycles and healthy sleep hygiene: 2 hours before bed, avoid food, screens, strong lights, and intense physical activity. Opt for nighttime routine to wing down; Epsom salt baths 3x weekly recommended. Daily morning exercise to raise the heart rate for 30 minutes.
Follow Up Labs 2 Months Later
At our follow-up visit two months later, Anna was feeling much improved. Her gastritis symptoms had fully cleared, and she was only dealing with occasional acid reflux when she would overeat or if she indulged in too many sweets.
Overall her stress level was improving, she was sleeping more soundly, and her energy level had greatly improved during the day.
She successfully added lemon water at six weeks on the protocol without increasing symptoms, which she was pleased about as this was a morning staple for her.
She was told to maintain the use of the DGL and gastromend supplements to provide continual anti-inflammatory support to her gastric lining while continuing to work on overall cortisol output and adrenal restoration with ongoing supplementation, therapy, and lifestyle modifications. The patient had started a new job, and her stress level was subsequently increasing, hence the need for ongoing adrenal support.
Summary
This case study is an excellent example demonstrating the multifactorial processes leading to disease development commonly seen in patients, as it is rarely a single cause-and-effect process. Addressing multiple organ systems through functional lab testing, lifestyle modification, dietary support, and supplementation work synergistically to provide long-term healing and results.
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