Gastroesophageal Reflux Disease (GERD) is one of the highest prevalent gastrointestinal (GI) disorders doctors see. This chronic condition can affect up to 20% of adults in the West and continues to grow. Recognizing and diagnosing GERD early on can help manage the symptoms affecting the quality of life for people with this GI disorder. This article will dive into the most commonly used labs by functional medicine providers that can help monitor GERD to allow for proper adjustments in managing and treating this condition.

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What Is GERD?

GERD can be categorized as non-erosive or erosive based on the presence of mucosal damage to the esophagus indicated by an endoscopy. This condition can be described as having symptoms or mucosal damage caused by the abnormal reflux of gastric contents into the oral cavity, esophagus, or lung. GERD can lead to esophagitis (esophageal inflammation) and precancerous cells in the esophagus. GERD can occur when there is a dysfunction of the lower esophageal sphincter (LES) meant to prevent the regurgitation of stomach contents into the esophagus. 

There are various risk factors for GERD. These risk factors include having a connective tissue disorder, hormonal imbalances, delayed stomach emptying, lifestyle factors such as a Standard American Diet (SAD), smoking, and drinking alcohol or coffee. Medications such as antidepressants, rescue inhalers for asthma, and NSAIDs (Non-steroidal anti-inflammatory drugs) may raise the risk of developing GERD.

Symptoms Of GERD

GERD can present with various typical, atypical, or extraesophageal symptoms. The typical symptoms are regurgitation and heartburn. These symptoms can be worse after meals or lying down. Atypical symptoms may coincide with other conditions, such as peptic ulcer disease (PUD) or gastritis. Atypical symptoms are epigastric (upper adomen) pain, dyspepsia (indigestion), nausea, bloating, and belching. Extraesophageal symptoms such as a chronic cough, asthma, laryngitis, or dental erosions may have a connection with the vagus nerve that can trigger the cough and reflux into further parts of the esophagus. These symptoms can drastically impact the quality of life for individuals with GERD, making it essential to diagnose and treat these patients appropriately.

Importance Of Regular Lab Testing For GERD Patients

GERD is typically diagnosed through assessing clinical symptoms and upper endoscopy. Conventionally, regular monitoring is done through esophageal pH testing. However, if a diagnosis has already been established, regular monitoring can also be completed through a well-taken history and a symptom analysis of heartburn and acid regurgitation. 

Functional medicine labs can also be helpful for the continued monitoring of GERD and GERD-related symptoms. Regular lab testing and continued monitoring are necessary as symptoms vary and change. It is also important to assess disease progression or improvements and the effectiveness of treatment protocols for any adjustments that need to be made.

Top Labs To Run Bi-Annually On Your GERD Patients

Functional labs are essential to comprehensive care for GERD patients. Here are some commonly used functional medicine labs that are used to assess, monitor, and adjust treatment protocols on a bi-annual basis for GERD:

SIBO Breath Test

SIBO is small intestinal bacterial overgrowth. This gastrointestinal condition is prevalent in GERD and can be associated with symptoms of GERD, including abdominal pain, burping, and heartburn. The breath test for SIBO is a typical test used to diagnose this condition. This test can be completed at home and assesses for bacterial overgrowth in the small intestine, indicating SIBO. The testing process involves breathing into a tube after fasting overnight for a baseline reading, drinking a specialized mixture, and then doing a breath sample over 3 hours to assess if there is hydrogen, methane, or a combination of both, as the bacteria will release these gases from the mixture. Testing for SIBO can help practitioners address and monitor underlying factors that may be contributing to the symptoms related to GERD.

Food Sensitivities

Food sensitivities or intolerances are an IgG immune response and are considered a delayed sensitivity as symptoms can occur hours or days after ingesting a food. This immune reaction can lead to gut inflammation and symptoms. People with GERD have been shown to have intolerances to multiple food items, and dietary modifications with avoidance of these foods have been indicated to reduce reflux symptoms. The food sensitivity panel is a blood panel that can be typically done as a finger prick or small blood sample that measures these immune responses to various foods. Testing for food sensitivities on a bi-annual basis can be helpful with GERD patients in monitoring these food reactions and symptoms associated with GERD.

Hormone Panel

Studies indicate that abnormally high levels of estrogen and progesterone can increase symptoms of GERD. This thorough hormone panel is a blood test that assesses 13 different hormones, including estrogen, progesterone, testosterone, and DHEA. Measuring these hormones can help medical practitioners consider any underlying factors contributing to GERD-related symptoms possibly triggered by elevations of hormones such as estrogen and progesterone. The results of this panel can help determine treatment protocols to address these imbalances.

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Nutrition For GERD

For digestive issues, nutritional intervention is a top priority in functional medicine. The typical nutritional approach for GERD is avoidance of food triggers, eating at certain times, and eating small meals. Avoiding lying down after eating and 3 hours before bedtime can help prevent symptoms such as reflux. Consuming smaller amounts of food throughout the day can also help prevent reflux. Eliminating food sensitivities and common foods that trigger GERD, such as citrus fruits, onion, garlic, dairy, gluten, spicy foods, tomato, mint, chocolate, and coffee, can also be beneficial. Another approach is adjusting the types of carbohydrates consumed, as these can impact the severity of GERD symptoms. Simple carbs such as refined sugar, white rice, and bread can cause the LES to relax and contribute to heartburn. On the other hand, fiber-rich foods such as vegetables, whole grains, beans, and other complex carbs can improve symptoms by promoting stomach emptying.

Supplements And Herbs For GERD

Here are some commonly used supplements and herbs to help improve symptoms associated with GERD:

Glycyrrhiza Glabra

Glycyrrhiza is also called licorice root. This herbal supplement can reduce inflammation in the tissues and can heal ulcerations. Glycyrrhiza has been shown to decrease symptoms such as belching, bloating, regurgitation, and heartburn. The suggested dosage is 75 mg twice daily for 30 days.

Probiotics

Probiotics can be beneficial for upper gastrointestinal health. It has been associated with being effective in relieving the frequency and severity of symptoms of GERD, such as reflux, nausea, heartburn, and belching. The effective doses range from 1-46 billion CFU of various strains for 12 weeks.

Melatonin

Melatonin has anti-inflammatory and analgesic effects. It can also improve the function of the LES by inhibiting gastric acid secretion and nitric oxide production, which has a role in LES relaxation, making this beneficial for GERD.

Curcumin

Curcumin is from the turmeric root, often used in teas and flavoring. It has effectively reduced the severity of ulcerations due to its ability to improve inflammation and antioxidant effects on the esophagus. It has been shown to reduce ulcers in conditions such as peptic ulcers at 600 mg five times daily for four weeks.

Demulcent Herbs

Demulcent herbs such as marshmallow and slippery elm have low toxicity and can improve reflux symptoms. These herbs can provide a protective barrier against inflammation and are recommended to use as a cold infusion or powder that is added to water at 5-10 grams with every meal for adults.

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Summary

GERD is a common chronic GI condition that is increasing in prevalence and can cause significant health consequences. Functional medicine doctors often provide guidance in managing this condition through regular testing to address the underlying triggers of GERD or to help reduce the risk factors for developing GERD. Integrative approaches that emphasize dietary modifications and clinically relevant supplements can benefit GERD patients and improve their overall quality of life.