What are the possible causes of esophageal erosion?

And by erosion, I’m wondering if you mean, like, esophagitis, and I don’t know if you’re on the live call, and if you are, you can certainly clarify using the question and answer box. But you said,​ “My patient has severe esophageal erosion …” ​So, again, I’m sort of thinking esophagitis “… ​and possibly ​H. pylori​ and SIBO tests in a couple of weeks. I suspect she has a low stomach acid, yet her gastro says it can’t be from low stomach acid due to the high erosion. I still believe she has low stomach acid. I know that any acid will cause problems, yet are there other things to suspect other than stomach acid? Are there bacteria that erode the esophagus or other ways it can erode, or only stomach acid?”

You’re spot on that when we see, again, if we’re talking about [the] esophagus here, that generally is due to the stomach contents, the gastric juices refluxing up into the esophagus, and even if you have relatively low stomach acid, that’s still going to be in acidic fluid. That’s going to be influencing the esophagus. What I would think about is more [of] what’s the cause of reflux.

Liz, I see you are here, so you’re saying it’s erosion. Okay, got it. Erosion. I’m kind of wondering, he said severe erosion. I’m thinking that this is essentially esophagitis, but it sounds like, basically, what we’re dealing with here is reflux. In terms of the underlying causes of erosion/esophagitis, so, basically, we’re saying inflammation of the esophagus and whether those pathologic changes are just an infiltration of inflammatory cells or the specific erosions. I would say, I don’t know how much it really would be a different etiology. I think as you’re saying, the underlying cause [is] probably reflux here. Yes, this could be a stomach acid issue, but I think more about what’s causing the reflux. Is there something in terms of a motility issue? Is she eating foods [that are] allowing relaxation of the lower esophageal sphincter? Is the patient taking a medication that’s allowing relaxation of the lower esophageal sphincter? Is she eating too much? Is there delayed gastric emptying. That is probably the direction I would start thinking about, is less about the stomach acid level and more about what’s allowing the reflux. Something is causing a relaxation.

And then Liz is saying “yes” to all of that, “My problem is that gastro.” That said, one other thing, though, when I see reflux, I agree with you. I do think, like, why is she not digesting? I do think, like, I’d love this patient to have more digestive support, but I would not use HCL, like, I wouldn’t use hydrochloric acid in a patient who has reflux or erosive changes in the stomach or esophagus. What I would think about using might be something like a motility agent and digestive enzymes that do not have HCL. Even then, I’m a little bit cautious, but I would think about using something like ​Iberogast​, which you can have the patient self-order online. I think FeelGood Natural Health​ carries Iberogast. You could get it off Amazon, just, I’m always a little

kresserinstitute.com

hesitant off Amazon because of some sketchy people there, but Iberogast is a good one. I also really really like a formula called ​Motility Activator​ through ​Integrative Therapeutics​. I think it’s something like artichoke and dandelion. But again, just supporting like peristaltic activity, the patient might need to eat smaller meals more frequently. If it’s an issue of volume, I think overall to support, like, the migrating motor complex, we do actually want to eat less frequently. But if it’s more of a stomach and lower esophageal sphincter issue, then you might need to start with smaller volume meals, [and] make sure the patient is not drinking fluids with meals because fluids can dilute the digestive enzymes. They can expand the stomach, again, increasing volume. I would say, like, no significant fluid intake 30 minutes before or after the meal, [and] make sure that the patient’s eating two to three hours before bed. If you want a digestive enzyme without hydrochloric acid, I like one called ​Digest​ by ​Transformation Enzymes​. Go to​ Emerson Ecologics​ or wherever you get your supplements, and browse through the digestive enzymes and choose something without HCL. One nice one that’s pretty benign would be ​Organic Digest Plus​, Dr. Formulated, I think, is the brand, and it’s a chewable digestive enzyme, so it doesn’t have HCl in it. It’s got a tropical banana papaya flavor. It kind of tastes good to me.

“I know that four to five hours between.” Yes, for the migrating motor complex, ideally, but again, if it’s a matter of, like, getting calories in, sometimes, it could be, like, eating every two to three hours during the day, but then maybe getting 13 hours [of fasting] overnight minimum. I do like people eating less frequently throughout the day. I think overall, that has the most value, but in terms of what you’re saying for this particular case, you might need to play with that until we get the reflux issue and look at triggers for reflux like citrus, caffeine, etc., and make sure those are out. I think we covered that.