Go ahead and file this news under “life-changing.”

Studies show that roughly 50% to 60% of patients with symptoms of gastroesophageal reflux disease (GERD), which is a type of chronic heartburn, may not be finding much (or any) relief from even the strongest prescription-strength acid-reducing drugs. Why?

Because they’re suffering from another condition instead! And if they find this out, they can finally get some relief!

But file this news under “dangerous” as well, because the strongest prescription heartburn drugs aren’t just failing to help these people—they also have serious side effects, such as an increased risk for bone fractures and bacterial infections.

If you believe that you have GERD or know someone who does, it’s critical to make sure that there hasn’t been a misdiagnosis.…


The folks that I’m speaking of above have a related disorder known as non-erosive reflux disease (NERD). Most but not all of these patients are female, and most but not all are younger and thinner than typical GERD sufferers. They experience the same severe feeling of heartburn as people with GERD but find little to no help from acid-suppressors…and unlike GERD sufferers, most people with NERD don’t show any evidence of acid erosion on the esophagus when it’s examined with an endoscope.

I learned all this from a recent chat with Prateek Sharma, MD, a professor of medicine at The University of Kansas School of Medicine in Kansas City.

He knows of at least one thing that these people must do.


What causes NERD? Several possible explanations are typically investigated, Dr. Sharma said. Some patients may be experiencing non-acid reflux. Others may have what’s called a hypersensitive esophagus, which feels distress even when exposed to small amounts of acid. High stress levels and certain dietary habits (indulging in “trigger” foods such as peppermint, chocolate, peppers, alcohol and caffeine) also can be to blame.

If your GERD isn’t responding well (or at all) to acid-suppressing drugs, ask your doctor if what you really have might be NERD. (It’s important to get an actual diagnosis so you can rule out other potential causes of symptoms, such as a stomach ulcer.) Just be aware that confirming a NERD diagnosis isn’t a walk in the park. The two main tools are a pH test and an impedance test. Both require a small tube with special monitoring electrodes to be passed through the nose and into the esophagus for a 24-hour period to record whether there is acid exposure or liquid movement from the stomach into the esophagus. Plus, Dr. Sharma told me that not all gastroenterologists have access to the equipment that’s necessary to perform the tests, so you may need a referral to a particular doctor or medical center. You can find gastroenterologists in your area by using the physician locator tool on the site of the American College of Gastroenterology here. Then look them up online (some doctors who treat NERD call themselves “upper GI specialists” or cite NERD as a specialty on their sites) and/or call to ask each whether he or she tests for NERD.


Doctors are at loose ends over how to effectively treat NERD, Dr. Sharma acknowledged. Options include avoiding certain foods (such as the ones mentioned earlier)…quitting smoking…avoiding alcohol…losing weight if you are overweight…eating smaller meals… wearing looser clothes…not lying down for three hours after a meal…and raising the head of your bed.

To hear what a naturopathic doctor had to say about NERD, I called Daily Health News regular contributor Andrew Rubman, ND, founder of the Southbury Clinic for Traditional Medicines in Southbury, Connecticut. He has a different theory on what may cause and what may help treat the condition. “In my patients, I have found the main cause of NERD to be insufficient production of hydrochloric acid in the stomach during digestion. When there isn’t enough of this acid, you don’t sterilize what you’re eating and it leads to an overgrowth of ‘bad’ bacteria. This can create inflammation, which induces the stomach to produce extra hydrochloric acid in between meals—when there’s no food in it,” he said. So if you suffer from NERD symptoms, Dr. Rubman suggests asking a naturopathic doctor about taking a digestive enzyme called Duozyme, as well as a supplement that includes bismuth citrate. These will help increase acid production during meals and decrease it in between them.

But Dr. Sharma was firm about one thing—whether you’ve gotten a NERD diagnosis or not, if GERD drugs aren’t working, don’t continue taking them. This is the most important message of all, because, as mentioned earlier, the strongest heartburn drugs (proton pump inhibitors) have been shown to heighten the odds of bone fractures and bacterial infections, as well as reducing the absorption of certain nutrients such as magnesium, calcium and vitamin B-12. So if they’re not providing you with any (or enough) relief, tell your doctor, because they’re probably not worth the risk.