Leaky Esophagus and Reflux, A Deadly Combination

Leaky Esophagus and Reflux, A Deadly Combination

Everyone in the digestive health sphere writes about leaky gut, myself included. I am guilty in fixating on the lower intestinal tract, most people that contact me suffer from either general dysbiosis and SIBO. Many people, however, are contacting me with upper gut overgrowth issues. There is less available information on these matters, so I am compelled to write about it more.

Different forms of reflux are believed to stem from gastrointestinal problems and most of the time when you improve one’s digestive health, reflux disappears. Correcting overgrowth, especially Gram-negative overgrowth in the digestive system is what relieves reflux for most people. However, why do some people get reflux symptoms and others have no symptoms whatsoever, even when they are both suffering from digestive issues? I was mistaken, I should have looked at the esophagus instead of the lower gut to determine why we develop reflux symptoms and what can be done to relieve it. The problem is esophageal inflammation from overgrowth; the solution is to reduce it and repair the esophagus.

Leaky Esophagus?

The average person refluxes stomach acid, pepsin, and chyme, multiple times throughout the day. When we burp, we reflux. When we sneeze, we reflux. When we swallow food, we reflux some more. Our esophagus can easily handle these components and the average person without upper gut issues, has little to no inflammation in the esophagus from the reflux. 1 2

So what changes? Why do people develop reflux disorders?

The esophagus has antireflux defense mechanisms in place to help protect itself from reflux that occurs throughout the day. When we reflux contents from our stomach, attach itself to the esophagus. One of the defense mechanisms is our esophagus ability to clear the reflux components. When we swallow, we swallow a mixture of saliva and salivary bicarbonate to help normalize the pH of the esophagus and inactivate both acid and pepsin. If we reflux into the oral cavity, less saliva and salivary bicarbonate are produced and what is produced is used within our oral cavity to protect the oral mucosa, which is why people with severe reflux have dry mouth. Also, we have cells in our esophageal lining that produce carbonic anhydrase which forms bicarbonate to help further buffer refluxed contents as well. Cells that produce the carbonic anhydrase are found in the basal layer of the esophagus (one of the outermost layers), which is easily damaged from overgrowth and bile reflux. 3 4 5 6 7 8 9

Most people are unaware that your stomach has a microbiome. Our stomach is not sterile. Either is our oral cavity or our esophagus. Nowhere in the body is sterile, not even the brain.

So what is the difference between the microbiome of someone that has reflux and someone who does not? We do have a few clues in trying to determine the difference. It appears in people that have reflux have a reduction in the probiotic mucus producing Gram-positive bacteria Akkermansia muciniphila. Akkermansia muciniphila would help to maintain the mucosal lining of the esophagus and the stomach, reducing inflammation and symptoms of reflux. Overgrowth of Gram-negative bacteria in the stomach (H. pylori for example) can cause elevated amounts of endotoxins in refluxed material causing inflammation in the esophagus and reflux symptoms. Finally, most people that have reflux symptoms are shown through studies to have an upper gut overgrowth of the stomach and the esophagus of Gram-negative bacteria. An overgrowth of Gram-negative bacteria causes an increased production of endotoxins which creates inflammation and immune reactions that irritate and degraded the esophagus mucosa and damage the lining. 10 11 12 13 14 15 16

The tissue structure of the esophagus also changes in people with reflux symptoms. The mucosa as mentioned earlier thins from microbiome changes and epithelial cells in the esophagus become damaged. The tight junctions in the esophagus open up allowing acid and pepsin to degrade the integrity of the esophagus further. Endotoxins have been shown in studies to open up the tight junctions from increased inflammatory responses. The front of the epithelial cells can protect itself from acid and pepsin, but the back of the cells cannot. The esophagus becomes weakened to refluxed material causing inflammation and the typical symptoms of reflux. The LES can also become weakened from repeated exposure to endotoxins from overgrowth, increasing the number of refluxed episodes. 17 18 19 20 21

Finally, bile reflux is a contributor to reflux symptoms. Bile is produced by our liver and released by our gallbladder into our duodenum to help facilitate fat digestion. Bile is alkaline, and if it can flow up into the stomach from a weak pyloric sphincter, it can irritate the stomach lining and cause gastritis and ulcers. A weak pyloric sphincter is similar to a weakened LES in that it is caused by the Gram-negative overgrowth in the upper gut and inflammation from increased endotoxin production. If bile is further refluxed into the esophagus it can cause more damage than stomach acid or pepsin; the tissue is fragile to bile. Bile reflux causes severe damage to the esophagus and is linked strongly to developing Barrett’s esophagus, esophagitis, and esophageal cancer. 22 23

Why people have symptoms of reflux is very complicated as you have read. The main issue that needs to be resolved for most people is to reduce opportunistic overgrowth in the upper gut and reduce inflammation so that overtime the sphincters and tissue can heal. Hopefully, “leaky esophagus” will continue to be studied so we can learn more about the mechanisms behind reflux symptoms and how to deal with them so that conditions like GERD, LERD, bile reflux, and NERD can be conditions of the past.

  1. I dont have H. Pylori according to the biopsy and tests, so I will look into the liver and gallbladder thanks!

  2. Hi John! This is very interesting I think bile relux is what is happening to me, two weeks ago I started having a LOT of pain in the colon, mainly in the sigmoid colon I could not eat anything. So I got a colonoscopy and it turns out they did not find anything in the large intestine they said is just inflamated but no ulcer, what they found mainly was a lot of bile in the stomach, a very severe gastritis and an inflamated esophagus. I already have an autoimmune condition called lichen sclerosis and a lot of digestive issues so I was guessing this stuff might be Crohns, I dont know what could be the reason of the pain in the large intestine and if it is connected or not to the bile. I am from Ecuador and here doctors dont even know what an autoimmune condition is, they just want me to pop a lot of pills, which I havent because I know it is bad on the long term and I am trying to find cures in alternative medicine. I just bought your book but couldnt find anything about bile reflux and the pyloric sphincter so bile does not continue going to the stomach, if you could please help me some suggestions?
    Thank you very much!!!!

    • Bile reflux will be added to the fourth edition of Fix Your Gut. There is not a lot of information about it in studies sadly. I would look into some sort of upper gut overgrowth like H. pylori. Sluggish liver and gallbladder can also cause issues that create bile reflux.

    • Caroline, I suggest you look into zinc carnosine. A naturopath prescribed that to me when I had upper-gut overgrowth with gastritis. It helped a lot. More recently, I tried Gastrazyme on my own. It seemed to help. Make sure you have vitamin A, zinc, and licorice in your daily regimen.

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