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data-widget_type="theme-post-title.default"> <div class="elementor-widget-container"> <h1 class="elementor-heading-title elementor-size-default">The Bidirectional Relationship Between Gut Microbiome and GERD: Cause or Consequence?</h1> </div> </div> <div class="elementor-element elementor-element-5f5279f7 elementor-align-left elementor-widget elementor-widget-post-info" data-id="5f5279f7" data-element_type="widget" data-widget_type="post-info.default"> <div class="elementor-widget-container"> <ul class="elementor-inline-items elementor-icon-list-items elementor-post-info"> <li class="elementor-icon-list-item elementor-repeater-item-7f530f1 elementor-inline-item" itemprop="datePublished"> <a href="https://nmc-magazine.com/2024/10/10/"> <span class="elementor-icon-list-text elementor-post-info__item elementor-post-info__item--type-date"> <time>October 10, 2024</time> </span> </a> </li> <li class="elementor-icon-list-item elementor-repeater-item-1ff52e9 elementor-inline-item" itemprop="author"> <a href="https://nmc-magazine.com/author/darmel/"> <span class="elementor-icon-list-icon"> <i aria-hidden="true" class="far fa-user-circle"></i> </span> <span class="elementor-icon-list-text elementor-post-info__item elementor-post-info__item--type-author"> Darmell </span> </a> </li> </ul> </div> </div> <div class="elementor-element elementor-element-4a742b43 elementor-widget elementor-widget-theme-post-excerpt" data-id="4a742b43" data-element_type="widget" data-widget_type="theme-post-excerpt.default"> <div class="elementor-widget-container"> GERD is a chronic condition that causes stomach acid flows back into the esophagus, causing symptoms like heartburn. Emerging research suggests a complex relationship between GERD and the gut microbiome, where imbalances in gut bacteria may contribute to the development and severity of GERD. Understanding this bidirectional relationship opens new possibilities for treatment, including microbiome-targeted therapies that go beyond traditional acid suppression methods. <br><br> AUTHOR: Ira Renko, MSc, Master in Molecular biotechnology </div> </div> </div> </div> <div class="elementor-element elementor-element-118c1818 e-flex e-con-boxed e-con e-parent" data-id="118c1818" data-element_type="container"> <div class="e-con-inner"> <div class="elementor-element elementor-element-54a89a27 elementor-widget elementor-widget-theme-post-featured-image elementor-widget-image" data-id="54a89a27" data-element_type="widget" data-widget_type="theme-post-featured-image.default"> <div class="elementor-widget-container"> <img loading="lazy" width="2560" height="1920" src="https://nmc-magazine.com/wp-content/uploads/2024/10/probiotici-Copy-1-scaled.jpg" class="attachment-full size-full wp-image-4338" alt="" srcset="https://nmc-magazine.com/wp-content/uploads/2024/10/probiotici-Copy-1-scaled.jpg 2560w, https://nmc-magazine.com/wp-content/uploads/2024/10/probiotici-Copy-1-300x225.jpg 300w, https://nmc-magazine.com/wp-content/uploads/2024/10/probiotici-Copy-1-1024x768.jpg 1024w, https://nmc-magazine.com/wp-content/uploads/2024/10/probiotici-Copy-1-768x576.jpg 768w, https://nmc-magazine.com/wp-content/uploads/2024/10/probiotici-Copy-1-1536x1152.jpg 1536w, https://nmc-magazine.com/wp-content/uploads/2024/10/probiotici-Copy-1-2048x1536.jpg 2048w" sizes="(max-width: 2560px) 100vw, 2560px" /> </div> </div> <div class="elementor-element elementor-element-c3d855 elementor-widget elementor-widget-theme-post-content" data-id="c3d855" data-element_type="widget" data-widget_type="theme-post-content.default"> <div class="elementor-widget-container"> <p><strong>Background information</strong></p> <p>Gastroesophageal reflux disease (GERD) is one of the most common chronic conditions affecting the digestive system, affecting around 8% to 33% of people globally and 10% to 20% of the population in Europe<sup>1,2</sup>.</p> <p>It is primarily driven by the dysfunction of the lower esophageal sphincter (LES), which acts as a barrier preventing the backflow of stomach contents into the esophagus. When the LES fails to function properly, it allows acidic gastric contents to reflux into the esophagus, causing irritation and inflammation<sup>3,4</sup>. This can lead to symptoms such as heartburn, regurgitation, and in severe cases, esophagitis. Several factors contribute to LES dysfunction, including obesity, diet, smoking, and certain medications. The chronic exposure of the esophagus to stomach acid can lead to complications like esophageal strictures, Barrett鈥檚 esophagus, and an increased risk of esophageal cancer<sup>5</sup>. While GERD has traditionally been attributed to mechanical and chemical factors, recent research suggests that the composition and functionality of the gut microbiome may also contribute to the pathogenesis of this condition<sup>6-8</sup>.</p> <p><a></a><a></a><strong>Bidirectional relationship: interplay between gut microbiome and GERD</strong></p> <p>The gut microbiome, comprising trillions of microorganisms residing in the gastrointestinal tract, plays a crucial role in maintaining overall health. Recent studies have begun to explore the connection between the gut microbiome and GERD. Although the exact nature of this relationship remains unclear<sup>9</sup>. Some research suggests that dysbiosis in the gut microbiome may contribute to the development of GERD<sup>10,11</sup>. For example, changes in the composition of the gut microbiota could affect gut motility, influence bile acid metabolism, or alter the production of short-chain fatty acids, all of which could impact the function of the LES and promote acid reflux<sup>12</sup>. Additionally, certain bacterial species have been found to influence the production of gases like hydrogen and methane, which can affect intra-abdominal pressure and potentially exacerbate GERD symptoms<sup>13,14</sup>.</p> <p>Gut microbiome as a potential cause of GERD</p> <p>The gut microbiome plays a significant role in regulating gastrointestinal motility. Specific bacterial species produce metabolites such as short-chain fatty acids (SCFAs), which influence gut motility by interacting with the enteric nervous system<sup>15</sup>. Dysbiosis, or an imbalance in the gut microbiota, can disrupt these processes, potentially leading to delayed gastric emptying or altered esophageal motility, both of which are risk factors for GERD<sup>10,11</sup>. Impaired gut motility can increase intra-abdominal pressure, leading to the relaxation of the lower esophageal sphincter (LES) and promoting acid reflux.</p> <p>Furthermore, gut microbiota is involved in the metabolism of bile acids, which are critical for digestion and the absorption of dietary fats. Bile acids also play a role in regulating gut motility and maintaining the integrity of the gut barrier<sup>16</sup>. What is more, dysbiosis can alter the composition of bile acids, leading to an increase in deconjugated bile acids that are more likely to reflux into the esophagus and cause mucosal damage. This bile acid reflux, in conjunction with gastric acid, can exacerbate the symptoms of GERD and contribute to esophageal inflammation.</p> <p>Since 70% of our immune system is in the gut, that has impact on overall health by modulation of inflammatory responses. Namely, dysbiosis can lead to an overproduction of pro-inflammatory cytokines and other mediators that can disrupt the esophageal mucosal barrier<sup>17,18</sup>. This disruption makes the esophageal lining more susceptible to acid damage and inflammation, both of which are characteristic of GERD. Additionally, certain microbial metabolites may directly affect the permeability of the esophageal epithelium, facilitating the penetration of acid and bile, thus worsening GERD symptoms<sup>19</sup>.</p> <p>Some gut bacteria even produce gases such as hydrogen and methane during fermentation processes which can increase intra-abdominal pressure, which may contribute to the relaxation of the LES and the subsequent development of acid reflux. Methanogenic bacteria have been associated with slower gastrointestinal transit times and increased gas retention, factors that could potentially promote GERD. Researchers have showed that there is a specific gut microbiome profile in individuals with GERD. Compared to healthy individuals, there is a reduced number of beneficial bacteria <em>Lactobacillus</em> and <em>Bifidobacterium</em> and a higher abundance ofpathogenicsuch as<em> Escherichia coli</em> and <em>Clostridium difficile</em>, which are known to induce inflammation and disrupt gut barrier integrity<sup>20,21</sup>.</p> <p>Following that, interventions aimed at modulating the gut microbiome have shown promise in managing GERD symptoms. Probiotic supplementation, for instance, has been reported to improve GERD symptoms by restoring the balance of the gut microbiota, reducing inflammation, and enhancing gut motility. These findings suggest that targeting the gut microbiome could be a viable therapeutic strategy for GERD.</p> <div class="wp-block-image"> <figure class="aligncenter size-large is-resized"><img fetchpriority="high" fetchpriority="high" decoding="async" width="1024" height="684" src="https://nmc-magazine.com/wp-content/uploads/2024/10/Depositphotos_367722622_L-1024x684.jpg" alt="" class="wp-image-4339" style="width:376px;height:auto" srcset="https://nmc-magazine.com/wp-content/uploads/2024/10/Depositphotos_367722622_L-1024x684.jpg 1024w, https://nmc-magazine.com/wp-content/uploads/2024/10/Depositphotos_367722622_L-300x200.jpg 300w, https://nmc-magazine.com/wp-content/uploads/2024/10/Depositphotos_367722622_L-768x513.jpg 768w, https://nmc-magazine.com/wp-content/uploads/2024/10/Depositphotos_367722622_L-1536x1025.jpg 1536w, https://nmc-magazine.com/wp-content/uploads/2024/10/Depositphotos_367722622_L.jpg 2000w" sizes="(max-width: 1024px) 100vw, 1024px" /></figure></div> <p>GERD as a leader of gut microbiome alterations</p> <p>While the gut microbiome may play a role in the development of gastroesophageal reflux disease (GERD), it is equally important to consider how GERD itself might lead to changes in the gut microbiome. The chronic acid reflux characteristic of GERD, as well as the treatments commonly used to manage it, can significantly impact the composition and function of the gut microbiota. The chronic exposure of the esophagus and upper gastrointestinal tract to stomach acid can create an unfavourable environment for certain bacterial species, leading to dysbiosis<sup>22</sup>. Moreover, the use of proton pump inhibitors (PPIs), a common treatment for GERD, has been shown to alter the composition of the gut microbiome<sup>23</sup>. By reducing stomach acidity, PPIs create conditions that favour the survival and overgrowth of bacteria typically suppressed by normal gastric acid levels. This can lead to conditions like small intestinal bacterial overgrowth (SIBO), which not only complicates GERD but also introduces a new set of gastrointestinal challenges<sup>24,25</sup>.</p> <p>The acidic pH, combined with the presence of bile and digestive enzymes, can inhibit the growth of acid-sensitive microorganisms while allowing acid-resistant species to proliferate. This selective pressure can lead to a shift in the microbial composition of the esophagus and, potentially, the upper gastrointestinal tract <sup>26</sup>.</p> <p>What is more, the chronic reflux of gastric acid into the esophagus and, at times, into the pharynx and oral cavity, can disrupt the normal microbiota of the stomach and small intestine. This disruption can decrease microbial diversity and the overgrowth of pathogenic bacteria. The altered microbial environment may further impair digestive processes and contribute to the progression of GERD symptoms<sup>27,28</sup>.</p> <p>A study by Nobile <em>et al</em>. (2020) found that patients with GERD exhibited significant differences in gut microbiota composition compared to healthy controls, with a reduction in the abundance of <em>Lactobacillus</em> species, known for their protective effects on the gut lining<sup>29</sup>. Conversely, research by Imhann <em>et al</em>. (2016) demonstrated that long-term use of PPIs in GERD patients was associated with a shift in the gut microbiome, including an increase in potentially pathogenic bacteria such as <em>Enterococcus</em> and <em>Clostridium difficile</em><sup>30</sup>.</p> <p><strong>Implications for treatment and management</strong></p> <p>The bidirectional relationship between the gut microbiome and GERD has significant implications for how the disease is treated. Traditional approaches that focus solely on acid suppression may not address the underlying microbiome imbalances that contribute to GERD. Integrative treatments that consider both the microbiome and GERD symptoms could offer more effective and long-lasting relief. For instance, combining PPI therapy with probiotics or dietary interventions aimed at restoring microbial diversity might help break the cycle of dysbiosis and reflux, leading to better outcomes for patients<sup>12</sup>.</p> <p><strong>Table 1. presents some of the most known probiotics that showed a positive impact on the progression of GERD</strong></p> <figure class="wp-block-image size-full is-resized"><img decoding="async" width="489" height="279" src="https://nmc-magazine.com/wp-content/uploads/2024/10/table.png" alt="" class="wp-image-4334" style="width:613px;height:auto" srcset="https://nmc-magazine.com/wp-content/uploads/2024/10/table.png 489w, https://nmc-magazine.com/wp-content/uploads/2024/10/table-300x171.png 300w" sizes="(max-width: 489px) 100vw, 489px" /></figure> <p>Specific strains of <em>Lactobacillus</em> and <em>Bifidobacterium</em> have been associated with improvements in gut motility, enhancement of the mucosal barrier, and reduction of inflammation<sup>31-41</sup>. These effects can help alleviate GERD symptoms and potentially reduce reliance on PPIs. Prebiotics, which are nondigestible fibers that promote the growth of beneficial bacteria, can also play a role in maintaining a healthy gut microbiome and supporting overall gastrointestinal health. Dietary interventions that emphasize the consumption of fiber-rich foods, fermented products, and foods low in refined sugars and fats can help support a diverse and balanced gut microbiome<sup>42</sup>. Additionally, dietary adjustments such as reducing the intake of trigger foods (e.g., fatty foods, caffeine, chocolate) can directly help manage GERD symptoms while also supporting microbiome health <sup>43,44</sup>.</p> <h4 class="wp-block-heading"><a></a><a></a><a></a><strong>Conclusion</strong></h4> <p>The relationship between the gut microbiome and GERD is a complex and dynamic interplay where each influences the other significantly.</p> <p>It is unclear whether alterations in the gut microbiome contribute to the development of GERD or whether GERD itself leads to changes in the gut microbiome.</p> <p>While the precise mechanisms by which the gut microbiome may cause GERD are still being elucidated, the evidence points to a significant role of microbial dysbiosis in the pathogenesis of this condition. Alterations in gut motility, bile acid metabolism, esophageal mucosal integrity, and intra-abdominal pressure are all potential pathways through which the gut microbiome could influence GERD development. Understanding these mechanisms not only enhances our knowledge of GERD but also opens up new possibilities for treatment strategies that target the gut microbiome to alleviate GERD symptoms and prevent its progression.</p> <p>Likely, future GERD management will increasingly incorporate microbiome-focused therapies, especially probiotics,  leading to more comprehensive and personalized care. However, further research is needed to clarify the causal relationships and to explore how specific microbial interventions might be optimized for GERD management.</p> <p class="has-small-font-size"><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><a></a><strong>References:</strong></p> <p class="has-small-font-size">1. 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Probiotic strains in gut health: Benefits of Lactobacillus and Bifidobacterium. Alimentary Pharmacology & Therapeutics, 49(8), 1025-1034.</p> <p class="has-small-font-size">42. Roberfroid, M. B. (2007). Prebiotics: The concept revisited. The Journal of Nutrition, 137(3), 830S-837S.</p> <p class="has-small-font-size">43. van Mierlo, T., & Meinders, M. J. (2020). Dietary management of gastroesophageal reflux disease (GERD): A narrative review. Nutrients, 12(10), 3052.</p> <p class="has-small-font-size">44. Rokkas, T., & Pistiolas, D. (2007). Diet and gastroesophageal reflux disease. 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href="https://nmc-magazine.com/winners-of-the-2024-fi-europe-innovation-awards-and-startup-challenge-crowned/" tabindex="-1" ><div class="elementor-post__thumbnail"><img loading="lazy" width="768" height="511" src="https://nmc-magazine.com/wp-content/uploads/2024/11/Informa-Markets_Fi-Europe-2024-Startup-Challenge-768x511.jpg" class="attachment-medium_large size-medium_large wp-image-4505" alt="" decoding="async" srcset="https://nmc-magazine.com/wp-content/uploads/2024/11/Informa-Markets_Fi-Europe-2024-Startup-Challenge-768x511.jpg 768w, https://nmc-magazine.com/wp-content/uploads/2024/11/Informa-Markets_Fi-Europe-2024-Startup-Challenge-300x200.jpg 300w, https://nmc-magazine.com/wp-content/uploads/2024/11/Informa-Markets_Fi-Europe-2024-Startup-Challenge-1024x682.jpg 1024w, https://nmc-magazine.com/wp-content/uploads/2024/11/Informa-Markets_Fi-Europe-2024-Startup-Challenge-1536x1023.jpg 1536w, https://nmc-magazine.com/wp-content/uploads/2024/11/Informa-Markets_Fi-Europe-2024-Startup-Challenge-2048x1364.jpg 2048w" sizes="(max-width: 768px) 100vw, 768px" /></div></a> <div class="elementor-post__text"> <h4 class="elementor-post__title"> <a href="https://nmc-magazine.com/winners-of-the-2024-fi-europe-innovation-awards-and-startup-challenge-crowned/" > Winners of the 2024 Fi Europe Innovation Awards and Startup Challenge crowned </a> </h4> <div class="elementor-post__excerpt"> <p>On 19 November the food industry celebrated its innovators and change makers at a glittering awards ceremony in Frankfurt during Fi Europe. 9 companies picked up accolades in the hotly contested 2024 Fi Europe Innovation Awards, in recognition of their contributions to driving positive change in the F&B industry. Earlier in the day, the 5 winners of the Startup Challenge were revealed at the Innovation Hub.</p> </div> <a class="elementor-post__read-more" href="https://nmc-magazine.com/winners-of-the-2024-fi-europe-innovation-awards-and-startup-challenge-crowned/" aria-label="Read more about Winners of the 2024 Fi Europe Innovation Awards and Startup Challenge crowned" tabindex="-1" > Read More </a> </div> </div> </article> <article class="elementor-post elementor-grid-item post-4497 post type-post status-publish format-standard has-post-thumbnail hentry category-news tag-arla-foods-ingredients"> <div class="elementor-post__card"> <a class="elementor-post__thumbnail__link" href="https://nmc-magazine.com/arla-foods-ingredients-moves-forward-with-acquisition-of-volac-whey-nutrition-business/" tabindex="-1" ><div class="elementor-post__thumbnail"><img loading="lazy" width="768" height="384" src="https://nmc-magazine.com/wp-content/uploads/2024/11/AFI-VOLAC-11-768x384.jpg" class="attachment-medium_large size-medium_large wp-image-4499" alt="" decoding="async" srcset="https://nmc-magazine.com/wp-content/uploads/2024/11/AFI-VOLAC-11-768x384.jpg 768w, https://nmc-magazine.com/wp-content/uploads/2024/11/AFI-VOLAC-11-300x150.jpg 300w, https://nmc-magazine.com/wp-content/uploads/2024/11/AFI-VOLAC-11-1024x512.jpg 1024w, https://nmc-magazine.com/wp-content/uploads/2024/11/AFI-VOLAC-11-1536x768.jpg 1536w, https://nmc-magazine.com/wp-content/uploads/2024/11/AFI-VOLAC-11-2048x1024.jpg 2048w" sizes="(max-width: 768px) 100vw, 768px" /></div></a> <div class="elementor-post__text"> <h4 class="elementor-post__title"> <a href="https://nmc-magazine.com/arla-foods-ingredients-moves-forward-with-acquisition-of-volac-whey-nutrition-business/" > Arla Foods Ingredients moves forward with acquisition of Volac Whey Nutrition business </a> </h4> <div class="elementor-post__excerpt"> <p>Arla Foods Ingredients is moving forward with its acquisition of Volac鈥檚 Whey Nutrition business, after it was approved by the UK鈥檚 Competition and Markets Authority. The regulator鈥檚 go-ahead followed an agreement between the two companies, which was signed in April 2024.</p> </div> <a class="elementor-post__read-more" href="https://nmc-magazine.com/arla-foods-ingredients-moves-forward-with-acquisition-of-volac-whey-nutrition-business/" aria-label="Read more about Arla Foods Ingredients moves forward with acquisition of Volac Whey Nutrition business" tabindex="-1" > Read More </a> </div> </div> </article> <article class="elementor-post elementor-grid-item post-4474 post type-post status-publish format-standard has-post-thumbnail hentry category-news"> <div class="elementor-post__card"> <a class="elementor-post__thumbnail__link" href="https://nmc-magazine.com/tosla-nutricosmetics-launches-lumina365-a-revolutionary-formula-for-sun-protection-ensuring-healthy-tan/" tabindex="-1" ><div class="elementor-post__thumbnail"><img loading="lazy" width="768" height="523" src="https://nmc-magazine.com/wp-content/uploads/2024/11/LUMINA365_1-1-768x523.jpg" class="attachment-medium_large size-medium_large wp-image-4482" alt="" decoding="async" srcset="https://nmc-magazine.com/wp-content/uploads/2024/11/LUMINA365_1-1-768x523.jpg 768w, https://nmc-magazine.com/wp-content/uploads/2024/11/LUMINA365_1-1-300x204.jpg 300w, https://nmc-magazine.com/wp-content/uploads/2024/11/LUMINA365_1-1-1024x698.jpg 1024w, https://nmc-magazine.com/wp-content/uploads/2024/11/LUMINA365_1-1-1536x1046.jpg 1536w, https://nmc-magazine.com/wp-content/uploads/2024/11/LUMINA365_1-1-2048x1395.jpg 2048w" sizes="(max-width: 768px) 100vw, 768px" /></div></a> <div class="elementor-post__text"> <h4 class="elementor-post__title"> <a href="https://nmc-magazine.com/tosla-nutricosmetics-launches-lumina365-a-revolutionary-formula-for-sun-protection-ensuring-healthy-tan/" > TOSLA Nutricosmetics Launches LUMINA365: A Revolutionary Formula for Sun Protection Ensuring Healthy Tan </a> </h4> <div class="elementor-post__excerpt"> <p>TOSLA Nutricosmetics has just announced the results of the clinical study for their new unique Lumina365 supplement. This innovative sugar-free ingestible delivers visible improvements in skin鈥檚 response to sun exposure, offering an additional layer of whole-body sun protection that reduces skin redness by almost 50%, helping to maintain an even skin tone, 24 hours after UVB exposure in just 8 weeks. </p> </div> <a class="elementor-post__read-more" href="https://nmc-magazine.com/tosla-nutricosmetics-launches-lumina365-a-revolutionary-formula-for-sun-protection-ensuring-healthy-tan/" aria-label="Read more about TOSLA Nutricosmetics Launches LUMINA365: A Revolutionary Formula for Sun Protection Ensuring Healthy Tan" tabindex="-1" > Read More </a> </div> </div> </article> </div> </div> </div> </div> </div> <div class="elementor-element elementor-element-6018a41 e-con-full elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile e-flex e-con e-parent" data-id="6018a41" data-element_type="container" data-settings="{"background_background":"classic"}"> <div class="elementor-element 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