I suffered from GERD my whole life. It started with chronic unexplained coughing as a kid and developed into symptomatic heartburn by around 16/17 years old and got worse from there. By 25/26 I was on nexium and shortly thereafter found out I had Barrett's esophagus.

During a period of very low carb dieting I was able to stop PPIs but when I was diagnosed with BE the doctor convinced me to get back on a PPI... I should NOT have listened. I went a few years with constant but painless reflux. (The PPI took care of the pain because non-acidic reflux doesn't hurt; however, I could still tell I was refluxing and I was refluxing more than ever).

As I learned more and more about nutrition, I decided to try to quit the PPIs for good. I figured out that my reflux is 100% caused by SIBO. I have to eat a diet that prevents SIBO form developing, which means limiting intake of FODMAPs. Starch is not generally a problem for me. Limiting FODMAPs is not paleo per se (e.g., alliums are full of FODMAPa but are paleo), but it is certainly consistent with it. If I have a bad flare up (usually after a time period when I cannot control my food, like vacations or holidays), I can hasten a recovery with betaine HCL and low carb dieting.

I am now convinced that betaine HCL works by helping to kill the bugs in the small intestine. When I have to use betaine HCL, I take 3 or 4 caps with water about 30 mins before eating. I think the acidified water gets into and cleans out the small intestine. I wouldn't use it for too long though since long term supplementation with methyl donors will affect your epigenome in unpredictable ways.

Incidentally, probiotics do not help and, in fact, significantly worsen my GERD. I will burp for a week after a a few days of taking probiotics... I think it's clear that bacteria in the small intestine is the problem for me. Low carb helps. Betaine helps. Avoiding FODMAps help. Probiotics hurt. Boozing hurts. Sum it up like this: limiting FODMAPs is the maintenance but betaine HCL is the (short term) therapy...

I've also tried rifamixin too, which works well. But, betaine HCL probably has fewer side effects and seems just as effective. It is certainly less expensive.

If your significant other has EE, he should experiment eliminating foods to see if he can figure out what might be causing it. By the way, I once tested for EE (over 50 million eisinophiles per whatever unit of area they test for -- that's quite high). I never tested so high again however so I suspect a lab lab error or a doctor error (taking a sample too low - it should be mid-esophagus). Or maybe paleo eliminated whatever was causing it... I think this is unlikely, though, because I still eat grains from time to time with no symptoms...

A recent research study linked peptic disease (heartburn, GERD, stomach ulcer) to gluten exposure in patients with gluten sensitivity.

PD (peptic disease) is not uncommon in the presentation of CD (celiac disease). It is more likely to be found in the second decade of life. CD should be included in the differential diagnosis of patients with non-HP(H pylori) PD and we suggest routine CD serology and small bowel biopsy in patients with unexplained PD.

The authors of this study recommend that all patients with non infectious peptic disease be screened for celiac disease.

Source: Scand J Gastroenterol. 2009;44(12):1424-8. http://www.sott.net/articles/show/238736-Acid-Reflux-Linked-to-Gluten-Intolerance?utm_medium=referral&utm_source=pulsenews

The only way I can "measure" the efficacy is by the fact that I used to take a cocktail of Prilosec, Tagamet and Tums in the course of a day. I thought any spicy food would flare up my GERD, so I avoided it. I adopted a Paleo diet and haven't taken any of those products in almost 18 months. No more GERD, reflux, or whatever else you want to call it. On the rare occasions I have some cereal grains, I get a reflux reaction. Corn tortillas, etc. will also trigger this response. Hopefully, Melissa will respond. If not, you might suggest your SO check out her blog: http://huntgatherlove.com/

She does a far better job than I can at explaining the success a Paleo diet can provide to a GERD sufferer.

Taking HCL did wonders for my GERD and I know it's worked for a ton of others.

As far as how I measure the efficacy, I used to get indigestion and reflux every time I ate, now I don't.

I had severe acid reflux, or perhaps it was bile reflux (since I don't have a gallbladder anymore).

I had to take an OTC PPI acid reducer every night and avoid eating at night. When I ate absolutely nothing at night, I had bile reflux (threw up bright yellow liquid.) I titrated the dose down over time as I was trying to train my stomach to not reflux (crazy idea, I know, but it mostly worked, and I needed something like 1/8th of a dose of 150mg Ranitidine HCL)

Eventually I settled on eating just a slice of cheese at night and that worked at keeping the bile reflux away.

When I went paleo, within the first 30 days, it got much worse for a while as my digestion adjusted - likely the removal of the grains fixed the mineral absorption issues, which then fixed my stomach acid. But then, the acid reflux (no longer bile) got much worse until I removed all dairy - then it all went away. (For a while I couldn't digest egg whites either, but that went away in another month, presumably once I got all my minerals at the right doses.)

I've been paleo for the last year. But a couple of months ago I tried some raw milk cheese, and the acid reflux (no bile this time) came back. So for me, it's the dairy that's a trigger. I can get away with very small amounts, but sustained intake over a week causes the reflux to return.

Edits: I take 2-3 caps of Now SuperEnzymes + 1 Betaine HCL before main meals due to the lack of gallbladder and this is very helpful.

I remember back in October when I accidentally ate some wheat from my son's birthday cake (I though I only ate the frosting, but perhaps I had some flour or had some other dish at that restaurant that had wheat. Reflux came right back, so it's not just dairy. (I had the usual GI syndromes, but also became very sensitive to cold. After going paleo, I can normally walk outside in just a dress shirt in 40'F weather and not feel cold, and I do this often and don't get sick. I do it often as a test of my health.)

So, please count this as another n=1. I'm not sure which flavor of reflux I had vs what your SO is suffering from. For sure there were episodes of bile reflux as the gallbladder removal surgery just connects the bile duct to the stomach.

My two year old daughter has Eosinophilic Esophagitis. Her triggers are dairy, beef and possibly wheat and soy. We are still trying to figure it all out. Standard treatment for pediatric patients is an elimination diet of the most common food allergens (dairy, wheat, soy, peanuts, tree nuts, eggs, fish and shellfish). In studies, this diet was found to clear the eosinophils in 75% of the participants. The eliminated food is then reintroduced one at a time to test for a reaction. Unfortunately sometimes there is no outward reaction so endoscopies are the only way know whether a food is safe. Other common EoE triggers are corn, potatoes, and beef. There is definately some overlap here with a paleo diet. I would definitely encourage your S.O. to try some dietary interventions, he may have just grown accustomed to feeling a bit crappy--a not uncommon occurence in pediatric sufferers of this disorder.

It sounded like one of the objections to trying dietary interventions and going off PPIs was that there's no way to tell it's working, short of endoscopy. But since he has no painful symptoms, he receives no feedback that the PPIs are working anyway. What evidence is there that the current treatment is effective? It doesn't sound like there's any.

To me, this means that endoscopy is in his future regardless of his treatment--otherwise, how do they know anything is working?

Also, there's nothing stopping him from continuing to take the PPI and revising his diet at the same time. It might be less helpful than also giving up the PPIs, but if some allergen is causing part of this problem, removing it can't be a bad idea. Harm reduction!

As an aside: I recall reading somewhere that the esophageal abnormalities seen in GERD patients were probably NOT caused by stomach acid washing over the tissues and mutating them or whatever. The surface tissues looked fine (they are, after all, evolved to withstand acid), but the abnormal cells were growing in deeper levels--suggesting the cause was coming from within the body, not within the GI system (insofar as you could consider the GI system to be "outside" the body--a weird concept to think about). So shutting down stomach acid might have no impact whatsoever on this cause.

Your SO might consider taking Domperidone instead of PPIs. It should help with both the motility and acid problems. It is a well established drug that's about 30 years old and is so mild that it is even sold OTC in some countries. Sadly, it is not available for sale in the US due to political reasons so most who use it import it from Canadian pharmacies. My GI is Canadian and he said there they prescribe it like it's water. My cousin in Latin America also took it when she was a baby for reflux and my parents know people there who've taken it for decades without problems. I take 10mg once per day before dinner and it works wonders, even though it's a trivial dose. Typical dosage is 4-8x that. Take it away and boy am I in trouble!

BTW, having taken PPIs for so long, your SO might consider checking for (usually non-cancerous) stomach polyps regularly. I assume B12 is already checked as well as watching for hip fractures.

Also, in case you didn't know, they don't protect the esophagus. They only protect it from acid damage. The enzymes are still there. Recent research also shows that Barrets is much more benign than previously thought, if that helps.

My father had severe problems for years with esophogeal strictures which I now realize probably stemmed from eosinophilic esophagitis. A couple of years ago I started feeling like I had something "stuck" quite often. But my gastroenterologist said that he couldn't see any physical reason for the feeling during two endoscopies and that it was probably just related to my GERD and BE. (I also got the feeling he thought I was just making it up.)

Gee, funny thing is, after I went paleo and dropped all grains I realized I haven't had that particular feeling since.

My NEW gastroenterologist is skeptical, but is willing to "let me try" to go off the PPI's - experimenting on my own basically. A couple of forays using various tactics have ended in failure, but I am going to work on cleaning up my diet better after the holidays and try again. Unfortunately, I am slowly coming to the realization that I am probably going to have to give up my dairy to give it a go this time so I am working my way up to that mentally.

Basically, just proceeding VERY methodically and cautiously because of the Barrett's ...