Causes of Refractory Reflux Esophagitis Unresponsive to Acid Suppressants (Association with SIBO) | Incheon Digestive Diseases

A burning sensation of heartburn, a feeling of something stuck in the throat, the unpleasantness of acid reflux...
Are you trapped in a cycle of recurrence where symptoms briefly improve after taking reflux esophagitis medication, only to inevitably return when you try to stop?

While everyone points to 'excessive stomach acid' as the culprit, have you ever wondered if that medication itself is providing the cause for the recurrence?

The real problem may not be 'stomach acid,' but 'Wigi-sangyeok (胃氣上逆),' where the energy that should descend instead surges upward.

Hello. I am Choi Yeon-seung, an Oriental Medicine Doctor who for 15 years has been fundamentally treating the causes of chronic reflux esophagitis that are not resolved by acid suppressants, from the perspective of 'small intestinal pressure (SIBO)' and 'Wigi-sangyeok.'

The Great Misconception of 'Excess Stomach Acid,' the Real Problem is 'Pressure'

When diagnosed with reflux esophagitis, we naturally think, 'too much stomach acid is being produced.' Because we experience the heartburn subsiding after taking acid suppressants, this belief becomes even more ingrained.

Of course, it is true that excessive secretion of stomach acid irritates the esophageal mucosa and causes heartburn. However, there is a decisive trap here that many people miss, which triggers recurrence.

The point is that chronic reflux esophagitis that recurs even after medication is very likely not caused by 'excess stomach acid.' In fact, among those who have suffered from heartburn for a long time or in the elderly, there are many cases of 'hypochlorhydria,' a state where the ability to secrete stomach acid is actually diminished.

The Source of Pressure, Rebellion from the Floor Below (feat. SIBO)

The epicenter of the pressure that constantly presses on the stomach and forces the lower esophageal sphincter open is the 'small intestine,' the floor below. And the main culprit creating that pressure is 'SIBO (Small Intestinal Bacterial Overgrowth).'

This situation can be easily understood by comparing it to a 'shaken cola bottle'🥤. A still cola bottle (a normal intestine) does not overflow even if the cap is opened. However, in a state where the bottle has been shaken violently, activating the carbon dioxide gas inside and increasing the pressure (a state where gas has filled due to SIBO), the cola erupts explosively even if the cap is opened just a tiny bit.

Wigi-sangyeok (胃氣上逆)

A phenomenon where stomach contents reflux due to pressure in the small intestine. In Oriental Medicine, this occurrence where the energy of the stomach (Wigi), which should descend, surges upward and refluxes into the chest and throat, is called 'Wigi-sangyeok (胃氣上逆).'

The Paradox of Acid Suppressants: Like Pouring Oil on a Fire While Trying to Put It Out

Doctor, if 'pressure' is the cause of all these problems, why do symptoms improve, even if only temporarily, when taking acid suppressants?

Here lies the most frightening 'paradox' that invites recurrence. Acid suppressants, as the name suggests, block the secretion of stomach acid. Since the acidity of the refluxing contents decreases, it is natural that the irritation and pain felt by the esophagus are reduced.

Conclusion

Ultimately, the reason your reflux esophagitis recurs is that you only turned off the 'fire (stomach acid)' of the pressure cooker, without resolving the 'pressure (SIBO gas)' itself that makes the inside boil.

You should now know the true cause of the problem and the direction for the solution. However, many people will feel the fear of, 'Then should I stop the medication immediately?'

Therefore, in the next session, I intend to provide an answer to that very realistic concern. The next topic is How to Safely Stop Acid Suppressants (PPIs) & Core Strategies for SIBO Treatment.

The tedious heartburn and the fear of recurrence can now be ended.

#RefluxEsophagitis #SIBO