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Did you know that small intestinal bacterial overgrowth (SIBO) is often mistaken for acid reflux? In my practice, at least half the patients who come in with a reflux diagnosis are actually suffering from SIBO. Why is the mistaken diagnosis so common? The symptoms of the two conditions are very similar and even identical in some cases. Burning upper abdominal pain that can feel like acid reflux is one of the commonest manifestations of SIBO. High levels of gas produced by bacteria in the upper GI tract can cause the lower esophageal sphincter to open inappropriately, mimicking acid reflux. To further complicate matters, acid suppressing drugs like proton pump inhibitors (PPIs) are a common cause of SIBO, but since SIBO symptoms are often misdiagnosed as acid-reflux, PPIs are frequently used to treat SIBO, perpetuating the cycle of symptoms. So how can you tell the difference to gain a proper diagnosis?…

Recently diagnosed with esophagitis and reflux, my doctor recommends I take proton pump inhibitors (PPIs) for the rest of my life, but I’d prefer to use alternatives, such as a healthy diet, exercise and stress reduction. Is this possible? -Dan Dr. Chutkan: Dan, you’re on the right track in being cautious of lifelong PPI use. Stomach acid is one of the most important components of digestion, and when you block stomach acid for extended periods of time with these drugs, you put yourself at risk for suboptimal digestion of minerals like calcium and magnesium, as well as an increased risk of infections like Clostridium Difficile and pneumonia. While PPI’s are one way to treat reflux and esophagitis (inflammation of the esophagus), there are lifestyle modifications that can be really useful in managing symptoms, independent of PPI’s and their adverse side effects. These lifestyle practices include: Eat five to seven small meals to avoid overfilling your stomach.Exercise regularly…

Proton pump inhibitors (PPIs) increase the risk of pneumonia in older adults (60+ years). Researchers analyzed data from over 75,000 adults who used PPIs for 1 or more years. They then looked at the incidents of pneumonia in year 2 of treatment and compared these rates to a control group (age and sex-matched) not taking PPIs. The study found that for every 420 people treated with a proton pump inhibitor, there was 1 additional case of pneumonia. Journal of The American Geriatrics Society →Takeaway: The detrimental effects PPIs have on the gut microbiome could be to blame for the increased risk of pneumonia. Approximately 40% of older adults are prescribed PPIs, yet a 2013 studyfound that roughly 85% of them might not need them. In Dr. Chutkan’s practice, The Digestive Center for Wellness, she is finding that proton pump inhibitors may have an even more negative impact on the gut microbiome and overall health than…