Probiotic Strains in the Treatment of GERD

We’ve talked a lot about the lower gastrointestinal tract and the gut microbiome but what about the upper gastrointestinal tract?

The upper gastrointestinal (GI) tract also has an extensive microbiome, and research suggests that it may play a role in the development and progression of common upper GI diseases such as GERD.

Gastroesophageal Reflux Disease (GERD) is inflammation caused by stomach acid splashing up into the esophagus due to relaxation of the lower esophageal sphincter (LES). The LES is the tiny doorway that opens when eating to allow food to pass from the esophagus into the stomach. 

This can cause symptoms like heartburn, nausea, and chest pain and can lead to food returning. If GERD is left untreated, it can lead to more serious issues.

The gastroesophageal microbiome (GE microbiome) consists of microbes from the oral cavity to the stomach. Certain bacteria thrive in different areas of this part of the tract varying in pH. Factors such as age, medication exposure, diet, and hygiene can influence the makeup of the GE microbiome.

Proton-pump inhibitors (PPIs) are a first-line therapeutic approach to treating many esophageal disorders, such as GERD. The main goal of PPIs is to lower acid production in the stomach by inhibiting the hydrogen-potassium ATPase pump (a protein responsible for making hydrochloric acid in the stomach). This, in turn, can cause the stomach to become more basic versus acidic. As you can imagine, this may impact the diversity of the GE microbiome.  

Besides PPI therapy, it has been suggested that probiotics may reduce GERD symptoms such as acid regurgitation/reflux. 

A 2020 systematic review compared 13 clinical studies that sought to determine the potential of probiotic use to alleviate upper-GI symptoms in adults diagnosed with GERD. Overall, they found a trend of positive outcomes suggesting probiotics are a beneficial way to manage GERD symptoms, particularly stomach gurgling, belching, nausea, and abdominal pain. Although this information is encouraging, some of the evaluated studies were weak, and additional placebo-controlled clinical trials are warranted to assess further compliance with probiotic therapy and targeting specific probiotic strains.

In an animal study, Aiba et al. suggested that certain strains of lactobacillus, such as L. johnsonii No. 1088 have antibacterial activity against H. Pylori but also help to reduce stomach acid, alleviating GERD symptoms. In human studies, Urita et al. identified B. bifidum YIT 10347 provided in fermented milk as improving gastrointestinal symptoms in people with GERD. Furthermore, a study by de Milliano et al. addressing probiotic use in pregnant women identified that the following strains significantly improved reflux symptoms: B. bifidum W23, B. lactis W52, B. longum W108, L. casei W79, L. plantarum W62, and L. rhamnosus W71.

To summarize, it is good to look for probiotics that contain a variety of strains from the genera of Lactobacillus and Bifidobacterium because they are associated with decreased inflammation and help fight against potential pathogenic bacteria. 

As always, talk with a Registered Dietitian if you have any questions regarding your diet and the supplements you take, including probiotics, and remember to speak with your medical providers before starting any new supplement or medication.

1. _{Aiba, Y., Nakano, Y., Koga, Y., Takahashi, K., & Komatsu, Y. (2015). A highly acid-resistant novel strain of lactobacillus johnsonii no. 1088 has antibacterial activity, including that against helicobacter pylori, and inhibits gastrin-mediated acid production in mice. MicrobiologyOpen, 4(3), 465–474.}
2. _{Cheng, J., & Ouwehand, A. C. (2020). Gastroesophageal reflux disease and probiotics: A systematic review. Nutrients, 12(1), 132.}
3. _{de Milliano, I., Tabbers, M. M., van der Post, J. A., & Benninga, M. A. (2012). Is a multispecies probiotic mixture effective in constipation during pregnancy? 'A pilot study.' Nutrition Journal, 11(1).}
4. _{D'Souza, S. M., Houston, K., Keenan, L., Yoo, B. S., Parekh, P. J., & Johnson, D. A. (2021). Role of microbial dysbiosis in the pathogenesis of esophageal mucosal disease: A paradigm shift from acid to bacteria? World Journal of Gastroenterology, 27(18), 2054–2072.}
5. _{URITA, Y., GOTO, M., WATANABE, T., MATSUZAKI, M., GOMI, A., KANO, M., MIYAZAKI, K., & KANEKO, H. (2015). Continuous consumption of fermented milk containing bifidobacterium bifidum YIT 10347 improves gastrointestinal and psychological symptoms in patients with functional gastrointestinal disorders. Bioscience of Microbiota, Food and Health, 34(2), 37–44.}