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Gastrointestinal Reflux as Dysautonomia

Pyrrhus

Senior Member
Messages
4,172
Location
U.S., Earth
Gastrointestinal Reflux as Dysautonomia

Within the esophagus and gastrointestinal system there are actually four different types of reflux, each associated with four different valves (sphincters) in the digestive system. All four valves (sphincters) in the digestive system are controlled by the autonomic nervous system, so dysfunction of these valves can be a form of dysautonomia. It is apparently common to have multiple types of reflux at the same time.

What does this mean for eating and digestive problems in ME/cfs?

  1. Gastro-esophageal reflux is when the lower esophageal sphincter fails to close, allowing the contents of the stomach, such as acidic enzymes, to flow back up into the esophagus. This often results in heartburn.
  2. Laryngo-pharyngeal reflux is when the upper esophageal sphincter fails to close, allowing contents in the esophagus to flow back up into the back of the throat and then down into the lungs. This often results in coughing fits and a feeling of "nasal drip" on the back of the throat.
  3. Duodeno-gastric reflux is when the pyloric sphincter fails to close, allowing contents in the small intestine, such as bile, to flow back up into the stomach and allowing stomach acid to continuously leak into the duodenum. Symptoms may include pain, nausea or vomiting. Vomit may have the dark brown color of bile. One patient describes it here: https://forums.phoenixrising.me/thr...y-disorder-duodenum-and-gaping-pylorus.79344/
  4. Ileo-cecal reflux is when the ileocecal sphincter fails to close, allowing food and bacteria in the large intestine to flow backwards into the small intestine. Although it is normal to have bacteria in the large intestine, bacteria are mostly absent from the small intestine.

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hapl808

Senior Member
Messages
2,162
My reflux is mostly of the LPR type I believe, although sometimes the LES type may be involved as well. In general, I think dysautonomia describes a lot of my symptom clusters - reflux, tachycardia, muscle weakness, etc.

What are the treatments for dysautonomia. The only things I've tried are stuff like more fluids, more salt or electrolytes, changing diet, various supplements. Unfortunately online they always mention stuff like physical therapy, but that's pretty hard when you're housebound and relatively severe.
 

GreenMachineX

Senior Member
Messages
362
My reflux is mostly of the LPR type I believe, although sometimes the LES type may be involved as well. In general, I think dysautonomia describes a lot of my symptom clusters - reflux, tachycardia, muscle weakness, etc.

What are the treatments for dysautonomia. The only things I've tried are stuff like more fluids, more salt or electrolytes, changing diet, various supplements. Unfortunately online they always mention stuff like physical therapy, but that's pretty hard when you're housebound and relatively severe.
I have this lpr too, and maybe dysautonomia but I'd need to research that more. Muscle weakness, bizarre heart rate at strange times, and lpr for sure though.
 

GreenMachineX

Senior Member
Messages
362
Gastrointestinal Reflux as Dysautonomia

Within the esophagus and gastrointestinal system there are actually four different types of reflux, each associated with four different valves (sphincters) in the digestive system. All four valves (sphincters) in the digestive system are controlled by the autonomic nervous system, so dysfunction of these valves can be a form of dysautonomia. It is apparently common to have multiple types of reflux at the same time.

What does this mean for eating and digestive problems in ME/cfs?

  1. Gastro-esophageal reflux is when the lower esophageal sphincter fails to close, allowing the contents of the stomach, such as acidic enzymes, to flow back up into the esophagus. This often results in heartburn.
  2. Laryngo-pharyngeal reflux is when the upper esophageal sphincter fails to close, allowing contents in the esophagus to flow back up into the back of the throat and then back down into the lungs. This often results in coughing fits and a feeling of "nasal drip" on the back of the throat.
  3. Duodeno-gastric reflux is when the pyloric sphincter fails to close, allowing contents in the small intestine, such as bile, to flow back up into the stomach and allowing stomach acid to continuously leak into the duodenum. Symptoms may include pain, nausea or vomiting. Vomit may have the dark brown color of bile. One patient describes it here: https://forums.phoenixrising.me/thr...y-disorder-duodenum-and-gaping-pylorus.79344/
  4. Ileo-cecal reflux is when the ileocecal sphincter fails to close, allowing food and bacteria in the large intestine to flow backwards into the small intestine. Although it is normal to have bacteria in the large intestine, bacteria are mostly absent from the small intestine.

View attachment 46357


My lpr feels like a scab in the back of my throat which makes me cough or gag too. Most people I've read say it feels like a pill, but mine feels sharper and I have to position myself in different ways when it hits (like can't lay on my back flat). I also get the globus sensation and tight throat feeling. I think I said this elsewhere, that for a condition as benign as reflux, it sure feels dangerous.
 

Pyrrhus

Senior Member
Messages
4,172
Location
U.S., Earth
With this type of reflux, is there a big risk of pneumonia? I was just diagnosed with it. What have you found to help it or is it chronic?

The only thing I have found to be helpful is taking a basic calcium antacid at the first sign of laryngopharygeal reflux (LPR). This de-activates the gastric enzyme particles that are landing in the lungs, reducing lung irritation. After about 30-45 minutes, the excess mucus production slows down and I stop coughing. I don't think you have to worry about pneumonia.

My lpr feels like a scab in the back of my throat [...] I also get the globus sensation

Very interesting. That could also be herpangina. Even a small herpangina blister can feel like a lump. When the herpangina blister breaks open, it feels like an ulcer...
 

GreenMachineX

Senior Member
Messages
362
The only thing I have found to be helpful is taking a basic calcium antacid at the first sign of laryngopharygeal reflux (LPR). This de-activates the gastric enzyme particles that are landing in the lungs, reducing lung irritation. After about 30-45 minutes, the excess mucus production slows down and I stop coughing. I don't think you have to worry about pneumonia.



Very interesting. That could also be herpangina. Even a small herpangina blister can feel like a lump. When the herpangina blister breaks open, it feels like an ulcer...
So you don't see this LPR as dangerous?

Regarding herpangina, an ENT scoped me several times to the area I have it and saw no abnormality which is good, but also frustrating because now I feel crazy.
 

Pyrrhus

Senior Member
Messages
4,172
Location
U.S., Earth
Most of the time I get it in the night just before falling into sleep, but also when eating special kinds of fast foods or by drinking orange juice.

I often experience the effects of laryngo-pharyngeal-reflux (LPR) when I eat something that triggers gastric acid production, such as amino acid supplements.

This doesn't mean that the gastric acid causes LPR. It just means that the gastric acid activates the gastric enzymes such as pepsin. Then, when a micro-particle of activated pepsin is ejected from the stomach and lands in the lungs, it triggers lung irritation, lung mucus production, and constantly clearing the throat.

But the underlying cause of LPR is dysautonomia. If the autonomic nervous system were working correctly, then the esophageal sphincters would be closed and no particles from the stomach could enter the esophagus or lungs.

I hope this helps.
 

kewia

Senior Member
Messages
234
Then, when a micro-particle of activated pepsin is ejected from the stomach and lands in the lungs, it triggers lung irritation, lung mucus production, and constantly clearing the throat.

Did you have similar problems when drinking directly pepsin wine?

I often experience the effects of laryngo-pharyngeal-reflux (LPR) when I eat something that triggers gastric acid production, such as amino acid supplements.

This is indeed very interesting. Did you have a special amino acid in mind?

But the underlying cause of LPR is dysautonomia. If the autonomic nervous system were working correctly, then the esophageal sphincters would be closed and no particles from the stomach could enter the esophagus or lungs.

Probably yes, but in my case I think it's a kind of detoxification. I've the feeling my body tries to transport out mucus where it doesn't belong to.
Why there is at all mucus and why it can't be detoxified naturally is still unclear to me. However, I've a lymphatic issue. So because detoxification doesn't work over the lymphatic pathway as expected, my body chooses another way, just an assumption.
I wish I had it more often as it gives me some kind of relief despite stressing other people around me with it.
 

GreenMachineX

Senior Member
Messages
362
I often experience the effects of laryngo-pharyngeal-reflux (LPR) when I eat something that triggers gastric acid production, such as amino acid supplements.

This doesn't mean that the gastric acid causes LPR. It just means that the gastric acid activates the gastric enzymes such as pepsin. Then, when a micro-particle of activated pepsin is ejected from the stomach and lands in the lungs, it triggers lung irritation, lung mucus production, and constantly clearing the throat.

But the underlying cause of LPR is dysautonomia. If the autonomic nervous system were working correctly, then the esophageal sphincters would be closed and no particles from the stomach could enter the esophagus or lungs.

I hope this helps.
I've been looking into dysautonomia and see the correlation to worsened lpr symptoms. I'm still figuring it out, but quite sure b12/folate imbalance in my case worsens all of that.
 

GreenMachineX

Senior Member
Messages
362
I often experience the effects of laryngo-pharyngeal-reflux (LPR) when I eat something that triggers gastric acid production, such as amino acid supplements.

This doesn't mean that the gastric acid causes LPR. It just means that the gastric acid activates the gastric enzymes such as pepsin. Then, when a micro-particle of activated pepsin is ejected from the stomach and lands in the lungs, it triggers lung irritation, lung mucus production, and constantly clearing the throat.

But the underlying cause of LPR is dysautonomia. If the autonomic nervous system were working correctly, then the esophageal sphincters would be closed and no particles from the stomach could enter the esophagus or lungs.

I hope this helps.
What natural treatments are there for dysautonomia?
 

EddieB

Senior Member
Messages
610
Location
Northern southern California
What natural treatments are there for dysautonomia?
I suffer terribly with this. I don’t seem to have a food trigger, I eat very bland, but doesn’t seem to matter. The stomach acts as though it’s constantly trying to digest. The gastrologists I’ve seen, seem to be thinking along these lines (dysautonomia, sort of) and urge me to use low dose antidepressants. They claim to have had success. I reluctantly tried a couple out of desperation, with not good results.
I have a positive biopsy for entero, so possibly a result of viral damage.
 
Messages
57
I also have LPR despite being young and eating a clean diet. If I get a brief remission of CFS symptoms (from cimetidine/valacyclovir), the LPR disappears as well. I think you're onto something Pyrrhus.
 

hapl808

Senior Member
Messages
2,162
I suffer terribly with this. I don’t seem to have a food trigger, I eat very bland, but doesn’t seem to matter. The stomach acts as though it’s constantly trying to digest. The gastrologists I’ve seen, seem to be thinking along these lines (dysautonomia, sort of) and urge me to use low dose antidepressants. They claim to have had success. I reluctantly tried a couple out of desperation, with not good results.
I have a positive biopsy for entero, so possibly a result of viral damage.

Same here. After years spent trying to adjust my diet, I've found things that maybe help a bit. But overall, my triggers seem to be 80% related to exertion (mental or physical) and 20% related to diet. Quite frustrating, because even talking on the phone too much will lead to days of reflux and coughing in addition to the other PEM symptoms. In a current minor crash at the moment - stomach constantly gurgling like it's trying to digest, slight burn causing coughing and discomfort, etc. Not pleasant.
 

hapl808

Senior Member
Messages
2,162
I’ve long felt that there’s an excessive amount of gas pressure, that overcomes the valves. My reflux is more of a vapor, not liquid. If it were strictly weak valves, I would think there would be liquid coming up as well. My original onset began with fatigue/ lower GI symptoms, the reflux/ upper stuff came later.

Another thing you can chase down is a diet called the Fast Tract Diet by Robillard. He has a whole site that explains it. Basically his theory is kind of what you said - it's excessive gas caused by improperly digested fermentable fibers and sugars. So his diet is unusual for reflux in that it focuses more on high GI foods and such, but different from the traditional diets like that. I've found it 'helpful', but only for the 20% part. Exertion still causes that reflux crash.

I've avoided PPI as the negatives seem to outweigh the positives. I've tried pretty much everything else without much success.
 

GreenMachineX

Senior Member
Messages
362
Another thing you can chase down is a diet called the Fast Tract Diet by Robillard. He has a whole site that explains it. Basically his theory is kind of what you said - it's excessive gas caused by improperly digested fermentable fibers and sugars. So his diet is unusual for reflux in that it focuses more on high GI foods and such, but different from the traditional diets like that. I've found it 'helpful', but only for the 20% part. Exertion still causes that reflux crash.

I've avoided PPI as the negatives seem to outweigh the positives. I've tried pretty much everything else without much success.
I tested out a PPI for 4 weeks, felt awful, so dropped it. I think I'd rather deal with lpr and reflux then the sides, but I am concerned about developing Barrett's and esophageal cancer long term.
 

GreenMachineX

Senior Member
Messages
362
Ive remained on them (PPI) for that reason. At least when I did the last endoscopy, there wasn’t esophagus damage. But I know it’s probably contributing to other problems.
Right, same here. My doctor who did my endoscopy said if I don't have barrett's by late 30's, then it's highly unlikely I ever will. Nevertheless, I'll probably get another endoscopy in 5 years to ensure no progression. I also plan to be healed of reflux by then though. Much hope for a better life.
 

hapl808

Senior Member
Messages
2,162
Fast Tract would likely cut out oatmeal, recommend only specific potatoes and rice (like jasmine rice is great but basmati is considered bad - for reasons of type of starch), probably recommend against most breads, etc. But lots of stuff is okay that might be counterintuitive.

Again, I haven't found his stuff to be anywhere close to a solution for me, but was pleasantly surprised that some foods I thought were bad for me (rice) and others seemed to work pretty okay in his framework.

Here's his main page. Just take it all with a grain of salt (assuming salt doesn't upset your system). :)

https://digestivehealthinstitute.org/fast-tract-diet/
 

GreenMachineX

Senior Member
Messages
362
Fast Tract would likely cut out oatmeal, recommend only specific potatoes and rice (like jasmine rice is great but basmati is considered bad - for reasons of type of starch), probably recommend against most breads, etc. But lots of stuff is okay that might be counterintuitive.

Again, I haven't found his stuff to be anywhere close to a solution for me, but was pleasantly surprised that some foods I thought were bad for me (rice) and others seemed to work pretty okay in his framework.

Here's his main page. Just take it all with a grain of salt (assuming salt doesn't upset your system). :)

https://digestivehealthinstitute.org/fast-tract-diet/
Why cut out oatmeal? I eat it every breakfast...