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IBD/IBS/GERD

IBD/IBS/GERD

Uncle, 75-year-old has been diagnosed with Parkinson’s early. Besides a very-low-carb diet and doing comprehensive gut testing, association with SIBO, etc., how would I know if I would supplement him with betaine hydrochloric acid empirically? He has no gut symptoms. Excess undigested food in the stool. Does he need HCI supplementation?

Chris Kresser: Yeah, that’s one possible way. Given the association with SIBO and the association of low stomach acid with...

This is the first patient I’ve had with truly high stomach acid, and he has a history of heavy NSAID use for migraines from the age of nine. He is 21 now and can’t even drink water without burping. Nearly everything he eats gives him reflux. Bread is the only thing that helps. He has a bleeding ulcer, resulting in surgery, and was put on PPIs a year-and-a-half ago. He stopped all these medications. He still gets headaches, although less severe. We’re doing a reset diet, and I’ve suggested slippery elm along with licorice tea. H. pylori has been ruled out. His stools are oily. Due to limited finances, we’ll do labs one at a time. Plan to start with Doctor’s Data, the comprehensive stool. Any suggestions regarding a treatment plan or to relieve his symptoms are welcome. He manages stress well by working a low-stress job and cutting out partying. He is active, which seems to help his headaches.

Chris Kresser: That’s a tough case. I’m wondering if he had the Heidelberg capsule test to demonstrate that he actually...

What about people on PPIs because of Barrett’s? How does the conversation go on these cases?

Chris Kresser: I think I answered at least one question about that in a previous Q&A and pretty soon we’re...

What are your thoughts on about the Prometheus IBD serology? It seems much more comprehensive than the Quest panel.

Chris Kresser: I’m not familiar with that, so I’d have to look into it. I assume you’re talking about the...

Do you use a tincture of demulcent herbs for reflux, or capsules?

Kelsey Marksteiner: I actually use a powder most of the time. I’ll recommend DGL powder or slippery elm powder or...

If SIBO and H. pylori are ruled out, what comes to mind next if someone has acid reflux immediately after eating carbs, but no problems after protein or fat, and in the Doctor’s Data test, the carb metabolism markers were normal? It feels very stomach based.

Kelsey Marksteiner: Usually when I hear that, that someone has reflux immediately after eating carbohydrates, I do think SIBO, but...

Does your GERD/heartburn diagnostics/treatment protocol change if bile reflux has been confirmed in someone with an esophageal hernia?

Chris Kresser: This is a similar question in the sense that we don’t have a lot of data on that,...

If H. pylori and SIBO have been ruled out, but there’s still acid reflux worsened by carbs, but not protein, would you still recommend trying the betaine HCl-and-pepsin combo?

Chris Kresser: Yes. Low stomach acid is still possible even without those two conditions. “Could a hiatal hernia be...

Assuming it’s reasonable to taper a proton pump inhibitor in a patient, what is your typical strategy? Do you start slowly, reducing the dose and see what happens? Do you add GastroMend or something like that first? Do you do a cross-taper and a trial of HCl?

Dr. Amy Nett: Yeah, so it varies in each patient depending on how long they’ve been on proton pump inhibitor,...

Can you use Prometheus Serology for IBD as an alternative to the LabCorp IBD blood panel?

Chris Kresser: So I did some research on it and read some studies, and I’m going to just kind of...

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