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

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, and we just have to approach it anecdotally. I’ve had a few patients like that, and I have approached it in the same way that we approach the typical presentation. It has worked well, so I would definitely just start there.

A 44-year-old female treated some time ago for dysbiosis unsuccessfully; less experience and knowledge then. She presented to me with severe depression which began after a horrific treatment for intractable acne in her teens, had loads of antibiotics but also Accutane which seemed to be the trigger for her mental health decline. I. Her CSA showed no growth of Lactobacilli, 4+ E. coli, 2+ Bifidobacterium, 4+ alpha hemolytic strep, 2+ coag negative staph it looks like, 4+ pseudomonas. No growth for yeast. No parasites. On the PCR she had—and I’m uncertain how to interpret the significance given the material discussed—she had high Barnesialla, Odoribacter, Pseudoflavonifractor, and E. coli. Lowest butyrate SIgA of 289 and evidence of fat malabsorption. Sensitivities for botanicals showed best for plant tannins and uva ursi, slightly less for oregano. Already gluten-free. Tried all sorts of diets including anti-Candida diet. Organic acids showed every single marker grossly elevated for dysbiosis. Started her micronutrients including B vitamins, probiotics enzymes, and botanical protocol, which is a hybrid of yours, but not using the same products as access to them in the U.K. was tricky. We’d like to repeat her CSA with the Doctor’ Data as the year has elapsed since she has massive bloating with the same issues. Never tested her for SIBO. I also plan to do that if she is game along with the Cyrex panels, then I’ll be following your protocols to the letter. Any insights into the aftermath of Accutane? What are risks of using a course in metronidazole followed by botanical protocol Paleo diet, pre and probiotics, and gut healing nutrients? Do you have any insights on pseudomonas in particular? I’m familiar with its love of biofilm but wonder if there are any other considerations.
Male patient with gut symptoms from loose bowels to cramping. Doctor’s Data test showed no parasites but did have no-growth Bifida and elevated lactoferrin and calprotectin. Had an appointment with specialist who ran biopsy, and while it showed no IBD, it did show lymphocytic colitis. Patient also had elevated cholesterol from triglycerides and cholesterol/HDL ratio 4.1, high ferritin, low vitamin D. Patient has gone overseas for a month. I have advised to follow a Paleo reset diet with cholesterol modifications and recommended more comprehensive bloods and DUTCH test. Patient’s reluctant to spend more money on testing. Feeling unsure whether to do gut protocol with him seeing as there are no parasites. Can I go into prebiotic straightaway to Bifidobacterium up?
In the GERD treatment section, one suggested step is supplementing with digestive enzymes, but no specific product is recommended. Is there a particular product recommendation that you’ve had success with or general guidelines to look for when shopping for a product?
Should HCl be avoided in IBD patients, given that they, by definition, have ulcers all over their GI tracts?
To clarify, you wait to use HCl until the patient is completely weaned off PPIs or just until they have lowered their dose significantly?
s HCl with pepsin safe with gastritis, a hiatal hernia, or Barrett’s esophagus? How would you recommend handling long-term use of PPIs in these conditions?

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

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