The GERD-Fibro Connection

Clinicians should be more alert to an association between gastroesophageal reflux disease (GERD) and fibromyalgia, says Don Goldenberg, MD, a fibromyalgia expert and affiliate faculty in rheumatology at Oregon Health & Science University in Portland, Maine. He also said in the interview, A Closer Look at the Interrelationship of Fibromyalgia and GERD, by Kathleen Doheny for Practical Pain Management, “For pain practitioners, routinely asking FM patients about any problems with irritable bowel and repeated reflux would be a very good start."

An article written last November for ProHealth, Is There a GERD—Fibro Connection?, continues to garner attention most likely for these reasons, so with ProHealth’s permission I am sharing the article in its entirety here on The Pained Ink Slayer’s blog.

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By Celeste Cooper

Could gastro-esophageal-reflux-disease (GERD) be co-morbid to fibromyalgia? A new study (October 2017) published in the peer-reviewed journal Pain suggests the answer is YES. Researchers found fibromyalgia patients are slightly more likely to develop GERD than people with GERD are likely to develop fibromyalgia (FM), but there is a bi-directional connection. As to why this “bi-directional association” occurs is up for debate according to a Practical Pain Management interview of fibromyalgia experts who reviewed the study.

What is GERD?

Anyone who has experienced heartburn knows the symptoms of an isolated event of gastric reflux, usually caused a specific thing, such as seriously spicy or fatty food, or eating too fast. For some of us, though, these symptoms are persistent and can be aggravated by many things.

These persistent symptoms may be a sign of gastroesophageal reflux disease (GERD). If you have mild acid reflux that occurs at least twice a week or moderate to severe acid reflux that occurs at least once a week, your doctor may order certain tests to confirm a diagnosis of GERD.

What happens?

The esophagus, a tube-like structure behind the breathing tube (trachea) in our neck, provides the passageway for food and beverages from the mouth to the stomach. When the esophagus becomes irritated, symptoms of heartburn, sour taste, burning, a sore throat, hoarseness, nausea, regurgitation, problems swallowing, and sometimes even severe chest pain may occur.

*Caution - Never assume chest pain is GERD until heart problems have been ruled out. Symptoms can mimic a heart attack.

Two gates, in our esophagus, called sphincters, act to control the flow of things we ingest. As we swallow the upper esophageal sphincter opens, gravity and esophageal motility move things along, and the lower esophageal sphincter (LES) opens to allow the contents to flow into our stomach, where digestion continues. When the LES gate fails, backwash of stomach acid (gastric reflux) occurs.

esophageal motility = synchronized contractions in the esophagus that moves food toward the stomach.

Normally, the lower gate (LES) relaxes to let food pass into the stomach where special acids continue the digestive process. But, when this normally tight muscle becomes floppy or opens ad lib, permanent erosive damage can occur, affecting many things, including our sense of taste and even our sense of smell if it gets into our airway passages during sleep.

Why does the sphincter stop working?

Sphincter dysfunction can be the result of heredity, life-style choices, myofascial pain syndrome, connective tissue disorders, a stress response, obesity, hormones, slow stomach emptying, certain neurological conditions, medications, cancer of the esophagus, or any other thing that interferes with normal esophageal motility.

What can we do?

There are things we can do. We can make healthier lifestyle choices, such as avoiding alcohol, caffeine, foods that are acidic, fatty, or spicy, and carbonated beverages. We can stop smoking and assess the side effects of our supplements and medications. Exercise is important to our wellness, but exercise that creates gravitational reflux, such as jumping, aggressive jogging, and yoga poses (i.e. downward facing dog) can aggravate symptoms.
Sleeping with our upper body at a slight angle (head higher than our waist) can help prevent gravitational reflux. (Try putting four-inch blocks under the head of your bed frame.) Learn about and use an anti-inflammatory diet, eat small frequent meals, and exercise regularly by walking or doing things like T’ai Chi, which has been found helpful for those of us with fibromyalgia. There are supplements and medications that can help, too. So, if you have symptoms, discuss them with your doctor or pharmacist.

Conclusion

One of the reviewers of the study, “Bidirectional association between fibromyalgia and gastroesophageal reflux disease,” Don Goldenberg, MD, a fibromyalgia expert and affiliate faculty in rheumatology at Oregon Health & Science University in Portland, Maine, told Practical Pain Management that this study should serve to raise awareness about the likelihood of an increased prevalence of co-morbidity. He suggests clinicians be alert to the possibility of this association and routinely assess for irritable bowel and GERD in their fibromyalgia patients. I couldn’t agree more. I have had GERD for many decades but never considered it might be related to fibromyalgia. So, if you are experiencing symptoms, be sure to discuss this connection with your heath care provider. I know I will.

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Additional Reading

GERD - and it isn’t about comforting Aunt Geordie coming for a visit.  By Celeste Cooper

Wang JC, Sung FC, Men M, et al. “Bidirectional association between fibromyalgia and gastroesophageal reflux disease: two population-based retrospective cohort analysis.” Pain. 2017 Oct;158(10):1971-1978. doi: 10.1097/j.pain.0000000000000994

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

http://www.CelesteCooper.com

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