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What is Heartburn and gastro-oesophageal reflux disease? (GORD, GERD, Acid reflux)

A friend of mine ask me about GORD and I have to admit I had no idea what it is so after my friend explained what it is I naturally went and did a little research.

Heartburn and gastro-oesophageal reflux disease (GORD) according to is:

Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet). GORD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth. This page has information on GORD for people aged 16 years or older.

So GORD it turns out can cause acid reflux which is what my friend was suffering from and one of the causes is apparently Hiatus hernia because this condition pushes the stomach into the diaphragm opening the related sphincter and allowing stomach acid to flow Bach up the oesophagus. That is the logic so I needed to remind myself about hiatus hernia so I checked YouTube and found this.

What causes GERD

The GERD Diet: What to Eat (and What Not to Eat) this article gives a completely contrasting view on how GERD occurs and thus has different treatment options

Gerd and Insulin resistance

Some of the research findings:

Insulin Resistance in Gastroesophageal Reflux Disease Laras Budiyani et al, Acta Med Indones – Indones J Intern Med • Vol 50 • Number 4 • October 2018

Insulin resistance is the disturbance of glucose regulation characterized by higher insulin level. In clinical context, insulin resistance can manifest as abnormalities that are related with cardiovascular event risk, known as metabolic syndrome. Several studies had reported that insulin resistance was associated with erosive esophagitis in patients with gastroesophageal reflux disease (GERD).


The literature review has consistently shown an association between gastroesophageal reflux disease, particularly erosive reflux disease, and insulin resistance. Their relationship is associated with interrelated inflammatory mediators. However, the pathophysiology involved is so complicated that many possible related factors may not be identified yet, such as the cellular mechanism associated with inflammatory mediators. Therefore, further research and literature study are needed to understand the relationship between both of them. Given the link between GERD and insulin resistance, it is recommended that clinical characteristics of insulin resistance syndrome or metabolic syndrome should be sought in patients with GERD, particularly erosive reflux disease, and the management given to the patient should involve both of these aspects.

Pathophysiology and treatment options for gastroesophageal reflux disease: looking beyond acid.

Gastroesophageal reflux disease (GERD) is a disorder due to the retrograde flow of refluxate into the esophagus. Although GERD is a common clinical diagnosis, its pathogenesis is quite complex. As a result of its multifactorial development, many patients continue to experience adverse symptoms due to GERD despite prolonged acid suppression with proton pump inhibitor therapy. The pathogenesis of GERD involves an interplay of chemical, mechanical, psychologic, and neurologic mechanisms, which contribute to symptom presentation, diagnosis, and treatment. As such, GERD should be approached as a disorder beyond acid. This review will investigate the major factors that contribute to the development of GERD, including factors related to the refluxate, esophageal defenses, and factors that promote pathologic reflux into the esophagus. In reviewing GERD pathogenesis, this paper will highlight therapeutic advances, with mention of future opportunities of study when approaching GERD.


Diabetes and Acid Reflux: How Are They Linked? I notice that this link is straight to a site run by surgeons who make money through gastric bypass and other surgeries so while the evidence is good I am concerned that the medical industry still resorts so easily to surgery.

lower esophageal valve

Proton pumps

What are they?

Taken from Ask a biologogist:

If we think of a cell membrane as a dam, we can get a better idea of how the transporters in membranes work. As water builds up on one side of the dam, the concentration gradient is high and has lots of potential energy. If water is let through a spillway or floodgate, it can spin a turbine and create energy. 

In the same way, cell membranes keep the concentration gradient of hydrogen high. When a hydrogen ion passes down the concentration gradient through a transporter, it makes that potential energy available. This energy can be used to take a molecule from inside the cell and move it out or can help make ATP in a specialized enzyme.

However, hydrogen ions can also be moved the other way, toward areas of high concentration. This is how concentration gradients are maintained. In the dam, this is like when pumps are used to keep the water level in a reservoir behind the dam high. To move water up the concentration gradient can take a lot of energy. But when that water level (or concentration gradient) is kept high, more energy is stored that can be used for other things.

For a more indepth explanation refer to the full article at Ask a biologogist:

Wikipedia also has a list of proton pumps and their function. This article also explains the proton pump actions related to cell respiration and therefore its implications for metabolism.

In cell respiration, the proton pump uses energy to transport protons from the matrix of the mitochondrion to the inter-membrane space.[1] It is an active pump that generates a proton concentration gradient across the inner mitochondrial membrane because there are more protons outside the matrix than inside. The difference in pH and electric charge (ignoring differences in buffer capacity) creates an electrochemical potential difference that works similar to that of a battery or energy storing unit for the cell.[2] The process could also be seen as analogous to cycling uphill or charging a battery for later use, as it produces potential energy. The proton pump does not create energy, but forms a gradient that stores energy for later use.[3]

Proton pumps and activity

Given the success of proton pump inhibitors I am investigating the link between proton pumps and physical activity and asking questions like; is the proton pump improved through activity. The reason being that the functioning of all energy pathways is improving through activity so is there any evidence that the proton pump energy pathway is improved through activity

Taking this argument further lead me to link insulin resistance and GERD and therefore ask if an increase insulin sensitivy will reduce GERD symptoms for example by improving the proton pump.

Prolonged Use of Proton Pump Inhibitors and Risk of Type 2 Diabetes


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