That Burning Feeling – More Than Just Too Much Acid
A burning sensation behind the breastbone, an acidic taste in your mouth, a feeling that food is sitting like a stone in your stomach – heartburn and acid reflux are extraordinarily common. At our practice in Zürich Seefeld, I see patients every week who have been taking proton pump inhibitors (PPIs) for months or even years without anyone investigating why they have reflux in the first place.
Here is what surprises many of my patients: reflux is not always caused by too much stomach acid. In fact, in my experience, the opposite is frequently the case.
What Actually Causes Reflux?
Lower oesophageal sphincter (LOS) dysfunction: The muscular valve between your oesophagus and stomach can weaken due to age, obesity, hiatal hernia, or certain medications. When this valve does not close properly, stomach contents – including acid – flow back upward.
Low stomach acid (hypochlorhydria): This is the overlooked cause. When stomach acid is too low, food sits in the stomach longer, ferments, produces gas, and that gas pushes the sphincter open. The small amount of acid that refluxes still burns the sensitive oesophageal lining. Ironically, PPIs can worsen this cycle.
Hiatal hernia: A portion of the stomach pushes through the diaphragm, compromising the anti-reflux barrier. Small hiatal hernias are very common and often asymptomatic, but larger ones can cause significant reflux.
Delayed gastric emptying: Gastroparesis or functional dyspepsia can keep food in the stomach too long, increasing reflux risk. This is often linked to diabetes, hypothyroidism, or autonomic dysfunction.
H. pylori infection: This bacterium can either increase or decrease acid production depending on where in the stomach it resides. Testing and appropriate treatment are essential.
Dietary and lifestyle factors: Large meals, eating late at night, alcohol, caffeine, chocolate, and high-fat foods can all trigger or worsen reflux. Obesity significantly increases intra-abdominal pressure.
The Problem With Long-Term PPI Use
Proton pump inhibitors are effective for short-term symptom relief and healing of oesophagitis. However, long-term use carries real risks: reduced absorption of magnesium, calcium, iron, and vitamin B12; increased risk of Clostridioides difficile infection; potential kidney effects; and rebound acid hypersecretion when trying to stop. For many patients, PPIs treat the symptom without addressing the cause.
How We Investigate Reflux
At our practice, I start with a detailed history: when does reflux occur, what triggers it, what medications are you taking, and what is your diet like? I test for H. pylori, check thyroid function, and assess for nutrient deficiencies that might indicate low acid or malabsorption. In some cases, I refer for gastroscopy to evaluate the oesophageal lining and rule out Barrett’s oesophagus or other pathology.
What We Do: A Root-Cause Approach
Identify the mechanism: Is this truly excess acid, or is it low acid with fermentation? Is there a motility issue? Is H. pylori involved? The treatment depends entirely on the answer.
Optimise stomach acid: For patients with low acid, strategies include betaine HCl supplementation with meals, apple cider vinegar protocols, and bitter herbs that stimulate natural acid production.
Heal the oesophageal lining: Demulcent herbs like slippery elm and deglycyrrhizinated liquorice (DGL) can soothe and protect the oesophageal mucosa while we address the root cause.
Dietary modifications: Smaller, more frequent meals, not eating within three hours of bedtime, identifying personal trigger foods, and optimising meal composition.
Structured PPI tapering: For patients on long-term PPIs who want to come off them, I guide a gradual tapering process with supportive measures to prevent rebound symptoms.
Conclusion
Heartburn and reflux deserve more than a lifelong prescription for acid-suppressing medication. By identifying and addressing the underlying cause, most patients can significantly reduce or eliminate their symptoms – often while improving their overall digestive health. If you are tired of just suppressing symptoms, book a consultation at our practice in Zürich Seefeld.
