INSIGHTS | 24. Reversing Reflux-Related Ulcers
Many suffer from heartburn and other reflux symptoms. Some have it so bad, their esophagus is eroding. Unfortunately, modern medicine has failed these people.
Article: Regression of an esophageal ulcer using a dietary supplement containing melatonin
Context
As you may have noticed, I’ve been on a research binge concerning reflux and promising alternative treatment options.
One reason is that the vast majority of people in my private life, over the age of 30, suffer from heartburn to the degree that their doctor has prescribed them a proton-pump inhibitor.
I started this process by first outlining the many and varied mechanisms by which reflux and heartburn can manifest
As you will see from the article above, there is far more to reflux than simply
”sphincter dysfunction” and “high stomach acid.”
In the article that followed, we explored the molecular pathways by which refluxed stomach content initiates protective mechanisms within your body and esophagus - with focus on the role of melatonin in providing protection against damage to the esophagus.
Melatonin is one of the most ubiquitous compounds in all animals, so to discuss all the ways in which it imparts an effect on the health of your body would be incredibly time-consuming.
What seems to be a more important question, is just how effective is melatonin?
The feared complication of chronic heartburn & reflux is damage to the esophagus. This damage, if poorly managed (e.g. with PPIs), will lead to dysplasia and eventual cancer.
In the prior INSIGHTS article, we explored how melatonin may prevent the progression of damage to cancer.
The question now remains, can melatonin reverse the ulcers of the esophagus?
It would seem that much of the published literature exploring the clinical use of melatonin for reflux is by a Brazilian, Ricardo de Souza Pereira.
In one case study published in the Journal of Pineal Research (2006), he illustrates reversal of an esophageal ulcer supplementing with melatonin.
Before we dive into that case, let us first take a look at the grading system for esophageal damage.
Savary-Miller Classification
The grading system is pretty descriptive, and these observations are made with a camera (endoscope) that is put down the patient’s throat to directly visualize the esophagus.
Grade 5 is Barrett’s esophagus, which marks a change in the cell type of the normal esophagus, and is believed to be a precursor to cancer.
Case Report
Pereira describes a 35-year-old male with chronic reflux, with symptoms lasting for more than 2 years before he brought himself to the attention of a gastroenterologist (GI).
Naturally, the GI prescribed omeprazole - a proton-pump inhibitor. Not surprisingly, this did not relieve his symptoms. His symptoms were so bad that he couldn’t eat, in large part due to pain and hematemesis (vomiting blood).
As a result of these symptoms, he lost 40 kilograms of weight over the course of 6 months.
After seeing 5 different GI specialists, he finally came to the attention of Pereira, and demonstrated the findings of his upper endoscopy.
What you see above is a terribly inflamed esophagus, and on the bottom left image is a large (6 centimeter) ulcer. In this same timeframe, his hair colored changed from black to yellow.
Pereira immediately started this patient on his melatonin + vitamin stack:
Melatonin 2.5 milligrams
Vitamin B12 50 micrograms
Vitamin B6 200 milligrams
Tryptophan 25 milligrams
Methionine 100 milligrams
Betaine 100 milligrams
Vitamin B9 10 milligrams
Two hours after the first capsule, his pain was gone and was able to tolerate eating a meal.
Within 32 days of treatment, he had regained about 30 kilograms of weight. His hair colored returned to black.
After 9 months of treatment, the patient underwent a follow-up evaluation of his esophagus.
His grade 4 ulcer had regressed to a grade 1 erosion.
Concluding Thoughts
Despite the widespread use of proton-pump inhibitors for the treatment of reflux and heartburn, we continue to have an epidemic of heartburn and rising rates of esophageal damage and cancer.
After decades of this approach, it is safe to say that PPIs are not treating the root cause of the problem.
Over the last few articles we have seen the following:
The complexity of something as simple as ‘heartburn,’ and all of the possible contributing causes
Molecular /physiologic rational and evidence for the role of melatonin in:
Relieving heartburn symptoms with potentially 100% efficacy
Stopping progression of esophageal inflammation to erosions and ulcers
Reversing the esophageal damage done by reflux of stomach content
Despite all of this evidence, if you are to go unto PubMed and search the terms ‘melatonin’ and ‘reflux or GERD,’ you will find about 10 articles ever written on the relationship.
Let that sink in.
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This is fascinating. I had a friend recently passed away from esophageal cancer, due mainly from a hiatial hernia and resulting reflux.
I find large doses of melatonin don't cause as much grogginess as the small doses.
Thanks for your work!
I take 300 micrograms of melatonin daily which helps me sleep better. This is first time I hear about benefits for acid reflux (I don’t suffer from it). I wonder how many other health benefits can be attributed to melatonin. Thank you.