Latest podcast: Gastro-oesophageal reflux disease: the gut microbiome as first principle

In this week’s podcast Dr Arun Dhir, a gastroenterology surgeon, clinical researcher and author of Happy Gut, Healthy Weight, joins Dr Michelle Woolhouse as they delve into the crucial connection between gut health and various chronic conditions, including Gastro-oesophageal reflux disease (GORD) and its links with obesity.

1 in 5 people experience GORD on a weekly basis and in this episode, Dr Arun discusses his algorithm for investigating an individual presenting with GORD. Dr Arun also talks to the challenges of diagnosing conditions like hiatus hernias and the importance of comprehensive investigations, while offering practical advice on improving gut health through diet, stress management, and complementary therapies.  

(0:26) Welcome Dr Arun Dhir  

(2:10) Dr Arun’s story  

(7:05) “All diseases begin in the gut”  

(10:56) The profile of human begins is changing  

(11:56) Factors causing GORD  

(17:57) Hiatus hernia  

(21:19) Intra-abdominal pressure  

(22:48) Helicobacter pylori  

(25:15) Gut testing  

(31:49) Gastrocolic reflex  

(34:24) Complementary treatment options  

(39:42) Low grade gastritis   

(43:22) Final remarks  

The gut microbiome plays a critical role in health, influencing conditions like GORD (Gastro-oesophageal reflux disease), obesity and inflammation, aligning with the concept that "all disease begins in the gut".  

GORD, affects 1 in 5 people weekly. It is driven by lifestyle factors, obesity, stress, and ultra-processed foods, with a long-term reliance on proton pump inhibitors (PPIs) often overlooking root causes. 

Baseline investigations are critical for diagnosing GORD and identifying conditions like hiatus hernias or oesophageal motility disorders including:  

• endoscopy   
• barium swallow   
• PH monitoring   

Differentiating between hiatus hernia types and assessing for mechanical failures, such as lower oesophageal sphincter incompetence, is essential for determining appropriate treatment pathways.  

Helicobacter pylori infection affects approximately 50% of the population, however it is not universally pathogenic; personalised treatment and deeper investigations like endoscopy are essential.  

GORD management consists of stress management, breathing techniques, and complementary therapies that may support GORD management such as:  

• mastic gum  
• licorice 
• apple cider vinegar   

Risk factors for GORD onset including modern lifestyles, microbiome depletion, and environmental toxins contribute to a rise in gut-related and immune conditions like eosinophilic esophagitis and food intolerances.