Science Update

New review demonstrates the role of melatonin in gastroesophageal reflux disease (GERD)

In a new review published last Friday in the International Journal of Molecular Sciences, researchers demonstrate the benefits of melatonin in preventing esophageal injury, providing protection from esophagitis as well as long term protection from chronic inflammation that can lead to gastroesophageal reflux disease (GERD) and Barrett’s esophagus.

GERD is a multifactorial process that can be due to stress, poor diet, impaired digestion, dysbiosis, hiatal hernia, and esophageal sphincter dysfunction. Risk factors associated with GERD include smoking, alcohol and NSAID use.

Previously I had shared research demonstrating that the damage of the esophagus in GERD to be cytokine-mediated due to inflammation and not caused directly by the acid in the stomach.  

Pharmaceutical interventions may provide symptom management but they do not correct many of the underlying factors and they have side effects. Lifestyle changes and nutritional support are usually sufficient to address acid reflux. For instance, patients should consider eating smaller meal portions, avoid laying down after meals and avoid eating right before bedtime. Also, alcohol and specific foods can trigger symptoms.

Although proton pump inhibitors (PPIs) may help with GERD’s symptoms, these medications may not be the solution. Recent studies have linked PPIs to chronic kidney disease and cardiovascular disease, as well as an increased risk of a heart attack. PPIs can also lead to other problems such as small intestinal bacterial overgrowth (SIBO).

Melatonin is often used to support sleep or for its antioxidant properties in cancer.  However, the entero-endocrine cells in the gastrointestinal tract are a major source of intestinal melatonin. Previous studies show that the gastrointestinal tract contains melatonin during fasting conditions as well as after a meal from tryptophan-rich foods. Melatonin is thought to act as a signal mediating the cross-talk between the GI tract and the liver, and its concentration in the gut depends on food intake.

Large amounts of melatonin are found in tissues of the GI tract that are continuously exposed to a hostile environment. One of the main functions of melatonin produced by the GI tract is to protect the esophageal and gastric mucosa from stressors and irritants. Previous research has demonstrated remission of GERD symptoms from melatonin supplementation comparable to PPIs.

Melatonin is a potent antioxidant that can influence all major functions of the GI tract, including secretion, motility, digestion and intestinal absorption. It has an inhibitory influence on gastric acid secretion resulting in an increase in gastrin release, which increases the contractile activity of the lower esophageal sphincter and reduces the symptoms of GERD.

It is important to note that older people are at a higher risk of complications due to decreased production of melatonin. It is also interesting that patients presenting with GERD often show reduced plasma levels of melatonin. This suggests a deficiency may weaken esophageal and/or duodenal barrier mechanisms, negatively impacting the upper GI tract mucosa.

Additional nutritional supplements that may be helpful to improve digestive function include probiotics and glutamine. Deglycyrrhiizinated licorice (DGL) is also a well-established anti-ulcer and mucosal healing botanical that is soothing and protective to the gastric mucosa and mucous membranes lining the digestive tract.

Helicoacter pylori is a major cause of gastritis. Mastic gum, methylmethionesulfonium, zinc-carnosine and vitamin C  together address both eradication of H. pylori and the healing and protection of inflamed mucosal tissue.

An alternative approach is typically more effective than what is provided by PPIs and does not have side effects or other complications that can be associated with medications, such as mineral deficiencies, bacterial infections and dysbiosis.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS


Source: Majka J, Wierdak M, et al. Melatonin in Prevention of the Sequence from Reflux Esophagitis to Barrett's Esophagus and Esophageal Adenocarcinoma: Experimental and Clinical Perspectives. Int J Mol Sci 2018 Jul 12;19(7). pii: E2033. doi: 10.3390/ijms19072033.