Probiotics may help ease gastro-oesophageal reflux disease (GORD) symptoms, reducing the number and frequency or reflux episodes.6

Studies have shown that Lactobacillus johnsonii No 1088 can reduce stomach acid secretion, while Bifidobacterium bifidum YOT 10347 can stick to the stomach wall and stimulate the protective mucin layer. Lactobacillus gasseri can stimulate pepsin, improving digestion and gastric emptying. A combination of six separate probiotic strains reduced reflux episodes by 40% during pregnancy.

However, a systematic review said that due to a substantial mix of outcomes and effects on symptoms, with only five out of 14 studies considered good quality, no general conclusions could be drawn.

Proton pump inhibitors can significantly alter the gut microbiota, increasing the risk of intestinal infections. Researchers found increased oral bacteria levels in the intestines of people taking PPIs, suggesting that reduced stomach acidity was not sufficiently neutralising ingested potential pathogens. The researchers suggested that PPIs and perhaps other antacids might even alter the gut microbiome to a greater extent than antibiotics.35

A separate study found that combining esomeprazole with Bacillus subtilis and Enterococcus faecium had a beneficial effect on reflux oesophagitis treatment with a reduction in associated diarrhoea syndrome and extending the time to relapse.36