Up to 50% of individuals taking proton-pump inhibitors such as Nexium aka "the purple pill" have small intestinal bacterial overgrowth. Many problems with reflux are actually a result of under-production of acid, called hypochlorydria. Signs of hypochlorhydria include pencil-thin stools, stomach discomfort upon palpation, difficulty digesting protein, and itchy anus. Many take these symptoms for granted, but don't take into consideration that many vitamins and minerals and downstream digestive functions depend on a properly acidic stomach. Natural treatments can include digestive enzymes as well as specific diet alterations. A full GI rebuilding protocol may be warranted.
Lombardo L, Foti M, Ruggia O, Chiecchio A: Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy. Clin Gastroenterol Hepatol.
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