When an individual decides to seek out chiropractic care, it’s typically for musculoskeletal (MSK) complaints such as low back and neck pain, headaches, and/or shoulder/hip/wrist/knee problems. However, there is a growing body of evidence that some services offered by doctors of chiropractic can provide some benefit to patients with ailments that do not fall into the MSK category such as gastrointestinal (GI) conditions like acid reflux or GERD (gastro-esophageal reflux disease).

According to the Cleveland Clinic, GERD affects about 20% of the United States population.  Gastro-esophageal reflux disease is chronic acid reflux where the stomach’s acid-containing contents leak back up and irritate the esophagus (the tube connecting the mouth and stomach) causing heartburn. In some cases, the lower esophageal sphincter (the opening into the stomach) doesn’t close properly, allowing the regurgitation of acid into the tube. The GERD patient may not have heartburn but may experience hoarseness, difficulty swallowing, a dry cough, halitosis, or the feeling of food getting stuck in the throat and choking.

The classic treatment for GERD usually involves over-the-counter medications starting with antacids, followed by H-2 receptor blockers, proton pump inhibitors (PPIs), or a prescription to relax the lower esophageal sphincter. Patients may also be advised to stop smoking, raise the head of their bed by approximately 6-8 in (15.24-20.32 cm), avoid pre-bedtime eating, eat smaller portions, lose weight, and reduce their intake of fat, dairy, and other trigger foods (spicy, fried, and fatty foods; chocolate; tomato sauce; onion; garlic; citrus fruits; alcohol; coffee; and carbonated drinks).

Up to 15 million Americans take PPIs and are often told they should take such medications indefinitely. Unfortunately, significant side-effects from long-term use can occur resulting in osteoporosis and bone fracture, chronic kidney disease, pneumonia, gut infection (include C-Diff), inflammatory bowel disease, heart disease, upper GI cancer, and more. While evidence is largely limited to case and small-scale studies, there may be a place for the chiropractic co-management of GERD with the use of manual therapies.

An interesting 2021 paper reported on a 35-year-old female who experienced full resolution of GERD after receiving chiropractic spinal manipulation to correct forward head posture and upper cross syndrome. A 2016 study found that between three and sixteen treatments consisting of thoracic spinal manipulation, diaphragm mobilization, traction of the cardia, and posture correction—all of which can be provided in a chiropractic setting—provided significant improvement in all but two of twenty-two GERD patients. Even better, the patients continued to report such benefits during a follow-up visit three months following the conclusion of treatment.

The findings from these studies suggest that GERD may have a musculoskeletal component that can be addressed with chiropractic care. However, more research is needed before treatment guidelines can be updated.