Impacts of intestinal fermentation on gastroesophageal reflux disease: can the tail wag the dog?

Communication between the foregut and the hindgut is amply illustrated by the gastro-colonic reflex and the impact of constipation on gastric function. Less well studied are the effects of the small intestinal or colonic microbiome and its metabolites on motor and secretory activities in the esophagus and stomach. In the study, the authors posit that small intestinal bacterial overgrowth promotes gastroesophageal and laryngo-pharyngeal reflux and in support of this hypothesis report an amelioration of related symptoms with antibiotic and dietary therapies. This editorial explores this hypothesis and also proposes an alternative one: changes in gastric and esophageal function consequent upon increased bacterial fermentation, not in the small intestine, but in the colon.