Gut Feeling
The Semiotics of Heartburn
Caffeinated coffee seems to cause more gastric acid production, and at lower pH (more acidic) decreases the sphincter tone.
Gastroesophageal Reflux Disease
The long and short of it.
Gastroesophageal reflux disease (GERD) occurs when there is abnormal passage of acidic stomach contents, or refluxate, into the esophagus, causing symptoms or complications. It is one of the primary causes of the informal name and symptom “heartburn” and GERD is a common phenomenon.
Estimates are that 15% to 18% of people around the have heartburn or regurgitation at least once a week, and 7% of people suffer from those symptoms daily.
Integrative medicine treatments for gastroesophageal reflux disease (GERD) include a variety of approaches that complement conventional therapies. Some of these treatments are supported by evidence from the medical literature:
Traditional Herbal Medicines (THM): Certain traditional herbal therapies, such as Betaine Hydrochloride (BHCl) 4500 mg of BHCl acid in capsules was able to reacidify gastric pH levels back to baseline.
Jianpi Therapy and Ligan Hewei Therapy: have been studied for their potential benefits in GERD management. These therapies, when combined with proton pump inhibitors (PPIs), have shown promise in improving symptoms like acid regurgitation and heartburn. However, the evidence is still limited, and further well-designed randomized controlled trials are needed to confirm their efficacy.
Transcutaneous Electrical Acustimulation (TEA): TEA has been investigated for its effects on gastroesophageal motility and GERD symptoms. Studies suggest that TEA can improve reflux-related symptoms, enhance esophageal motility, and improve gastric accommodation, potentially through vagal mechanisms.
Lifestyle Modifications and Behavioral Interventions: Lifestyle changes, such as dietary modifications, weight loss, and head-of-bed elevation, are commonly recommended. Additionally, cognitive-behavioral therapy and diaphragmatic breathing may help manage symptoms, particularly in cases of esophageal hypersensitivity or functional heartburn. The classic abs-roller exercises are an incredible way to strengthen overall abdominal muscles that helps strengthen the core and improve regurgitation symptoms.
Endoscopic Therapies: Endoscopic treatments, such as transoral incisionless fundoplication and radiofrequency ablation (Stretta), offer minimally invasive options for patients who are not candidates for surgery or prefer to avoid long-term medication. These therapies are generally considered for patients with milder forms of GERD and have shown varying degrees of success in clinical trials.
Adjunctive Pharmacotherapy: Alginates, H2 receptor antagonists, and baclofen are used as adjunctive treatments for specific symptoms like nocturnal reflux or regurgitation. These agents can be tailored to the patient's GERD phenotype.
Homeopathy: Many of the symptoms associated with GERD, such as indigestion and heartburn, or even associated disorders such as hiatal hernia, are mentioned in homeopathy sources and treated with a wide variety of short-term remedies, such as phosphorus, nux vomica, nitric acid, pulsatilla, carbo vegetabilis, arsenicum, bryonia, china, anacardium, argentum, sepia, lycopodium, graphites, and kali bichromium.
Antiinflammatory Botanicals: Herbs are often used are meadowsweet (Filipendula ulmaria),which also reduces acidity, chickweed (Stellaria media), and chamomile (Matricaria recutita).
Anti-anxiety Botanicals: Many herbal experts recommend botanicals as part of an overall approach to anxiety management, given the connection between anxiety and GERD. Examples are valerian (Valeriana officinalis) and skullcap (Scutellaria lateriflora)
Demulcent Botanicals: Demulcent, or mucilaginous, botanical medicines can be used as muco-protection of the esophageal mucosa, both to soothe irritated tissues and promote healing. These are known for their soothing properties on mucous membranes. These include chamomile, marshmallow, skullcap, and valerian. They help alleviate symptoms by forming a protective barrier over the esophageal lining, thus reducing irritation from gastric acid.
Pharmaceuticals : Starting out with a proton pump inhibitor, both for symptomatic relief and for diagnostic purposes, Histamine-2 receptor antagonists, over-the-counter antacids, such as calcium carbonate, aluminum hydroxide, and magnesium hydroxide, can be helpful.
Surgery: Patients with long-standing, more severe GERD should undergo an appropriate diagnostic workup, which may include a referral to a gastro-enterologic specialist and upper endoscopy to rule out esophagitis, ulcers, Barrett esophagus, or adenocarcinoma. For people with intractable symptoms, fundoplication should be considered.
Bio-mechanical Therapy: Some naturopathic physicians recommend hernial reduction adjustments, an abdominal manipulation technique. Aside from surgery, no documented allo-pathic interventions exist for the treatment of hiatal hernia.
Mind-Body Therapy: Practice stress management and relaxation techniques. Relaxation training can improve symptoms of GERD, by addressing the issue that stress exacerbates GERD symptoms.
While these integrative approaches can be beneficial, they should be considered as part of a comprehensive management plan tailored to the individual patient's needs and clinical presentation. Further research is needed to establish the long-term efficacy and safety of these treatments.
As always the goal here at Autonoma Health is to bring zero cost to consumer information about science and science backed tools in understanding a wide variety of diseases; and as tiny as a speck it may be in the microcosm of therapeutics, at the heart of it all, if even one of us derives value, it would have been worth the while.
“Caffeinated coffee seems to cause more gastric acid production, and at lower pH (more acidic) decreases the sphincter tone.”
The long story: a deep dive on heartburn
Symptoms of GERD result from the interplay of many factors, including the amount of time the esophagus is exposed to refluxate, the degree of refluxate causticity, and the susceptibility of the esophagus to damage. Three main mechanisms or factors prevent refluxate from entering the esophagus: the lower esophageal sphincter (LES), the crural diaphragm (which acts as an external esophageal sphincter), and the location of the gastroesophageal junction below the diaphragmatic hiatus.
Dysfunction or malalignment in any or all of these structures could lead to symptoms of GERD, although the major pathologic mechanism is some abnormality in tone of the LES.
“Cow's milk protein is a common cause of gastroesophageal reflux disease in infants, and a trial of elimination should be considered.”
Certain beverages may exacerbate symptoms of GERD, some by affecting LES tone. For example, coffee, including instant coffee, decaffeinated, and ground coffee, decreases LES initially and, in some people with sustained decreased tone, for up to 90 minutes after ingestion.
Another study found an association between pH and titratable acidity and the frequency with which some beverages, such as juices, sodas, coffee, and tea, caused heartburn symptoms in 394 people with GERD. Caffeine itself has some ability to decrease LES tone.
Persistent, long-term difficulties may cause distress, both to a man and to his partner. Despite this, only about 10 per cent of men experiencing long-term erectile dysfunction seek help for it.
Treatment is aimed at relieving the underlying cause, either by increasing blood flow to the penis or helping men to relax and feel less anxious. is aimed at relieving the underlying cause, either by increasing blood flow to the penis or helping men to relax and feel less anxious.
In general, if the condition is intermittent it is usually the result of a psychological cause, such as an anxiety disorder and depression. Other psychological factors may include stress, anxiety about sexual performance or relationship difficulties.
Factors Associated With Decreased Tone of the Lower Esophageal Sphincter
Integrative Therapy
Lifestyle
Lifestyle modifications are the first line of therapy and can lead to improvement or elimination of symptoms. For example, GERD symptoms may improve if smokers quit and if obese patients lose weight.
Demulcent Botanicals
Demulcent, or mucilaginous, botanical medicines can be used as muco-protection of the esophageal mucosa, both to soothe irritated tissues and coat the stomach lining. These include Licorice, Marshmallow root, Slippery Elm.
Licorice (Glycyrrhiza glabra)
For long-term use, licorice should be prescribed as deglycyrrhizinated licorice to prevent the side effects of one of its phytochemicals, glycyrrhizin.
Slippery Elm (Ulmus fulva) Root Bark
Slippery elm root bark powder is one demulcent botanical that can be used for symptomatic relief and promotion of healing of irritated esophageal or gastric mucosa. Most health food stores, integrative pharmacies, and herbal dispensaries with botanical products for sale in bulk will have slippery elm. Write back to us for dosages.
"The prolonged use of decoctions or infusions of dried, unprocessed licorice root can cause hypertension, hypokalemia, and edema because of the mineralocorticoid action of a saponin glycyrrhizin, also called glycyrrhizic acid."
Marshmallow Root
Marshmallow root is another mucilaginous herb foindividualsallergic to other plants in the daisy family (Asteraceae) mayexperience an exacerbation of their allergic symptoms withconsumptions usually taken at 5 to 6g daily, in divided doses, as an infusion of the leaves or root
■ Precautions
As with slippery elm, a decrease in absorption of orally administered drugs taken simultaneously with marshmallow may occur.
Antiinflammatory Botanicals
Examples are meadowsweet (Filipendula ulmaria),which also reduces acidity, chickweed (Stellaria media), and chamomile (Matricaria recutita).
Chamomile (Matricaria recutita)
Chamomile is well known for its mild sedative actions and for its antispasmodic effects on the gastrointestinal tract. In GERD, it is used as a non-demulcent anti-inflammatory agent.
■ Dosage
Chamomile is most commonly prepared as a hot water infusion (tea) of 1 to 3 g of the flowers, steeped in a cup coveredwith a saucer, taken three to four times daily.
■ Precautions
Chamomile is generally well tolerated, although individualsallergic to other plants in the daisy family (Asteraceae) mayexperience an exacerbation of their allergic symptoms withconsumption of chamomile.
Anti-anxiety Botanicals
Many herbal experts recommend botanicals as part of an overall approach to anxiety management, given the connection between anxiety and GERD. Examples are valerian (Valeriana officinalis)and skullcap (Scutellaria lateriflora).
Pharmaceuticals
Both histamine-2 (H2) receptor antagonists or blockers(H2Bs) and PPIs are commonly used for the symptoms of GERD. A meta-analysis showed that both H2Bs and PPIs are effective in GERD symptomatic improvement, but PPIs are significantly more effective than H2Bs. PPIs are also used in a 1-week therapeutic trial to test and diagnose GERD empirically.
The optimal dosing time for PPIs is 30 minutes before a meal, although adherence to the ideal dosing regimen may or may not lead to better symptom control. Some clinicians use H2Bs or PPIs indefinitely as necessary to control symptoms.
“Aggressive, long-term acid suppression can decrease theabsorption of vitamin B12. Consider regular intramuscular injections of vitamin B12 with histamine-2 receptor blockersor proton pump inhibitors.”
In one study, between 10% and 40% of people who tookPPIs for GERD failed to respond symptomatically, partially or completely, whereas another study found that 85% of people taking PPIs had persistent GERD symptoms even though 73% of those patients were still satisfied with the treatment. Some debate exists about the reasons that certain patients may not respond to PPIs. Investigators have theorized that these patients may actually have functional or non erosive reflux disease, or they may have weakly acidic or alkaline refluxate.
Biomechanical Therapy
Some naturopathic physicians recommend hernial reduction adjustments, an abdominal manipulation technique, when GERD symptoms are complicated by the presence of a hiatal hernia.
Mind-Body Therapy
Relaxation training can improve symptoms of GERD, by addressing the issue that stress exacerbates GERD symptoms, especially in people suffering from chronic anxiety.
Other Therapies to Consider
Homeopathy
Homeopathy can be a therapeutic consideration. Many of the symptoms associated with GERD, such as indigestion and heartburn, or even associated disorders such as hiatal hernia, are mentioned in homeopathy sources and treated with a wide variety of short-term remedies, such as phosphorus, nux vomica, pulsatilla, carbo vegetabilis, arsenicum, bryonia, china, anacardium, argentum, sepia, lycopodium, graphites, and kali bichromium.
Surgery
The most common surgical procedure is the Nissen fundoplication, either open or laparoscopic, whereby the fundus of the stomach is wrapped wholly (total fundoplication) or partially (partial fundoplication) around the lower esophagus to create an area of high pressure meant to prevent refluxate from entering the esophagus and causing symptoms.
One review examined health-related quality of life and GERD symptoms after 1 year in 4 studies involving 1232 people who underwent medical management versus laparoscopic surgical management.
Overall, the surgical approach seemed to improve symptoms of GERD more effectively than did medical management, although in some cases dysphagia (8% to 12% postoperatively),25 costs after 1 year, and adverse effects were more pronounced in the surgical group.
Special Considerations in Pediatrics
The treatment of GERD in infants usually involves dietary interventions such as the normalization of feeding techniques, volumes, and frequency, if these are abnormal.
Formula can be thickened with a tablespoon of rice cereal per ounce, to decrease the number of regurgitation events, increase calorie density, and reduce the number of crying times. A short trial of a hypoallergenic diet, inparticular to exclude milk and soy, can be helpful in children suspected of having allergies to those foods. Older children with GERD are advised to avoid tomatoes, chocolate, mint, and classically offending beverages (juices, sodas, caffeinated beverages and to lose weight.
With respect to positioning during meals, infant GERD is worse when infants are seated, supine, or on their side and better when they are prone or carried upright. Because of the risk of sudden infant death syndrome, a prone position cannot be recommended for sleep.
Older children may have some relief when they lie on their left side or with the head of the bed elevated. As with adults, children experience some symptomatic improvement with H2Bs and PPIs; the dose of PPIs is higher per kilogram than for adults (0.7 to 1.5 mg/kg/day).
“Older children may have some relief when they lie on their left side or with the head of the bed elevated.”
Antibacterial Herbs
This is where there is infection with H. Pylori is suspected or confirmed, antibacterial and immune-stimulant herbs may be selected such as echinacea and garlic. Anti-inflammatory and carminative remedies, such as chamomile and marigold.
Yoga and Exercise
Doing yoga on a regular basis, particularly relaxing poses such as the corpse pose, may be of benefit if you have a peptic ulcer. Although stress is no longer thought to be the primary cause of peptic ulcers, persistent stress makes peptic ulcers worse. You should be sure to wear loose clothing that does not restrict your waist and to avoid doing any exercises for an hour after a meal.
“Introduction of bicycle exercise in the treatment of ulcer promoted acceleration of ulcer defects healing.”
Osteopathy and Chiropractic
For about a century, osteopaths and chiropractors have manipulated the region of the spine from which the nerves to the stomach and duodenum emerge to treat uncomplicated peptic ulcers, as an adjunct to normal medical treatment.
Caution:
Consult your doctor before taking vitamin A and zinc supplements with prescribed medications.
Pregnant women and women trying to conceive should not take vitamin A supplements.
Consult a herbalist before taking one of the traditional herbal remedies
If you need help with the dosages, feel free to write to us.
In closing
Let this be an urge to encourage our readers towards an overall healthy lifestyle and well-being, one that reduces the incidence of any such chronic disease. A lot of health rests in years of effort in the lifestyle department and if it helps there’s a surfeit of data supporting the claim.
Monitoring stress levels, blood pressure, weight and abdominal girth measurements form the initial assessment of risk factors for peptic ulcers and serve a good starting point.
That said, we’re always here should you need to discuss symptoms.
And as always, thank you for your interest in science. ✨
Until next time,
L’Chaim! ✨
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