Gastro-Esophageal Reflux Disease

Overview of Gastro-esophageal reflux disease

Motility disorders of the distal esophagus (e.g. reduced peristaltic amplitude, decreased velocity and increased duration of peristaltic contractions) cause prolonged exposure of the esophagus to refluxed gastric contents.[1]

Indian epidemiology then other

Causes of Gastro-esophageal reflux disease

Factors which facilitate reflux are i.e.

• Hernia, fatty meal
• Diabetes mellitus, sliding hiatus
• Prolonged gastric tube intubation
• Scleroderma Drugs – e.g. Anticholinergics, β-adrenergic agents, calcium channel blockers, nitrates
• Ascites, obesity, pregnancy
• Alcohol, smoking
• Pyloric obstruction, fatty foods
• Gastroparesis
• Large meals, Z-E syndrome [1]

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Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology of Gastro-esophageal reflux disease

The pathophysiology is multifactorial, but dysfunction of the lower esophageal sphincter (LOS) has a primary role. [1]

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Sign & Symptoms of Gastro- esophageal reflux disease (GERD)

• Typical symptoms: e.g. Heartburn, acid regurgitation.
• Atypical symptoms: Dysphasia, Globus sensation, noncardiac Chest pain, either dyspepsia or abdominal pain.
• Extraesophageal symptoms: In detail, Hoarseness or sore throat, Or both, sinusitis, otitis media, chronic cough, laryngitis or polyps on the vocal cords or both, dental erosions, non-atopic asthma, recurrent aspiration or pulmonary fibrosis, or both.
• Sleep related GERD can present with multiple awakenings. Additionally, Substernal burning and/or chest discomfort, indigestion or heartburn. Other symptoms include a sour or bitter taste in the mouth, water brash, coughing or choking.
• Malignancy: Esophageal adenocarcinoma, head also Neck cancer.
• All in all, Barrett’s esophagus is found in 10–20% of patients with Reflux esophagitis, the squamous epithelium is injured by chronic gastro-esophageal reflux also repair is effected by columnar instead of squamous cells Upper GI scopy can be diagnostic assisted by biopsy. This columnar epithelium may undergo malignant transformation.[1]

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Diagnosis of Gastro-esophageal reflux disease

Your Doctor  will often be able to diagnose gastro-esophageal reflux disease (GERD) based on your symptoms.

They may prescribe medication to treat it without needing to carry out any tests.

Tests you may have i.e.:

• Endoscopy
• Either Barium swallow or barium meal test
• Manometry
• 24-hour pH monitoring
• Blood tests [1]

Differential Diagnosis of Gastro-esophageal reflux disease

• Acute gastritis
• Atrophic gastritis
• Chronic gastritis
• Crohn’s disease
• Peptic ulcer disease
• Gastrinoma
• Gastric Adenocarcinoma
• Primary gastric lymphoma [4]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Gastro-esophageal reflux disease

1. Firstly, Radiology Barium swallow with fluoroscopy Upper esophageal sphincter disorders Defective opening of pharyngo-esophageal segment Airway aspiration.
2. Secondly, Upper esophageal endoscopy
3. Thirdly, Manometry

• Upper esophageal sphincter
• Tone of upper esophageal sphincter also relaxation

During swallowing i.e.-

• Coordination between relaxations of upper esophageal sphincter and contraction of the pharynx.
• Body motility
• Evaluation of amplitude, duration also velocity of waves.
• Lower esophageal sphincter tonic pressure and relaxation.

4. Esophageal pH testing
5. Scintigraphy. [1]

Treatment of Gastro-esophageal reflux disease

Heartburn and gastro-esophageal reflux disease (in other words; GERD) can often be treated with self-help measures and over-the-counter medicines.

If these don’t help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option.

Self-help

You may find the following measures can help reduce heartburn and other symptoms of GERD:

• Eat smaller and more frequent meals, rather than 3 large meals a day – don’t eat or drink alcohol within 3 or 4 hours before going to bed, and avoid having your largest meal of the day in the evening.
• Avoid anything you think triggers your symptoms – common triggers e.g. coffee, chocolate, tomatoes, alcohol, and fatty or spicy food.
• Don’t wear tight clothing – clothes that are tight around your tummy may make your symptoms worse.
• Raise the head of your bed by up to 20cm (8 inches) – placing a either piece of wood or blocks underneath one end of your bed may reduce symptoms at night; don’t just use extra pillows, as this can put a strain on your tummy.

• Try to relax – stress can make heartburn also GERD worse, so learning relaxation techniques may help if you’re often feeling stressed.
• Maintain a healthy weight – if you’re overweight, losing weight may help reduce your symptoms.
• Stop smoking – smoke can irritate your digestive system and may make your symptoms worse.

If you’re taking medication for other health conditions, check with your GP to find out whether they could be contributing to your symptoms.

Different medicines may be available, but don’t stop taking any prescribed medication without consulting your doctor first.[1]

Medication

A number of different medications can be used to treat symptoms of GERD.

Over-the-counter medicines

Over-the-counter heartburn and GERD medicines are available from pharmacies without a prescription. The main types are:

• Antacids – these neutralize the effects of stomach acid
• Alginates – these produce a coating that protects the stomach and esophagus (gullet) from stomach acid
• Low-dose proton-pump inhibitors and H2-receptor antagonists

Surgery may be an option if:

• The above treatments don’t help, aren’t suitable for you, or cause troublesome side effects.
• You don’t want to take medication on a long-term basis.

The main procedure used is called a laparoscopic Nissen fundoplication (in other words; LNF). Alternative techniques have been developed more recently, although these aren’t yet widely available. [1]

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Homeopathic Treatment of Gastro-esophageal reflux disease

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Gastro- esophageal reflux disease (GERD) :

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Homoeopathic Approach:

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution, family history, presenting symptoms, underlying pathology, possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’. The disease diagnosis is important but in homeopathy, the cause of disease is not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness are also looked for.

No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology is not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can be greatly improved with homeopathic medicines.

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy.

Medicines:

1. Podophyllum:

• Nausea, with acidity. Vomiting of the contents of the stomach and of bile, at time mixed with blood, or of hot frothy mucus.

2. Arsenic:

• Craving for acids and brandy. Constant desire to drink, but takes very little at a time.
• Eructations, Hiccough, Nausea, Vomiting of food also drink as soon as they reach the stomach.
• The distress in the stomach is not relieved by vomiting, but the extreme irritability, burning and indescribable distress continue.
• Inflammation and ulceration, with terrible distress. In the pit of stomach, anxiety, soreness, burning or internal chilliness.

3. Argentum nitricum:

• Craving for sugar.
• Nausea, Retching; vomiting; ejecta become black.
• Furthermore, Flatulent distention of stomach, extreme.
• Pit of stomach painfully swollen Bursting sensation in pit, ameliorated by eructations.
• Besides this, Eructations difficult, as if esophagus were spasmodically closed.
• Vomiting of glairy mucus. Lastly, Pain in pit, extends around sides or into the chest.

4. Anacardium:

• Feeble digestion; melancholy especially after eating.
• All in all, a shattering sensation in the pit of the stomach on every step after eating.

5. Ipecac:

• General loss of appetite as from weakness of the stomach.
• Furthermore, Aversion to all food; or dislike for sweets and dainty things. No thirst.
• Nausea, which seems to come from the stomach, with empty eructations also salivation.
• Besides this, Retching and vomiting of food; of bile; of green, bilious mucus; of blood; renewed after taking cold drinks or smoking tobacco.

6. Baptisia:

• The whole throat becomes red, frequent inclination to swallow, with pain at the root of the tongue.
• General sore throat with a constrictive sensation; additionally, frequent efforts to swallow.

7. Hepar sulph:

• Basically, Speech very weak, voice lost. Hoarseness, painless.
• Cough hoarse, paroxysmal,  aggravation from the slightest cold, caused by tickling in the upper part of the throat, left side, talking and stooping.
• Cough rough, scraping, suffocative, in the evening on going to sleep. Dyspnoea.[3]

Diet & Regimen of Gastro-esophageal reflux disease

• Eat plenty of whole foods naturally low in fat also sugar, such as fruits, vegetables, whole grains, nonfat dairy, and fish.
• Steer clear of fatty meat, sugary drinks (especially carbonated drinks), processed foods, and fatty, sugary desserts.
• Either Drink little or no alcohol and caffeine.[2]

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References use for Article Gastro-esophageal reflux disease

[1] Medicine Golwala

[2]https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gastro-oesophageal-reflux-disease-gord#:~:text=in%20the%20oesophagus.-,24%2Dhour%20pH%20monitoring,nose%20and%20down%20your%20oesophagus.

[3]https://www.pritikin.com/acid-reflux diet#:~:text=Eat%20plenty%20of%20whole%20foods,or%20no%20alcohol%20and%20caffeine.

[4]https://www.wikidoc.org/index.php/Gastroesophageal_reflux_disease_differential_diagnosis

Frequently Asked Questions

What is Gastroesophageal reflux disease?

Gastro-esophageal reflux disease (GERD) is caused by recurrent reflux of gastric contents into the distal esophagus.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Gastroesophageal reflux disease?

• Podophyllum
• Arsenic
• Argentum nitricum
• Anacardium
• Ipecac
• Baptisia
• Hepar sulph

What causes Gastroesophageal reflux disease?

• Hernia, fatty meal
• Diabetes mellitus, sliding hiatus
• Prolonged gastric tube intubation
• Scleroderma Drugs
• Ascites, obesity, pregnancy
• Alcohol, smoking
• Pyloric obstruction, fatty foods
• Gastroparesis
• Large meals, Z-E syndrome

What are the symptoms of Gastroesophageal reflux disease?

• Heartburn
• Acid regurgitation
• Dysphasia
• Globus sensation
• Noncardiac Chest pain
• Dyspepsia
• Abdominal pain.