Gastroesophageal reflux disease

Latest Edit: Iva Lloyd, ND 2015-10-30 (EDT)

Gastroesophageal reflux disease

Heartburn
Causes	Dietary Factors, Infections, Alcohol, Stress, Dehydration, Smoking
See Also	Digestive Conditions, Obesity, Gastritis, Peptic Ulcer, Asthma
Books	Books on Digestive and Liver Conditions
Articles	Articles on Digestive Conditions

Gastroesophageal reflux disease (GERD) occurs when stomach acid refluxes back from the stomach into the esophagus. GERD happens when the lower esophageal sphincter relaxes inappropriately or if gastric (stomach) emptying is delayed. Approximately 20% of North Americans experience GERD. Reflux causes heartburn and can damage the mucosal lining of the gastrointestinal tract including the esophagus.

Naturopathic Assessment

Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. With GERD, the causes are variable and include lifestyle and environmental factors. The main causes of GERD include things which reduce lower esophageal sphincter tone, change the acidity levels in the stomach, or increase abdominal pressure. These include the following:

Lifestyle

• Dietary factors

• Certain foods lower esophageal sphincter tone and can irritate the esophagus including: alcohol, spicy and fatty foods, chocolate, citrus foods and juices, coffee, carbonated drinks.
• Some food allergies and food sensitivities can aggravate GERD.
• Eating large meals or eating too close to going to bed can increase the chance of heartburn.

• Dehydration

• Dehydration and heartburn tend to go hand-in-hand.

• Alcohol

• Frequent alcohol consumption, particularly more than 7 drinks per week is associated with increased risk of GERD.

• Breathing

• Dysfunctional breathing and chest breathing is associated with an increased risk of GERD.

Social

• Stress

• Heartburn is more common when under stress.

Environmental

• Infection

• H. pylori infection is associated with heartburn.

External

• Smoking

• smoking cigarettes reduces lower esophageal sphincter tone, prolongs acid clearance and has been related to increased numbers of reflux events.

Medical Interventions

• Prescription Medications

• Medications such as the following can initiate or exacerbate GERD symptoms: Anticholinergics, Beta-blockers, Bronchodilators, Calcium channel blockers, Dopamine-active drugs, Progestin, Sedatives, Tricyclic antidepressants

Physiology

• Pregnancy

• When heartburn symptoms occur for the first time with pregnancy they generally will subside after the baby is born.

Common Questions

• Are you a smoker?
• How much alcohol do you consume?
• Do you experience heartburn?

• How often do you experience heartburn?
• Is the heartburn associated with any particular foods?
• Is it worse when you bend over? are lying down? while eating?
• Does it disturb your sleep?

• Have you tried taking antacids?

• Does this improve your symptoms?

• Do you ever feel as if food is stuck behind your chest?
• Do you ever feel nauseous?
• Does food ever come back up?
• Have you coughed up any blood?
• Do you have difficulty swallowing?
• Has there been any unintentional changes to weight?

Diagnostic Testing

The diagnosis of GERD is based on a thorough history taking and a person's symptoms. Diagnostic testing for GERD is not typically required unless symptoms are severe. Additional testing may include:

• Imaging Studies including:

• Esophagogastroduodenoscopy is a tube with a camera attached to it is passed through your mouth into the esophagus, stomach, and small intestine. This can be used to examine the esophagus for any damage.
• Esophageal manometry evaluates lower esophageal sphincter function
• Barium swallow

• Other testing

• Gastro Test and betain hydrochloride are used to assess the level of acidity in the stomach.
• Stool Analysis may be required to assess for occult blood or bleeding that may be coming from the irritation in the esophagus, stomach, or intestines.

Related Conditions

Heartburn is a common symptom of the following conditions:

• Obesity
• Gastritis
• Hypochlorhydria
• Peptic Ulcer
• Hiatal hernia
• Esophagitis
• Esophageal stricture
• Esophageal ulcer
• Hemorrhage
• Barrett's metaplasia
• H. pylori infection
• Asthma
• Zollinger-Ellison Syndrome
• Scleroderma

Characteristics

The lower esophageal sphincter muscle is located at the union of the esophagus and the stomach. The role of this sphincter muscle is to prevent food from moving back into the esophagus. If this sphincter muscle doesn't close well, food, liquid, and stomach acid can leak back into the esophagus. This is called reflux or gastroesophageal reflux.

Tightness of diaphragm, a stomach that is raised too close to the diaphragm or weakness of the sphincter muscle can all contribute to reflux. Other characteristics include:

• Acid reflux

• Reflux of acidic stomach contents can damage the mucosal lining of the esophagus.

• Chest pain

• Chest pain can be confused with heart attack (Myocardial Infarction) or Angina pectoris.

• Can be caused by excess or deficient stomach acid

• Association with certain age groups

• GERD is most common in adults over 40 years of age, but can occur in infants and children.

Common Symptoms

Common symptoms include the following:

• Heartburn or a burning pain in the chest (under the breastbone)

• Pain that is worse by bending, stooping, lying down or eating
• Pain that is worse at night or worse right after eating

• Gas and Bloating
• Belching
• Indigestion
• Nausea after eating
• Regurgitation
• Bitter taste in mouth

Other symptoms associated with GERD include:

• Bringing food back up (regurgitation)
• Cough or wheezing
• Difficulty swallowing
• Hiccups
• Hoarseness or change in voice
• Sore throat

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. GERD may be considered a chronic disease by conventional medical standards, however symptoms can be eliminated with dietary and lifestyle changes.

It is always advisable to work with a naturopathic medical doctor before engaging in any treatment plan. If you have trouble or pain swallowing food, vomiting with blood, or bloody or black stools seek medical attention prior to engaging in any treatment plan. As heartburn symptoms can mimic those of a heart attack if you have chest pain, shoulder pain, wheezing, or shortness of breath or if you have heartburn symptoms along with lightheadedness, sweating or dizziness seek medical attention immediately.

Home Care

Home Care strategies include:

• If overweight or obese, focus on attaining a healthy body mass index

• Research indicates that maintaining a normal BMI may reduce the likelihood of developing GERD and associated complications.

• Quit smoking cigarettes.

• Avoid medications that aggravate GERD symptoms.

• Balloon Exercise

• GERD/Heartburn can occur with dysfunctional breathing, especially with chest breathing. chest breathing results in the stomach moving too close to the diaphragm putting pressure on the sphincter muscles that are responsible for keeping it closed. The following exercise is designed to gently drop the stomach back into place and strengthen the sphincter (round) muscle that links the esophagus to the stomach.

• First thing in the morning, on an empty stomach, drink a large glass of water.
• Stand on your toes and then drop on your heels five times. Heel-toe, heel-toe repeated. This helps to move the stomach back into place.
• Blow up a balloon. It doesn't matter whether or not you are successful in blowing up the balloon, it is the action of blowing up the balloon that will strengthen the sphincter muscles.

Lifestyle

Lifestyle recommendations include:

• Dietary recommendations:

• Avoid foods that exacerbate GERD symptoms: coffee, alcohol, spicy and fatty foods and chocolate.
• Avoid food allergies and food sensitivities.
• Relax while consuming food: always sit down, eat meals slowly and deliberately, avoid doing other activities simultaneously.
• Eat smaller, more frequent meals with low fat content.
• Increase dietary fiber intake.
• Ensure you drink adequate water, but not while eating.

• Exercise

• Regular exercise can reduce the frequency and severity of GERD.

• Posture

• Improvement in posture and diaphragmatic function has been found to help improve ineffective breath control that is commonly seen in patients with GERD.

• Breathing

• Patients with GERD often use their upper chest to breathe in response to gut discomfort, thereby weakening diaphragmatic strength/useage and causing ineffective breath control while speaking. Thus breathing exercises can help correct this problem.

Naturopathic Therapies

Naturopathic Therapies for GERD include:

• Clinical Nutritional Supplementation includes:

• Vitamins such as Vitamin D
• Other supplements such as Choline, Lecithin, Melatonin, Peppermint oil (Mentha piperita).

• Herbs such as Marshmallow root (Althea officinalis), Slippery Elm (Ulmus rubra), Gentiana lutea, Hops (Humulus lupulus), Horehound (Marrubium vulgare), Angelica (Angelica sinensis), Marigold (Calendula officinalis), Chamomile (Matricaria recutita), Ginger (Zingiber officinale), Meadowsweet (Filipendula ulmaria).

• Herbs with the following actions: demulcent, anti-inflammatory, astringent, alterative and carminative can be used in the treatment of heartburn.

• Homeopathics can be helpful in the treatment of acute and chronic GERD.

• Gemmotherapies such as Ficus carica

• Traditional Chinese Medicine & Acupuncture

• According to TCM, GERD can be caused by: Stomach Heat, Qi Stagnation, Liver Qi Stagnation, Yin Deficiency, Cold and Yang Deficiency, Food Stagnation, or Phlegm Damp.

References

Reviewed by Iva Lloyd, BScH, RPE, ND [1]