Condition Treated / Pain Conditions

Acid Reflux (GERD)

Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease is a chronic symptom of mucosal damage caused by stomach acid coming up from the stomach into the esophagus.

GERD is usually caused by changes in the barrier between the stomach and the esophagus, including abnormal relaxation of the lower esophageal sphincter, which normally holds the top of the stomach closed; impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. These changes may be permanent or temporary ("transient").

Another kind of acid reflux, which causes respiratory and laryngeal signs and symptoms, is called laryngopharyngeal reflux (LPR) or "extraesophageal reflux disease" (EERD). Unlike GERD, LPR is unlikely to produce heartburn, and is sometimes called silent reflux.

Cause

Factors that can contribute to GERD:

• Hiatal hernia, which increases the likelihood of GERD due to mechanical and motility factors.
• Obesity: increasing body mass index is associated with more severe GERD. In a large series of 2000 patients with symptomatic reflux disease, it has been shown that 13 % of changes in esophageal acid exposure is attributable to changes in body mass index.
• Zollinger-Ellison syndrome, which can be present with increased gastric acidity due to gastrin production.
• Hypercalcemia, which can increase gastrin production, leading to increased acidity.
• Scleroderma and systemic sclerosis, which can feature esophageal dysmotility.
• The use of medicines such as prednisolone.
• Visceroptosis or Glénard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.

Prevention

GERD is largely preventable through changes in lifestyle, which are also used as treatment.

Relief is often found by raising the head of the bed to 30 degrees, raising the upper body with pillows, or sleeping sitting up. The upper body must be raised, not just the head; pillows that only raise the head do little for heartburn and put strain on the neck. Sleeping on the left side also keeps gravity working for you, keeping your stomach below your esophagus.

Eating a big meal causes excess stomach acid production, so attacks can be minimized by eating smaller meals. It is also important to avoid eating shortly before bedtime.

Gaining even a few pounds increases your risk of heartburn. Exactly why isn't clear, but the leading theory is that more body fat puts more pressure on the stomach, which can cause highly acidic stomach contents to reflux to the lower esophageal sphincter. For the same reason, tight clothing around the abdomen can also increase the risk of heartburn.

Though less well supported by evidence, a sufferer may benefit from avoiding foods that trigger their symptoms. These commonly include acidic fruit or juices, fatty foods, coffee, tea, onions, peppermint, chocolate, especially shortly before bedtime.

Treatment

 Chinese Medical modalities such as acupuncture, herbal medicines and lifestyle education have been used for centuries as effective and natural treatments for GERD.

According to Chinese Medicine, the most common reasons that create energetic imbalances resulting in GERD are emotional upset and eating the wrong foods.
Chinese Medicine views reflux as rebellious energy (Qi) that is rising up into the esophagus rather than descending to the small intestine. Two common energy imbalances related to acid regurgitation include Stomach Fire and Liver Qi invading the Stomach.

Stomach Fire occurs when too much heat overflows into the stomach. Herbs that can be used to treat this Stomach Fire include the following:

• Huang lian, obtained from the rhizome (root structure) of the Chinese goldthread plant, Coptis chinensis. Huang lian is thought to relieve inflammation of the intestines, reduce heat in the blood, and generally cool the stomach.
• Lu gen, obtained from the rhizome of the Phragmites communis (reed) plant, that draws heat from the stomach.
• Shi gao, a form of gypsum (calcium sulfate), that clears heat and fire from the stomach;
• Zhi mu, rhizomes of the Anemarrhena asphodeloides plant, that provide a cooling effect on the stomach.
• Zhu ru, shavings from the Arundinaria japonica (bamboo) plant, that clears heat from the stomach.

The second cause for acid reflux is said to be an imbalance in the liver. One function of the liver, according to Traditional Chinese Medicine (TCM), is to ensure a proper flow of qi (body energy) throughout all parts of the body. Qi flows through specific pathways, known as meridians, to ensure that all organs of the body are functioning properly. If the liver does not function as it is supposed to, medical problems can develop anywhere in the body. Acid reflux is such a problem.

Again, a variety of herbs can be used to treat acid reflux caused by a liver imbalance, including:

• Bai shao, root of the white peony (Paeonia lactiflora), chosen for its ability to calm the liver;
• Chai hu, root of the Chinese thorowax (Bupleurum chinensis), to stimulate movement of qi in the liver;
• Fang feng, root of the Ledebouriellae divaricatae plant, which expels wind from the body and produces a balance between liver and spleen;
• Mu xiang, costus root (Aucklanida costus), to promote movement of qi and strengthen the spleen;
• Xiang fu, rhizome of the Chinese nutgrass (Cyperus rotundus), which regulates qi in the liver and promotes the circulation of qi.

Combining acupuncture with Chinese herbal formulas is recommended as these medicines can be used to cool the Stomach Fire or to regulate the overbearing Liver energy. For most who suffer with GERD regaining a balanced and healthy digestive system includes dietary, lifestyle changes, exercising regularly and learning relaxation techniques. Lifestyle recommendations include: quitting smoking, eliminating or reducing alcohol, refraining from eating before going to bed, avoiding fast foods, and consuming four to six light meals a day, instead of two or three large meals. Finally, avoid common food triggers such as dairy products, tomatoes, citrus fruits and beverages, garlic, peppermint, and fish oil supplements.