Gastroesophageal reflux

Also known as reflux, heartburn, or acid indigestion. Reflux is derived from "re" meaning "back" and "fluxus" meaning "flow". Gastroesopageal reflux is a form of dyspepsia (indigestion) where stomach contents are regurgitated into the oesophagus and sometimes the mouth, which results in a burning sensation in the stomach or chest. This is commonly described as "heartburn'. There may also be the sensation of fluid in the oesophagus or mouth, and a sour or bitter taste. The resulted burning sensation is not necessarily due to increased secretion of HCL, and is usually the result of dietary and lifestyle factors including stress.

Complications include ulceration and inflammation of the oesophagus, haemorrhage, pain on swallowing, chronic coughing or hoarseness, and a sore throat. Chronic reflux can lead to changes in the oesophageal cells, known as Barrett's oesophagus, that increase the risk of cancer of the oesophagus.

Aetiology

The primary cause of gastroesophageal reflux is incompetence of the lower oesophageal sphincter, which means that the ring of muscle between the oesophagus and the stomach does not close tightly enough and may allow some stomach contents to move backwards into the oesophagus or mouth. In the past this condition was attributed solely to a sliding hiatus hernia.

Gastroespohageal reflux may be caused by conditions or activities that waken the lower oesophageal sphincter or increase the pressure of the stomach, as outlined below.

Conditions that increase the chances of reflux:

• Ascites and obesity
• Eating large meals
• Lyi8ng flat after eating
• Pregnancy and the oral contraceptive pill
• Wearing clothes that fit tightly across the waist or abdomen
• Ageing
• Irritable bowel syndrome
• Peptic ulceration
• Asthma
• Sliding hiatus hernia

Substances that weaken the tightness of the lower oesophageal sphincter:

• Alcohol
• Cigarettes
• Methylxanthinbe alkaloids: Caffeine and theophylline (coffee, chocolate, tea)
• Garlic and onions
• High fat foods
• Peppermint and spearmint oils
• Some drugs (anticholinergics, calcium channel blockers, diazepam, meperidine)

Possible supplements:

• Digestive enzymes, papaya, or bromelain.
• B complex vitamins
• Slippery elm
• Calcium carbonate

Herbal treatment

As  much as possible avoid dietary and life style factors that aggravate the reflux or have a weakening affect on the lover oesophageal sphincter.

Action required:

• Demulcent
• Mucous membrane trophorestoratrive
• Vulnerary
• Anti-inflammatory

A typical prescription

Chamomile                                                 40 mL

Marshmallow root/leaf                                 40 mL

Meadow sweet                                            40 mL

Rib wort                                                      50 mL

Calendula                                                    30 mL

Dosage - 5mL 3 times daily after meals

Rationale

The Carminative, anti-inflammatory and sedative effects of chamomile make it and ideal herb for this condition

Marshmallow has a soothing effect because of it's high mucilage content

Meadowsweet reduces excessive stomach acidity, is anti-inflammatory, demulcent and healing and number one herb in reflux as it works as an antacid.

Ribwort is restorative to mucous membranes.

Calendula has vulnerary activity therefore encourages healing.

Gentian would be prescribed if the HCl production were low so that food is not sitting in the stomach for extended periods of time. Gentian also, over time, increases the integrity of the lower oesophageal sphincter.

Tablets/Capsules: Golden seal tablets

Diet and lifestyle:

Food to avoid:

Avoid carbonated drinks, fatty foods, processed foods, sugar, spicy foods, garlic and onions, coffee (regular or decaffeinated), alcohol, chocolate and smoking.

Limit foods that reduce the compliance of the lower oesophageal sphincter or increase the production of stomach acid.

If oesophagitis is present avoid foods and drinks that irritate the mucosa, for example citrus fruits, tomatoes, pepper, spices, and very hot or very cold foods and drinks.

Food to include:

Consume pineapple or papaya with meals, Consume aloe vera juice. Drink liquids between meals (not within one hour of eating) to avoid distending the stomach excessively. Consume smaller meals, eat food slowly, chew adequately and relax during meals, don't eat within 2-3 hours of bedtime.

Other:

• Elevate the head of the bed by about 15-20 centimeters
• Avoid tight clothing, particularly after eating
• Avoid lying down or bending over after eating
• Lose weight if needed
• Reduce stress
• Note that the early signs of angina or heart attack can sometimes be very similar to those of gastroesophageal reflux. If symptoms are long lasting and other symptoms such as pain down the left arm, weakness, dizziness, or shortness of breath occur, seek medical advice.
• Whilst antacids may provide initial relief from heartburn they may ultimately make the situation worse. By neutralizing stomach acid they inhibit correct digestion of foods and hinder nutrient absorption. Inadequate digestion of foods can contribute to symptoms such as heartburn and indigestion. Self medicating with antacids may increase the likelihood of side effects from these medications and may mean that the condition is not treated correctly leading to ulceration, inflammation and Barrett's oesophagus.