Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backflow, also known as acid reflux, can irritate the lining of your esophagus. While many people experience acid reflux occasionally, GERD is diagnosed when mild reflux happens at least twice a week, or moderate to severe reflux occurs at least once a week.

Symptoms —

GERD presents with several uncomfortable symptoms. Most commonly, people experience:

• A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• Sensation of a lump in your throat

In addition, some people may develop a chronic cough, hoarseness, or throat irritation due to acid exposure.

Causes —

GERD is primarily caused by frequent acid reflux. Normally, when you swallow, a circular band of muscle at the bottom of your esophagus — the lower esophageal sphincter (LES) — relaxes to allow food and liquid to enter the stomach. Afterward, the sphincter closes again.

However, if this sphincter relaxes abnormally or becomes weak, stomach acid can flow back into the esophagus. Over time, this repeated backwash irritates the esophageal lining and leads to inflammation.

Risk factors

Several conditions can increase the risk of developing GERD. For instance:

• Obesity
• Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
• Pregnancy
• Connective tissue disorders, such as scleroderma
• Delayed stomach emptying

Furthermore, certain lifestyle factors can aggravate acid reflux, including:

• Smoking
• Eating large meals or eating late at night
• Eating certain foods (triggers) such as fatty or fried foods
• Drinking certain beverages, such as alcohol or coffee
• Taking certain medications, such as aspirin

Complications

If GERD is left untreated, chronic inflammation can lead to serious complications. Over time, this may include:

Esophageal Stricture

Scar tissue forms due to repeated acid damage. As a result, the esophagus narrows, making swallowing difficult.

Esophageal Ulcer

Stomach acid can erode the esophageal lining, forming open sores. Consequently, these ulcers may bleed, cause pain, and further impair swallowing.

Barrett’s Esophagus

Long-term acid exposure can cause precancerous changes in the lower esophagus. Importantly, this condition increases the risk of esophageal cancer.

Diagnosis

To confirm GERD or check for complications, doctors may recommend several tests.

Upper Endoscopy

Your doctor passes a thin tube with a camera down your throat to examine the esophagus and stomach. This test can reveal inflammation or other damage.

Ambulatory Acid (pH) Probe Test

Doctors place a monitor in the esophagus to measure how often stomach acid enters it and how long it stays there.

Esophageal Manometry

This test measures muscle contractions in the esophagus while swallowing. Therefore, it evaluates coordination and muscle strength.

Barium X-ray

After you drink a chalky liquid, X-rays capture images of the upper digestive tract. Doctors may also ask you to swallow a barium pill to check for narrowing.

Treatment

Over-the-counter medications

The options include:

• First of all, antacids such as Mylanta, Rolaids, and Tums provide quick relief by neutralizing stomach acid. However, they do not heal an inflamed esophagus.
• Next, H-2-receptor blockers like famotidine reduce acid production and provide longer relief.
• Finally, proton pump inhibitors (PPIs) such as omeprazole are stronger acid blockers that allow damaged tissue to heal.

Surgery and other procedures

When medications fail or long-term use is not preferred, procedures may be considered.

Fundoplication

The top of the stomach is wrapped around the LES to strengthen it. Usually, this is done laparoscopically.

LINX Device

A ring of magnetic beads is placed around the junction of the stomach and esophagus. As a result, reflux is prevented while still allowing food to pass.

Ayurvedic Perspective on GERD

In Ayurveda, GERD resembles Amlapitta, a disorder involving aggravated Pitta dosha along with impaired digestion (Agni).

Treatment Principle according to Ayurveda —

• Amlapitta Chikitsa
• Udavarta Chikitsa
• Vatanulomana Chikitsa
• Amapachana Oushadhas

Primarily, Tikta (bitter) rasa is preferred. On the other hand, Madhura (sweet) rasa is avoided in the initial phase because of its snigdha (unctuous) quality. Simultaneously, Ama pachana and Vata anulomana are performed. In some cases, Mrdu Virechana and Sadyovamana are advised.

First Phase

Kashayam —

• Amrta Sadangam kashayam
• Guduchyadi Kashayam
• Pachanamrta kashayam
• Indukantham kashayam
• Tiktaka Kashayam
• Patola and Nimba Kashaya
• Triphala Aragvadha Kashaya
• Triphala Nimba Yashtimadhu Katukarohini Aravagdha Kashayam
• Guduchyadi Kashayam

Ghritam —

• Indukantham Ghrita
• Mahatiktam Ghrita
• Dadimaadi Ghritam
• Manika Ghrita

Other important shamana oushadhas —

• Bhaskara Lavanam
• Pravala Panchamrtam
• Kalyanaka Gudam
• Kamadugha Rasa + Amlapittantaka Loham
• Shankha Bhasma
• Avipattikara Churnam

Second Phase

Kashayam —

• Drakshadi Kashayam
• Mrdvikadi Kashayam
• Madhuyashtiyadi Kashayam
• Vidaryadi Kashayam
• Shatavari Kshira Kashayam
• Kalyanaka Kashayam

Lehyam —

• Shatavari Lehyam
• Dashamula Haritaki
• Parushakadi Lehyam
• Drakshadi Lehyam
• Sukumara Lehyam
• Kalyanaka Gudam

Churnam —

• Triphaladi Churnam

Rasa Oushadhas —

• Amlapittantaka Loham
• Kamadugha Rasa
• Sutashekahara Rasa
• Dharamanduram
• Shankha Bhasmam
• Pravala Bhasmam
• Narikela Lavanam

Some Do’s and Don’ts

• Medicines should be taken one hour after meals and at bedtime
• Additionally, raising the head end of the bed by six inches helps reduce reflux
• Avoid coffee, tea, very spicy, sour, and salty foods
• Likewise, avoid chocolate, oily foods, smoking, and painkillers like aspirin
• Eat small, frequent meals instead of large meals
• Importantly, avoid Aasavas and Arishtas in this condition

The Reference —

1. Gastroesophageal reflux disease (GERD)
2. Principles & Practice of Ayurvedic Clinical Medicine