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Gastro-Oesophageal Reflux

Bhagwati Ayurveda & Panchkarma / Gastro-Oesophageal Reflux

Gastroesophageal reflux disease (GERD), also known as acid reflux, is a long-term condition where stomach contents come back up into the esophagus resulting in either symptoms or complications. Symptoms include the taste of acid in the back of the mouth, heartburn, bad breath, chest pain, vomiting, breathing problems, and wearing away of the teeth. Complications include esophagitis, esophageal strictures, and Barrett’s esophagus.

Risk factors include obesity, pregnancy, smoking, hiatus hernia, and taking certain medicines. Medications involved include antihistamines, calcium channel blockers, antidepressants, and sleeping medication. It is due to poor closure of the lower esophageal sphincter (the junction between the stomach and the esophagus). Diagnosis among those who do not improve with simpler measures may involve gastroscopy, upper GI series, esophageal pH monitoring, or esophageal manometry.

Treatment is typically via lifestyle changes, medications, and sometimes surgery. Lifestyle changes may include not lying down for three hours after eating, losing weight, avoiding certain foods, and stopping smoking. Medications include antacids, H2 receptor blockers, proton pump inhibitors, and prokinetics. Surgery may be an option in those who do not improve with other measures.

Symptoms

  • Reflux esophagitis – inflammation of esophageal epithelium which can cause ulcers near the junction of the stomach and esophagus
  • Esophageal strictures – the persistent narrowing of the esophagus caused by reflux-induced inflammation
  • Barrett’s esophagus – intestinal metaplasia (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus
  • Esophageal adenocarcinoma – a form of cancer

Causes

  • 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 2,000 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.
  • A high blood calcium level, 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.

Treatment

According to Ayurveda, Acid Reflux is a result of aggravation of Pitta Dosha. Pitta is an Ayurvedic humour that symbolizes heat or fire. It is hot, sharp, intense, acidic and pungent in nature and is located in the stomach. Aggravated pittaleads to increase of acidic content in stomach fluids. Actually, the reflux of the stomach’s liquid contents into the oesophagus occurs in most normal individuals. In such patients, the refluxed liquid contains acid more often due to aggravated pitta, which leads to acid reflux.

Diet & Lifestyle Advice

  • Avoid tea, coffee, and carbonated or alcoholic beverages.
  • Avoid processed and fermented foods.
  • Avoid using garlic, ginger, onions, tomatoes, and vinegar in cooking.
  • Also avoid rich gravies, sour, salty, and spicy foods.
  • Curd should be strictly avoided.
  • Take meals in a relaxed atmosphere at regular intervals.
  • Practice Yoga and Pranayama such as Vajrasana, Bhujangasana, Salabhasana, Bhastrika Pranayama, Shitali Pranayama and Shitkari Pranayama.

Prevention

Certain foods and lifestyle are considered to promote gastroesophageal reflux, but most dietary interventions have little supporting evidence. Some evidence suggests that reduced sugar intake and increased fiber intake can help. Avoidance of specific foods and of eating before lying down should be recommended only to those in which they are associated with the symptoms. Foods that have been implicated include coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods. Weight loss and elevating the head of the bed are generally useful. A wedge pillow that elevates the head may inhibit gastroesophageal reflux during sleep. Stopping smoking and not drinking alcohol do not appear to result in significant improvement in symptoms. Although moderate exercise may improve symptoms in people with GERD, vigorous exercise may worsen them.[