Heartburn or Gastroesophageal Reflux

Heartburn or gastroesophageal Reflux is a condition in which gastric acids pass from the stomach into the esophagus or the mouth. It is gastric acid that can be detected in the mouth or throat causing retrosternal burning that spreads upward the throat.

It often occurs in a association with other gastro intestinal disease symptoms like epigastric pain, abdominal distention and discomfort, nausea and indeterminate gnawing hunger, but it may occur alone.

Chronic acid reflux and heartburn can contribute to a number of other problems depending where the acids ends up. If gastric contents are aspired into the lungs, as may occur during sleep, bronchitis and asthma may result. If the throat is affected it can cause hoarseness and sore throat and if the oesophagus is scarred, dysphagia and regurgitation may result.

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Acid reflux  it is often marked by the production of excess acid in the stomach. Other symptoms include those of diaphragmatic spasm, hyperventilation, shallow breathing, dysphagia and palpitations, and is tension in the diaphragm muscle that probably contributes to gastroesophageal reflux.

The diaphragm in effect is the foundation of the sphincter between the oesophagus and stomach: excessive tension in this muscle can lead to a functional hiatus hernia and reflux of stomach acid back into the oesophagus.

Other major factors are associated with Gastroesophageal acid reflux are:

  • Obesity and metabolic syndrome
  • Delayed gastric emptying
  • Reduced lower esophageal sphincter pressure
  • Visceral hypersensitivity accentuated by psychological stress.

Conventional medicine treatment for heartburn and gastro oesophageal reflux:

Simple antacids magnesium trisilicate and aluminium hydroxide are readily available and are often used initially by patients, the former tends to cause diarrhoea whilst the latter causes constipation. Many antiacids contaim sodium which may exacerbate fluid retention and one should not use in case of hypertension.

Alginate-containing antiacids are the most often prescribed agents for gastroesophageal acid reflux they form a gel or “foam Raft” with gastric contents and thereby reduce reflux.

Proton Pump inhibitors (PPIs) inhibit gastric  Hydrogen/Potassium-ATPase. PPIs reduce gastric acid secretion by 90% and are the drugs of choice for all but the mild cases. Patients with severe symptoms need prolonged treatment, often for years.

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Physiology and pathology of altered gastric digestion capacity:

It is noteworthy that the secretory capacity of the stomach changes physiologically throughout a lifetime, influencing gastric protein digestion.  It is well established that gastric acid secretion decreases with age, resulting in low gastric acidity in more than 50% of all patients aged 60 years and older. It has been reported that low gastric acid output is associated with pathologies like atrophic gastritis, celiac disease, diabetes mellitus, rheumatoid arthritis, and Sjögren syndrome.

On the other hand, decrease of the gastric acidity is the therapeutic goal in patients with dyspepsia, such as gastritis, ulcer, erosion, and reflux symptoms. Approximately 25% to 54% of the adult population in Western countries is affected by dyspeptic disorders per year.

Despite large differences in mechanisms of action between the currently available drug subclasses of antacids, sucralfate, H2-receptor blockers, and PPIs, all these pharmaceuticals effectively suppress gastric acidity and therefore substantially increase intraluminal pH levels. Five days of PPI intake was shown to increase the gastric pH to an average pH of 5.0.

The use of these medications can reduce the stomach digestive capacity and create further problems. Low acidity can lead to poor nutrient absorption and abnormal bowel flora contributing to be susceptible to bacterial and parasitic infections.

Special caution should be taken with patients that are using PPIs and special attention with risk patients that may be predispose them to further ailments as seen below:

  • Clostridium difficile, Salmonella and Campylobacter infection, since the decrease in gastric acidity may increase the risk of these gastrointestinal infections;
  • Risk of bone fractures (hip, wrist or spine) following the reduction of calcium absorption, especially in the elderly and patients with other risk factors.
  • Risk of magnesium deficiency (monitoring of magnesium levels before and during treatment with PPI should be considered, especially in patients taking digoxin and diuretics and in patients with treatments greater than 3 months).
  • Deficiency of Vitamin B12. Like all medicines that reduce gastric acidity, they can reduce the absorption of vitamin B12.
  • PPis also lower Vitamin C concentration in the gastric juices in its active form and will affect its absorption.

Acid reflux and Chinese Medicine:

 Etiology

 Diet:

Diet plays a major role in the appearance of heartburn in Chinese medicine, the most common cause its overeating certain foods like chillies, spices, alcohol, coffee and chocolate which can create heat in the stomach. Also eating too late at night, while rushing or in stress can disrupt the function of the stomach contributing to food stagnation. The natural direction of chi of the stomach is to descend, if we eat more than the stomach can cope it will obstruct the natural descending function of the stomach and create undigested and accumulated food, making the chi which is blocked to ascend and create regurgitation.

People with a weak digestive function which is directly related to the organs of Spleen/pancreas, can damage the digestive power by eating too much of cold raw foods, medications (antibiotics) and herbs that are cold in nature contributing to a weaker digestion which further damage the spleen/pancreas digestive power creating more stagnation due to undigested food, which is a contributing factor to invert the descending function of the stomach.

 Emotions

Another cause of reflux and heartburn is repressed emotion, buried frustrations of everyday life and supressed anger and resentments. In Chinese medicine this will affect the liver organ and create stagnation of the chi, which will affect the descending function of the stomach and possibly among other symptoms are reflux and heartburn. These patients will often note that stress and tension will aggravate any digestive problems inclusive heartburn and reflux which tends to be episodic and related to the patients emotional state.

Treatment and management of Gastroesophageal reflux:

Practical measures in the treatment of gastroesophageal reflux:

  • elevation of the head of the bed by 10 to 15 cm. This improves esophageal clearance at night
  • regular meal times and not eating on the run
  • avoidance of foods that reduce lower esophageal sphincter tone. these include chocolate, fatty foods, spicy foods, coffee, tomato concentrates and onions, but susceptibility will  vary from individual to individual.
  • refraining from overeating
  • avoiding eating at bed time
  • losing weight if overweight.

Herbal therapy:

Herbal treatment is according to individual cases and emphasis is given in different aspects of the disorder.

Main aspects to have into account are:

  • Improving mucosal protection with Althaea, Ulmus.
  • Bitter herbs are to be used cautiously, in one hand they improve digestive juices output and accelerate gastric emptying, but strong bitters may be too strong and increase stomach acidity, lighter bitters are more appropriate like Cynara or Achilliea.
  • Herbs which are anti-inflamatory will improve healing and alleviate symptoms like Matricaria, Filipendula.
  • Ansiolitic herbs are also very important if the patient recognizes that the condition gets worse with stress or ansiety. Herbs like Valeriana or Scutelaria are useful.

Diaphragm exercises, and Abdominal breathing:

Some meditation and breathing practices are of some importance if there is reduced pressure in the lower esophageal sphincter and accumulated tension on that area, as it helps calm the mind. Deep abdominal breathing may also help decongest diagrammatic muscles and release tension on the area.

 

Any advice in this article does not replace consultation with a qualified therapist. Self medication is not advised.

Article written by Sérgio Caroço, ND, BSc (honors) TCM: Acupuncture.

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