GERD, Gastroesophageal Reflux Disease

Clinic

• GORD or GERD is one of the chronic upper GI diseases where stomach content persistently and regularly flows up into the esophagus
• Risk factors include obesity, pregnancy, smoking, hiatal hernia, and taking certain medications.
• Acid reflux is due to poor closure of LES (Lower Esophageal Sphincter)

Signs / Symptoms

Adults

• Acidic taste in the mouth, Regurgitation, and Heartburn are most common
• Other symptoms include Odynophagia, Sore throat, Increased salivation (Water brash), nausea, chest pain, coughing, and globus sensation.
• Acid reflux can induce asthma attack symptoms like shortness of breath, cough, and wheezing in those with underlying asthma.

• Complication: Reflux esophagitis, Esophageal strictures, Barrett's esophagus, Esophageal adenocarcinoma, Laryngeal injury and Aspiration pneumonia.
• Note that these are dynamic post nodes

Children / Babies

• GERD may be difficult to detect in infants and children since they cannot describe it.
• It may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems, such as wheezing.
• Inconsolable crying, refusing food, crying for food and then pulling off the bottle or breast only to cry for it again,
• Failure to gain adequate weight, bad breath, and burping are also common.
• Children may have one or many symptom and no single symptom is universal in all children with GERD.

Causes	Entities	Miasms	Related disease
Hiatal hernia Obesity Obstructive sleep apnea Gallstones H. pylori infection	Stomach, Eructation Gastric dilation	PLV	Achalasia: GERD is due to poor closure of LES but achalasia is characterized by incomplete LES relaxation/ Increased LES tone, and lack of esophageal peristalsis. Gastroparesis Ileus Sandifer syndrome Dyspepsia

Remedies

• Ambr, Asaf, Bry, Calc, Caps, Carb-v, Chin, Lob, Lyc, Mag-c, Nat-m, Nux-v
• Phos, , Puls, Rheum, Sep, Sulph-ac, Anac, Apis, Arg-m, Arg-n, Ars, Bism, Canth, Carb-ac, Chel, Dios, Ign, Iris, Kali-c, , Nat-c, Nat-p, Nat-s, Nit-ac, Staph, Tab, Teucr, Val
• Morgan Pure By Paterson (Bowel Nososde), Robinia Pseudacacia, Tamarindus Indica and Populus Tremuloides

Banerji protocols
First line	Iris C200 BD or 15-20 min before food Lyc C30 BD
Second line	Condurango C30 BD Ars C3 tBD or 15 min before food
Third line	Nat-p C30 5-20 min before food

Ambr

• Hypersensitive / Hysterical women, who are weakened by age or overwork.
• Sensation as if food did not go down into the stomach.
• Eructation + Violent convulsive cough
• Distension of abdomen after midnight.
• Heartburn from drinking milk.

Ip

• Heart burn with nausea or vomiting and excessive flatulence.
• Suitable in pregnancy digestive problems
• Clean tongue + Thirstless

Nux-v

• Heart burn + Flatulence but without Nausea / Vomiting
• Stomach is generally out of order + Coated Tongue with creamy fur
• Acidity after Rich / Spicy food / Alcohol.
• Polycrest of modern lifestyle.
• Gastralgia, pain goes into back and chest
• Nausea/ Violent retching and patient feels if he vomits, he will get relief.

Robinia

• Excellent remedy for hyperchlorhydria when the eructation and vomiting is so sour that it sets the teeth on edge or dulls them.
• The acidity in Robinia is accompanied by frontal headache, which agg with motion.
• Acidity in children; infants with sour smell of the body.

Calc

• Burning sensation / Acrid eructation / Heartburn/ Acidity / Hyperchlorhydria.
• Feeling of pressure over the stomach +Vomiting of food and mucus.
• Loud belching.
• Sour Eructation / Vomiting.
• Swelling over pit of stomach
• Pica: Craving for indigestible things like chalk, coal, pencil
• Craving for eggs
• Milk disagrees

Staph

• Heart burn caused by smoking.

Ars

• Foul / Sour taste/ Hot burning sensation in Esophagus / Pharynx
• Eructation of Sour/ Acrid fluid/ Nausea
• Retching / Vomiting of slimy mucus tingled with blood.
• Trembling / Coldness of extremities + Oppressive anxiety + Stomachache
• Irregular / Frequent pulse.

Chin

• Abdominal discomfort, Only relieved by belching.
• Sour and bitter eructation or offensive flatus, Worse
  • At night
  • After meals
• Dyspepsia causes eructation and finally undigested food is vomited

Nat-p

• Sourness / Hyperacidity (Like vinegar): Eructation/ Vomiting/ Stomach/ Stools/ Expectoration / Perspiration
• Ulceration of stomach with sour risings.
• Vomiting and diarrhea of infants who have been fed with excess sugar and milk.
• Key point: Yellow creamy coating of tongue and posterior portion of the roof of mouth

Puls

• Dryness of the mouth + No thirst, only a desire to moisten the mouth
• Putrid / Bad / Sour-bitter taste in the morning on walking
• Sensation as if food had lodged under the sternum
• Tongue coated with thick rough white fur;
• Water-brash / Acidity / Heartburn and eructation tasting of food
• Dyspepsia due to Fatty foods/ Pork/ Pastry / Mixed diets.
• The patient is chilly, but is worse from heat, Worse in the evening.

Phos

• Acid peptic disorders (A.P.D)
• Regurgitation of ingesta/ Water-brash + Esophagus spasm
• Craving for Cold Drink / Food, which gives temporary relief in Burning / Heartburn.
• Hungry soon after eating.
• Belching after eating.
• Vomiting; water is thrown up as soon as it gets warm in the stomach.
• Gastritis + Burning extending to throat.
• Craving for Salt/ Acid / Spicy things.
• Spitting of blood without nausea

Aesc

• Heart burn / Great burning distress
• Pressure as from stone in the pit of stomach
• Empty eructation of wind

Ferr

• Heartburn
• Vomiting only of food after eating and drinking

Rheum

• Rheum is a remedy for suckling and children where liver and bile duct is mainly affected.
• Sourness is so marked that even washing does not remove that sour smell from child.
• Desire for many things but cannot eat them.

Carb-v

• Key points: Slowness/ Sluggishness / Lack of reaction
• Slow / Weak digestion causes excessive flatulence and distension esp in the upper part of abdomen.
• Eructions rancid and loud, but do not give any relief to the patient.
• Asthmatic breathing with water-brush.
• Constrictive pain extending to chest with acidity.
• Aversion to meat, fat and milk.
• Desire for salty things.

Sul-ac

• Marked debility /Weakness esp the digestive tract
• Craving for stimulants / Fresh food
• Heartburn / Gastralgia
• Water causes coldness of the stomach; must be mixed with liquors.
• Aversion to the smell of coffee.
• Recurring aphthae in Mouth / Throat