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

Children / Babies

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

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

Top remedies			Concomitants / Modalities
Acid Reflux and GERD	Robinia	Hyperchlorhydria when the eructation and vomiting is so sour that it sets the teeth on edge or dulls them. Acidity in children; infants with sour smell of the body. Intense heartburn Sour belching and vomiting	Acidity is accompanied by frontal headache, Acidity agg with motion Night time agg, Lying down agg Acidity can causeinsomnia
Sour, Bitter Belching/ vomiting	Iris	Vomiting of sour bitter fluid that burns the throat Smarting, burning sensation in the throat, and heartburn Burning distress and pains in the epigastric region at frequent intervals. Constant nausea may be present with these symptoms. There is excessive indigestion. Food is vomited an hour after eating Heartburn; burning in throat	Vomiting with weakness Headache arising with acidity
Heartburn + Dysphagia	Nat-p	Sour belching, waterbrash Vomiting of sour fluid or cheesy, curdled masses. 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.	Lump sensation in the throat + Loss of appetite (Maybe) Key point: Yellow creamy coating of tongue and posterior portion of the roof of mouth

Second class remedies			Concomitants / Modalities
Burning Pain in Throat	Ars	Regurgitation of acrid matter, water brash, heartburn, Esophagitis Foul / Sour taste/ Hot burning sensation in Esophagus / Pharynx Eructation of Sour/ Acrid fluid/ Intense nausea Retching / Vomiting of slimy mucus tingled with blood.	Burning agg upon swallowing. Swallowing is difficult and painful. Weakness Irregular / Frequent pulse Trembling / Coldness of extremities Oppressive anxiety + Stomachache
Sour Taste in Mouth	Calc	Regurgitation of sour substances + Flow of sour, watery fluid from the mouth. Foul odor from the mouth + Nausea. (Maybe) Sour, bitter belches, vomiting of sour, bitter slime and heartburn (Maybe) Burning from the food pipe extends to the throat. Continued loud belching esp after eating + Cough/ Nausea. Burning sensation / Acrid eructation / Heartburn/ Acidity / Hyperchlorhydria. Feeling of pressure over the stomach +Vomiting of food and mucus. Sour Eructation / Vomiting. Swelling over pit of stomach	Pica: Craving for indigestible things like chalk, coal, pencil Craving for eggs Milk disagrees
Bloating + Heartburn	Carb-v	Sour, offensive belching that gets worse after drinking or eating Burning sensation in the throat and dysphagia Even the simplest of food tend to trigger the condition. Slow digestion causes excessive Flatulence esp in upper part of abdomen. Rancid / Loud Eructions, but do not give any amel	Asthmatic breathing with water-brush. Constrictive pain extending to chest with acidity. Aversion to meat, fat and milk. Desire for salty things. General Slowness/ Sluggishness / Lack of reaction
Acid Reflux + Cough	Nux-v	Vomiting usually appears from coughing. Throat is sore and raw Swallowing may be painful. Burning in the throat, esp at night time Regurgitation of food + Heartburn and sour belching Heart burn + Flatulence without Nausea / Vomiting Stomach is generally out of order + Coated Tongue with creamy fur	Gastric cough that agg at night time and prevents sleep Acidity after Rich / Spicy food / Alcohol Polycrest of modern lifestyleGastralgia, pain goes into back and chest Nausea/ Violent retching he feels if he vomits, he will get relief.
Acid Reflux + Laryngitis (Hoarse Voice)	Phos	Hard, dry, racking cough Heartburn, Sour belching, Sour taste in the mouth Vomiting of food or sour, Acidic liquid Acid peptic disorders (A.P.D) Regurgitation of ingesta Water-brash + Esophagus spasm Belching after eating. Gastritis + Burning extending to throat.	Craving for Cold Drink / Food, which amel Burning / Heartburn temporary Hungry soon after eating Craving for Salt/ Acid / Spicy things. Spitting of blood without nausea Vomiting; water is thrown up as soon as it gets warm in the stomach.
Acid Reflux from Fatty Food	Puls	Heartburn and water brash. Belching of food, bitter taste in mouth, Nausea and a sensation of having a lump (Maybe) Putrid / Bad / Sour-bitter taste in the morning on walking Sensation as if food had lodged under the sternum Water-brash / Acidity / Heartburn and eructation tasting of food Dyspepsia due to Fatty foods/ Pork/ Pastry / Mixed diets.	Fatty food like creams, pastries, and ice creams trigger the acid reflux Dryness of the mouth + No thirst, only a desire to moisten the mouth Tongue coated with thick rough white fur She is chilly, but agg from heat Agg in the evening.
Acid Reflux + Intense Sour Belching	Sul-ac	Sour vomiting and nausea Sour vomiting mostly appears after eating. Heartburn / Gastralgia Water causes coldness of the stomach; must be mixed with liquors.	Marked debility /Weakness esp the digestive tract Craving for stimulants / Fresh food Aversion to the smell of coffee. Recurring aphthae in Mouth / Throat

Third class remedes			Concomitants / Modalities
	Ambr	Sensation as if food did not go down into the stomach. Eructation + Violent convulsive cough Distension of abdomen after midnight.	Hypersensitive / Hysterical women, who are weakened by age or overwork Heartburn from drinking milk.
	Ip	Heart burn with nausea or vomiting + Excessive flatulence. Suitable in pregnancy digestive problems	Clean tongue + Thirstless
	Staph	Heart burn caused by smoking.
	Chin	Abdominal discomfort, Only relieved by belching. Sour and bitter eructation or offensive flatus, Worse Dyspepsia causes eructation and finally undigested food is vomited	Agg At night After meals
	Aesc	Heart burn / Great burning distress Empty eructation of wind	Pressure as from stone in the pit of stomach
	Ferr	Heartburn Vomiting only of food after eating and drinking
	Rheum	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.

Reflux in Children

Vomit soon After Milk	Aeth	He throws up all the milk immediately after its intake forcibly. The character of vomiting is like Curdled milk / Cheesy matter/ Frothy white matter. He gets drowsy after vomiting. Repeated hiccoughing.
Irritable / Restless Infants	Cham	Wind colic and regurgitation of food. Colic causes pain in stomach due to obstruction of wind in the intestines. He vomits out whatever has been Drunk / Eaten, Vomit is usually Slimy/ Sour smelling. Abdomen is distended, full and tensed. Hiccough and foul smelling belches Stomach problems. The child cries, screams, groans and asks to be carried around.
Vomiting + Colic Abdomen	Nat-p	It works by neutralizing the stomach acid and promotes healthy digestion. Children vomit out curdled milk or cheesy masses. Child may experience several attacks of acid reflux during the day, along with vomiting. Abdominal colic is usually very intense and can lead to restless sleep. A characteristic yellow, creamy coating on the back of the roof of mouth and tongue
Night agg	Robin	Acid reflux in babies when there is a regurgitation of stomach acid with sour vomiting. The child tends to have a rancid odor all over the body. Symptoms agg during the night time and disturb the child’s sleep. Abdominal distension is well noted, and burps may be present. Burping can bring temporary relief, but the child may cry with colic after eating.
Sour Smelling Vomiting	Calc	Whatever has been eaten gets vomited, Vomit: Curdled milk / Milk in the form of cheese Stomach cramps may appear along with vomiting. Abdomen is hard and tense, and there are frequent hiccoughs and belching. Vomiting in infants during the teething period
Excessive Burping	Carb-v	Violent belchings that are foul-smelling Offensive belchings occur after eating or drinking + Gagging and vomiting. Child feels very uncomfortable after eating even the smallest amount of food. Abdominal pain may arise with much flatus. Stomach is distended and seems full to bursting with trapped wind. Release of gas brings comfort to the baby.
Vomiting of Food/ Milk Soon After eating	Sanic	All the food comes up with a gush immediately after eating. Child usually tends to fall asleep after eating The vomiting looks like large and tough curds. Abdominal bloating + Gurgling sounds.