GERD, Gastroesophageal Reflux Disease

Clinic

• Gastro-oesophageal reflux disease (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

• 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.

Factors that have been linked with GERD, but not conclusively:

• Obstructive sleep apnea
• Gallstones, which can impede the flow of bile into the duodenum, which can affect the ability to neutralize gastric acid

H. pylori infection: In 1999, a review of existing studies found that, 40% of GERD patients also had H. pylori infection. The eradication of H. pylori can lead to an increase in acid secretion, leading to the question of whether H. pylori-infected GERD patients are any different than non-infected GERD patients. A double-blind study, reported in 2004, found no clinically significant difference between these two types of patients with regard to the subjective or objective measures of disease severity.

Entities

• Stomach, Eructation
• Gastric dilation

Miasms

• PLV

Related disease

• 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

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 two doses daily or 15-20 min before food Lyc C30 two doses daily
Second line	Condurango C30 two doses daily Ars C3 two doses daily 15 min before food
Third line	Nat-p C30 5-20 min before food

Ambr

• Adapted to hypersensitive and hysterical women, who are weakened by age or overwork.
• Patients are very bashful, intensely shy.
• After eating there is a feeling as if food did not go down into the stomach.
• Eructations with violent convulsive cough are a peculiar symptom
• Distension of abdomen after midnight.
• Heartburn from drinking milk.

Ip

• Heart burn with nausea or vomiting and excessive flatulence.
• It is suitable in pregnancy also.
• Clean tongue with thirstlessness.

Nux-v

• Heart burn with flatulence and much acidity but without nausea and vomiting,
• Tongue is coated with creamy fur, stomach is generally out of order.
• Acidity after rich and spicy food and after alcohol.
• Patient is irritable in temperament
• It is great polycrest and frequently prescribed medicine for several conditions that originate from so called modern lifestyle.
• He is very industrious, quick and irritable.
• Such patients who do a lot of mental work, lead a sedentary life and frequently indulge in stimulants, drugs or alcohol.
• All gastric problem starts from heart burn; gastralgia, pain goes into back and chest
• Amel from vomiting.
• Nausea; violent reteching 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 in the stomach, acrid eructations; feeling of pressure over the stomach with vomiting of food and mucus.
• This polycrest is very effective in cases of heartburn, acidity or hyperchlorhydria.
• Heartburn with loud belching.
• Frequent sour eructations and sour vomiting.
• Swelling over pit of stomach like an inverted saucer.
• Craving for indigestible things like chalk, coal, pencil; marked craving for eggs.
• Milk disagrees

Staph

• Heart burn caused by smoking.
• Patient often has lot of frustration and suppressed anger that precipitates sickness.

Ars

• Foul or sour taste, hot burning sensation in the esophagus and pharynx
• Eructation of sour, acrid fluid, nausea, retching and vomiting of slimy mucus tingled with blood.
• Trembling and coldness of extremities with pain in stomach and oppressive anxiety
• Irregular and frequent pulse.

Chin

• Abdominal discomfort which is only relieved by belching.
• Key point: Sour and bitter eructations or offensive flatus, worse at night and after meals
• Another key note: Food does not digest but lies a long time in the stomach causing eructations and finally is vomited undigested.

Nat-p

• Hyperacidity, sour smelling sweats, acid condition of stomach with nausea and vomiting of acrid fluid,
• Sour eructations, Vomiting of sour fluid like vinegar.
• Ulceration of stomach with sour risings.
• Ailments from too much lactic acid in the system as a result of too much sugar.
• Sourness; sour eructation, vomiting, stomach, stools, expectoration even sweats.
• Suitable in cases of vomiting and diarrhea of infants who have been fed with excess sugar and milk- excess of acidity.
• Key point: Yellow creamy coating of tongue and posterior portion of the roof of mouth

Puls

• Key point: Dryness of the mouth, Putrid taste in the morning on walking, A sensation as if food had lodged under the sternum
• Tongue coated with thick rough white fur; acidity and heartburn
• Food taste bitter, sour or putrid; water-brash and eructation tasting of food
• No thirst, only a desire to moisten the mouth
• Bad taste is special indication of Puls
• Dyspepsia arising from fatty foods, pork, from pastry or mixed diets.
• The patient is chilly, but is worse from heat, Worse in the evening.

Phos

• Wonderful remedy for Acid peptic disorders (A.P.D).
• Regurgitation of ingesta, waterbrash with spasm of esophagus.
• Patient has marked craving for cold drink and cold food, which gives temporary relief in the burning and heartburn.
• Hungry soon after eating.
• Belching after eating.
• Vomiting; water is thrown up as soon as it gets warm in the stomach.
• Gastritis with burning extending to throat.
• Craving for salt, acid and spicy things.
• Craving for cold food which is vomited as soon as it becomes hot in the stomach
• Spitting of blood without nausea is also common in this remedy.

Aesc

• Excellent remedy for heart burn, great burning distress
• Pressure as from stone in the pit of stomach
• Empty eructations of wind

Ferr

• Remarkable remedy for heart burn, 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

• Slowness, sluggishness and lack of reaction are the key points
• Slowness in metabolism or 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 waterbrush.
• Constrictive pain extending to chest with acidity.
• Aversion to meat, fat and milk.
• Desire for salty things.

Sul-ac

• Like all acids, it also has marked debility
• Here the debility or weakness affects esp the digestive tract; makes it relax, with a craving for stimulants.
• Heartburn and gastralgia.
• Water causes coldness of the stomach; must be mixed with liquors.
• Aversion to the smell of coffee.
• Desire for fresh food.
• Recurring apthae in mouth and throat.