Abstract–
The Globalization is now pervading each country of the world and bringing this to the door of every person. This comfort and luxury are the gift of modern and evolved science as well as a new improved life-style but along with the free package of some intractable diseases. But this increased life time is not comfortable for all as it is full of stress, tension and worries. The fast changing lifestyle especially in the developing and undeveloped countries is putting an extra burden on the human economy which leads to sedentary habits especially related to food. People are more prone to eat spicy and junk food which causes many gastric troubler oesophageal sphincter. Gastro-oesophageal reflux disease is one of the most common and grievous diseases of them. This article examines homeopathy’s function in treating Gastro-Esophageal Reflux Disease, emphasising its holistic tenets and customised therapeutic approaches.
Introduction
“By eating many fruits and vegetables in place of fast food and junk food, people could avoid diseases and obesity too.”
Nowadays stress is increased due to workload, and along with that food habits also changed. People are more prone to eat spicy food, bakery products which causes many GIT complaints and one of the main complaints is gastro -oesophageal reflux disease.
Gastro oesophageal reflux disease, also known as acid reflux, is a long-term condition where stomach contents come back up into the oesophagus resulting in either symptoms or complications.1,2 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, oesophageal strictures, and Barrett’s oesophagus.
This is the only way through which a state of complete health can be regained by removing all the signs and symptoms from which a patient is suffering. The aim of homeopathy is not only to treat Gastro-Oesophageal Reflux Disease, but to address its underlying cause and individual susceptibility of the patient.3 Homoeopathy treats a person as a whole, correcting internal imbalance and making hormonal coordination in between different organs of the body. So the study is carried out to rule out the efficacy of Homeopathic remedies in management of gastro-oesophageal reflux disease.
Gastro-Esophageal Reflux Disease –
Definition
Gastro-oesophageal refers to the stomach and oesophagus. Reflux means to flow back or return. Therefore, gastro-oesophageal reflux is the return of the stomach’s contents back up into the oesophagus. In normal digestion, the lower oesophageal sphincter opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the oesophagus. Gastro-oesophageal reflux occurs when the lower oesophageal sphincter is weak or relaxes inappropriately, allowing the stomach’s contents to flow up into the esophagus.4
Epidemiology-
16 studies of Gastro-Oesophageal Reflux Disease epidemiology published since the original review were found to be suitable for inclusion (15 reporting prevalence and one reporting incidence), and were added to the 13 prevalence and two incidence studies found previously.
Prevelence
The range of GASTRO-OESOPHAGEAL REFLUX DISEASE prevalence estimates was 18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America.
Incidence per 1000 person-years was approximately 5 in the overall UK and US populations, and 0.84 in paediatric patients aged 1-17 years in the UK. Evidence suggests an increase in Gastro oesophageal reflux disease since 1995 (p<0.0001), particularly in North America and East Asia Gastro oesophageal reflux disease is prevalent worldwide, and disease burden may be increasing. Prevalence estimates show considerable geographic variation, but only East Asia shows estimates consistently lower than 10%.5
Gastro oesophageal reflux disease is caused by a failure of the lower oesophageal sphincter. In healthy patients, the “Angle of His”—the angle at which the oesophagus enters the stomach—creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the oesophagus where they can cause burning and inflammation of sensitive oesophageal tissue.3
Aetiology
There is no known single cause of gastro-oesophageal reflux disease (Gastro oesophageal reflux disease). It occurs when the oesophageal defences are overwhelmed by gastric contents that reflux into the oesophagus. This can cause injury to tissue. Gastro oesophageal reflux disease can also be present without oesophageal damage (approximately 50 – 70% of patients have this form of the disease).
Gastro oesophageal reflux occurs when the lower oesophageal sphincter barrier is somehow compromised. Occasional reflux occurs normally, and without consequence other than infrequent heartburn, in people who do not have Gastro oesophageal reflux disease. In people with gastro oesophageal reflux disease, reflux causes frequent symptoms or damages the oesophageal tissue.
Even when the lower oesophageal sphincter and the diaphragm are intact and functioning normally, reflux can still occur. The lower oesophageal sphincter may relax after having large meals leading to distension of the upper part of the stomach. When that happens there is not enough pressure at the lower oesophageal sphincter to prevent reflux. In some patients the lower oesophageal sphincter is too weak or cannot mount enough pressure to prevent reflux during periods of increased pressure within the abdomen.
The extent of injury to the oesophagus – and the degree of severity of Gastro oesophageal reflux disease – depends on the frequency of reflux, the amount of time the refluxed material stays in the oesophagus, and the quantity of acid in the esophagus.6
Pathophysiology of Gastro oesophageal reflux disease –
The oesophagus and the stomach are separated by a high-pressure zone produced by tonic contraction of specialized smooth muscle of the lower oesophageal sphincter and the phasic contraction of the cural diaphragm. In normal individuals, this functional barrier is maintained except to allow ante-grade flow with swallowing and retrograde flow with belching and vomiting. Reflux is likely when the lower oesophageal sphincter has a very low basal pressure. In patients with a weak sphincter, increases in intra-abdominal pressure can easily overcome that pressure and produce pathological amounts of reflux. On the other hand, most patients with reflux have relatively normal pressure and it is felt that the lower oesophageal sphincter tends to relax at inappropriate times, leading to reflux (transient lower oesophageal sphincter relaxations).
Hiatus herniation predisposes to reflux as a result of a dissociation of a weak lower oesophageal sphincter with the added pressure provided by the diaphragm. In addition, a hernia predisposes to inadequate clearance of gastric contents away from the lower oesophagus.
Most of the fluid volume of reflux ate is promptly cleared from the oesophagus by one or more swallows. Small amounts of residual acid are neutralized by weakly alkaline saliva with subsequent swallows. Clearance is delayed during sleep when swallowing is lower oesophageal sphincters reliably triggered by reflux. Smoking exacerbates the effects of reflux by inhibiting salivation, thereby delaying acid clearance.
Repeated and prolonged exposure to gastric secretions can result in erosion and ulceration of the oesophageal mucosa. The occurrence of injury, expressed as erosive esophagitis, is dependent on three factors: (1) duration of exposure; (2) the chemical composition of the reflux ate; and (3) the natural resistance of the individual. Thereby, we can explain several well-known clinical observations. First, the severity of esophagitis tends to be worse when oesophageal acidification is prolonged, and reducing gastric acid secretion promotes healing of peptic esophagitis. Secondly, two patients with similar levels of reflux, as measured by pH monitoring, may have marked differences in mucosal appearance at endoscopy. One may have severe erosive esophagitis while the other, a normal-looking mucosa. The role of bile and pancreatic juice in producing esophagitis in patients with an intact lower oesophageal sphincter and pylorus is limited. This mechanism is of considerable importance in patients without an intact pylorus.
Heartburn, on the other hand, is dependent primarily on mucosal sensitivity, not mucosal ulceration. Thus, some patients with symptomatically severe heartburn may have no peptic esophagitis, while others with no heartburn can present with a peptic stricture secondary to longstanding peptic esophagitis. Therefore, the severity of heartburn is a poor predictor of esophagitis.
This is a particular problem in older patients who often present with advanced oesophageal damage despite relatively modest symptoms.7
Clinical features-
1. Heartburn – Heartburn is a pain or discomfort typically described as burning in nature. Its primary position is usually lower retrosternal, deep to the xiphi-sternum. Heartburn commonly radiates upwards, retro-sternal, occasionally as far as the neck. There may be associated epigastria pain.
2. Regurgitation – Regurgitation describes the intermittent, sudden and often spontaneous sensation of material moving from the stomach proximally towards the oesophagus and throat.
Regurgitation is the second ‘typical’ symptom of Gastro oesophageal reflux disease. Patients with regurgitation often, but not always, also have heartburn. Although the two symptoms can be closely linked temporally, heartburn tends to be more frequent.
Complications of acid regurgitation -Severe acid regurgitation can be associated with other problematic symptoms including choking attacks, cough, asthma, hoarseness of voice, a foul taste in the mouth in the morning, bad breath, a sore tongue, dental caries and nasal aspiration. Nasal aspiration is a particularly unpleasant consequence of regurgitation, usually occurring at night.7
3. Water brash – Sometimes it’s also called acid brash. If you have acid reflux, stomach acid gets into your throat. This may make you salivate more. If this acid mixes with the excess saliva during reflux, you’re experiencing water brash. Water brash usually causes a sour taste, or it may taste like bile. You may also experience heartburn with water brash because the acid irritates the throat.
4. Problems with swallowing
5. Odynophagia – pain on swallowing. It is usually reported in response to hot or cold foodstuffs.
6. Dysphagia – The sensation of obstructed swallowing is unusual in patients with heartburn and regurgitation and, when present, is worthy of special clinical attention. Chest pain
7. Vomiting
8. Sore throat
9. Chronic cough, particularly at night
10. Lung infections
11. Nausea
Investigation of Heartburn and Acid Regurgitation –
- Upper gastrointestinal endoscopy
- Oesophageal biopsy at upper gastrointestinal endoscopy
- Upper gastrointestinal radiology
- Ambulatory reflux monitoring
- Bernstein testing
- Oesophageal manometry 9
Complications-
- Esophagitis:
- Barrett’s oesophagus
- Iron deficiency anaemia
- Benign oesophageal stricture
- Gastric volvulus10
Preventive Measures and Diet –
If you’re looking for a way to prevent the frequent heartburn that goes along with Gastro oesophageal reflux disease, some easy lifestyle changes may do the trick. A smarter diet, better sleep habits, and stress relief could help keep you free of the uncomfortable burning sensation in your chest that’s a hallmark of digestive disease.
Get on a Gastro oesophageal reflux disease Diet –
Gastro oesophageal reflux disease is short for gastro-oesophageal reflux disease. A key way to prevent it is to make tweaks to your diet and the way you eat.
Have small, frequent meals.
Avoid trigger foods. Some things you eat can make your heartburn act up, like:
Chocolate, Citrus fruits and juices, Peppermint, Tomato products, Fried, fatty, or spicy foods, Garlic and onions
You may also want to keep a food diary, where you jot down everything you eat and note the time you have Gastro oesophageal reflux disease symptoms. It may reveal a pattern that shows you which foods are triggers for your heartburn.
Cut back on alcohol, tea, coffee, and carbonated drinks. Tweak Your Bedtime Routine
Don’t eat before bedtime.
Prop up the head of your bed 6 to 10 inches.
Homoeopathic treatment-
There are homeopathic remedies acting on gastric lower oesophageal sphincter including gastro-oesophageal reflux disease, gastritis, peptic ulcers, hiatal hernia, and many more. Treatment modality may depend on the severity of the condition, while preventive measures are always useful and can be adopted.
The treatments which are available in different systems of medicine cannot avoid the pathogenesis of gastric lower oesophageal sphincter especially gastro-oesophageal reflux disease. So recurrence of gastro-oesophageal reflux disease even after the conventional treatment is becoming a great problem. Constant efforts are being made to evolve and effective treatment as well as prevention of recurrence of the gastro-oesophageal reflux disease. Hence it is time to find out such a medicinal treatment which will solve this problem.
Homoeopathic medicine offers a unique, safe and effective means of treating Gastro oesophageal reflux disease. Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity Homoeopathic Therapeutics for
GASTRO-OESOPHAGEAL REFLUX DISEASE –
1. Arsenic Album- Cannot bear the sight or smell of food. Great thirst; drinks much, but little at a time. Nausea, retching, vomiting, after eating or drinking. Anxiety in the pit of stomach. Burning pain. Heartburn; gulping up of acid and bitter substances which seem to excoriate the throat. Vomiting of blood, bile, green mucus, or brown-black mixed with blood. Stomach extremely irritable; seems raw, as if torn. Gastralgia from slightest food or drink. 11
2. Phosphorus – Sour taste and sour eructation’s after every meal. Belching large quantities of wind, after eating. Vomiting; water is thrown up as soon as it gets warm in the stomach. Post-operative vomiting. Cardiac opening seems contracted, too narrow; the food scarcely swallowed, comes up again. Region of stomach painful to touch, or on walking. Inflammation of stomach, with burning extending to throat and bowels.11
3. Sulphur – Complete loss of, or excessive appetite. Putrid eructation. Food tastes too salty. Drinks much, eats little. Great acidity, sour eructation. Burning, painful, weight-like pressure. Nausea during gestation.11
4. Acetic Acid – Salivation. Fermentation in stomach. Vomits after every kind of food. Epigastria tenderness. Burning pain as of an ulcer. Cancer of stomach. Sour belching and vomiting. Burning water brash and profuse salivation. Hyperchlorhydria and gastralgia. Violent burning pain in stomach and chest Nausea and faintness when rising up.12
5. Sulphuric Acid – Heartburn; sour eructation’s; sets teeth on edge. Craving for alcohol. Water causes coldness of stomach; must be mixed with liquors. Relaxed feeling in stomach. Sour vomiting. Hiccough. Coldness of stomach relieved by applied heat Nausea with chilliness.12
Conclusion and Summery-
In this study it has been observed that diet is one of the important parts in managing the Gastro oesophageal reflux disease. Gastro-oesophageal reflux disease is a long-term condition where stomach contents come back up into the oesophagus 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, oesophageal strictures, and Barrett’s oesophagus.
Disease is an unstable state of disequilibrium where the person loses a sense of well-being either physically, mentally, socially or spiritually. For the person to get diseased Susceptibility plays an important role. If the susceptibility is lower oesophageal sphincters than the cause flows in the direction of least resistance.
For these homoeopathic treatments is the proper mode of treating it as complete health can be regained by removing all the signs and symptoms from which a patient is suffering.
References–
1. Gastro-oesophageal Reflux and Gastro-oesophageal Reflux Disease in Adults. [Internet] NIDDK. November 13, 2014. Retrieved 13 September 2016.
Available from: https://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease#cite_note-NIH2014-4
2. Kahrilas, PJ; Shaheen, NJ; Vaezi, MF; American Gastroenterological Association, Institute; Clinical Practice and Quality Management, Committee (October 2008). [Internet] American Gastroenterological Association Institute technical review on the management of gastro-oesophageal reflux disease.. Gastroenterology. 135 (4): 1392–1413,1413. e1–5. [Internet] doi:10.1053/j.gastro.2008.08.044. PMID 18801365. Available from: https://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease#cite_note-NIH2014-4
3. Hahnemann Samuel, In: Introduction of organon of medicine, 6th edition, B. Jain publisher’s pvt. Ltd. December 1921, p.94, 165,166,242,243
4. Gastro-oesophageal Reflux Disease [Internet]
Available from: https://www.webmd.com/heartburn-Gastro-Oesophageal Reflux Disease /guide/reflux-disease-Gastro-Oesophageal Reflux Disease -1
5. PubMed [Internet] Available from: https://www.ncbi.nlm.nih.gov/pubmed/23853213
6. Adapted from IFFGD Publication: Gastro oesophageal reflux disease Questions and Answers. Revised 2010 by Ronnie Fass, MD, Chair, Division of GI and Hepatology, Metro Health Medical Centre, Cleveland, OH. Original Contributors: Joel E. Richter, MD, Philip O. Katz, MD, and J. Patrick Waring, M.D. Editor: William F. Norton, International Foundation for Functional Gastrointestinal Disorders, Milwaukee, WI [Internet]
7. Talley Nicolas In: Clinical Gastroenterology, 3rd Ed., Elsevier 2011, p.1.
8. Harrison’s Gastroenterology and Hepatology, McGraw-Hill Medical; First edition 2010, p.120.
9. Weir john In: Homoeopathy and explanation of its principlower oesophageal sphincter, 1932, p. 23
10. Davidson In: principlower oesophageal sphincter and practise of medicine book, 23rd International Edition, Elsevier 2018, P.NO. 414
11. Boericke William, In: Boericke’s New Manual of Homoeopathic MATERIA MEDICA with REPERTORY. 3rd ed. B. Jain publisher’s pvt. Ltd. p. 73,452,546.
12. Kent J. T. Lectures on HOMOEOPATHIC MATERIA MEDICA. Export ed, B. Jain publishers pvt Ltd. p.18, 978.
