When the lower esophageal sphincter malfunctions (it opens when it shouldn’t or does not properly close) a condition known as GERD (Gastro-esophageal Reflux Disease) occurs. This condition causes the backflow of stomach contents and acid into the esophagus and the throat.
Normally, peristalsis allows the ingested food to move downward from the mouth to the esophagus. The lower esophageal sphincter (LES) opens up to enable the food to enter the stomach; once the food passes the abdomen the LES immediately closes. If the valve relaxes or has a problem closing completely, reflux happens. Since stomach acid accompanies the backflow of stomach contents, they irritate the esophageal wall causing pain and discomfort. Frequent occurrences of reflux will eventually damage the esophageal wall. We all occasionally experience heartburn but when it happens many times each week, the frequent irritation of the esophagus eventually leads to a chronic acid reflux condition known as GERD. Besides the most obvious symptom of heartburn, other symptoms of GERD include chronic coughing, dysphagia (swallowing problems), abundant production of saliva, an acrid taste in the mouth, frequent burping, and regurgitation.
According to the American Gastroenterological Association a third of the population of the United States suffers from GERD each year. High risk individuals are people over the age of 40 although GERD can strike people at any age.
Doctors diagnose GERD based on the symptoms. Diagnostic tools to test for this disorder include barium swallow with x-ray (performed on patients whose condition does not respond to medications), pressure testing of the lower esophageal sphincter, esophageal activity testing, and endoscopy. Barium swallow with x-ray is also performed to rule out GERD-like conditions such as cancer of the esophagus or Barrett’s esophagus.
When it comes to triggers for GERD, certain foods that are acidic such as citrus and tomatoes among others can precipitate the development of this condition. Other food triggers include onions, garlic and spicy foods as well as alcohol, soda and coffee. One can also include chocolate and peppermint into this list. Smoking cigarettes can relax the LES or make a current GERD condition even worse. A hiatal hernia, obesity and pregnancy all are factors that add pressure on the stomach and can also cause the occurrence of GERD.
Sadly, no cure for this condition exists and so the aim of GERD treatment is to alleviate the symptoms and minimize the damage. Surgery is an option and its aim is to tighten the LES; it is not considered a first-line treatment for GERD. PPIs (proton pump inhibitors) such as Prilosec are Nexium are the most commonly prescribed drugs for GERD. They can lessen the output of stomach acid and thus help prevent the rise of GERD.
Basically, PPIs provide significant relief of the symptoms of GERD; the problem is that long term use of these drugs can result in certain adverse side effects. To completely heal the ulcers caused by GERD, the body’s environmental acidity needs to be neutralized for a month to three months. In this role, PPIs are excellent choices for this. However, for chronic ulcers, frequent use of these drugs is required. Certain studies have suggested that extended PPI intake can do more harm than good to the body. Long-term PPI use can lead to a stomach environment in which acid is severely inadequate to process and absorb vital nutrients including calcium and vitamin B12. This can eventually result in lack of vitamins in the body and disrupt the cycle of re-absorption and creation of bones, resulting in weak and fragile bones. Women who are in menopause are especially affected by this since their state of menopause already may be causing them significant bone loss. Gastric polyps and even rebound symptoms (upon cessation of intake) and dependency can also occur from long term use of PPIs.
When seen from the perspective of TCM (Traditional Chinese Medicine), GERD is a sign of a hidden internal imbalance. Practitioners of TCM believe that reflux and heartburn are the result of strife between the abdomen and the liver. In TCM, the liver is the organ system responsible for keeping everything in the body (blood, digestion, energy, emotions) and ensures that everything in the body flows smoothly and in their proper directions. If the liver is overworked, often because of severe and/or frequent stress, it weakens and fails to keep everything flowing smoothly. The normal flow and direction of things becomes disrupted and oftentimes things start to flow in opposite directions. This is known as a rebellious liver qi when things flow in their opposite direction. Thus the normal flow of food towards the stomach is reversed causing the flow of stomach contents back into the esophagus; the energy flow of the stomach rebels upwards resulting in GERD symptoms such as reflux, heartburn, frequent burping, and a thick greasy tongue coating. Some clear signs of stagnation of liver qi is a “plum pit qi” which is characterized as a lumpy sensation in the throat that is usually accompanied by a cough.
Western medicine and TCM have different methodologies when it comes to treating GERD. Unlike TCM, Western medicine does not consider stress to be a huge factor in the pathological development of GERD. TCM has a term known as differential diagnosis in which the impact of stress causes patterns of disharmony and imbalances between the organ systems of the body. Acupuncturists are trained to treat these disharmonies and imbalances and of course, the symptoms of the condition, as well.
The plan of treatment for reflux, heartburn and other GERD symptoms depends on the patient’s constitution as well as his/her presenting symptoms. Most of the time, acupuncturists normalize and sooth the liver, relieving the stress that causes the liver to rebel against its neighbor the stomach. These practitioners help bring back the normal downward movement of qi in the stomach, dispel heat and clear the dampness that usually accumulates when the stomach qi is interrupted. Chinese herbal medicine is often combined with acupuncture for the treatment of GERD. These two TCM modalities can also be used in conjunction with Western modes of treatment. Usually a combination of TCM and Western medicine along with dietary and lifestyle recommendations is the best approach when addressing GERD.
Dr. Vickery is a licensed acupuncturist in Tarzana, CA., and the founder and clinical director of Vickery Health and Wellness.