GERD (Gastro-esophageal Reflux Disease) is a condition caused by a dysfunctional lower esophageal sphincter (LES). This sphincter is the “door” that separates the esophagus to the abdomen. If the LES does not close in an appropriate manner (opens when it shouldn’t), it causes the backflow of stomach contents and acid into the esophagus and the mouth.
Normally, through peristalsis, food is conveyed down the esophagus. The LES eases down to allow food and fluids to pass into the stomach. After the food and/or fluids enter the stomach, it then closes immediately once more. If the sphincter relaxes when it shouldn’t or does not close completely shut, reflux happens. The flow back of the highly acidic stomach contents into the esophagus may result in pain and if this condition keeps on occurring, over time, it will lead to the damage of the esophageal lining. Practically everyone experiences heartburn from time to time, but when it happens on a regular basis or many times a week, it results in the chronic irritation of the esophagus, which may eventually turn into GERD. Heartburn is the typical symptom of GERD. Dysphagia, a sensation of a lump in the throat, abundant saliva production, a sour taste in the mouth, constant burping, and regurgitation are the other telltale signs of GERD.
People over the age of 40 are more susceptible to GERD than people of younger age. In the United States, the American Gastroenterological Association estimates that around 34% of Americans suffer from GERD.
Diagnostic exams such as endoscopy, x-ray with barium swallow, and testing of esophageal activity, are usually done to rule out esophageal cancer or Barrett’s esophagus or in instances where the patient does not respond to medications. GERD is often based on its manifested symptoms.
Citrus, tomatoes and other acidic foods as well as fried or fatty foods, onions, and garlic are foods that can trigger GERD. Stomach acid production can increase (making one at higher risk for GERD) when one keeps on drinking alcohol, soda, or coffee. Certain factors that can cause the LES to relax include smoking cigarettes, alcohol, chocolate, and peppermint. They all can potentially worsen the reflux. Hiatal hernia, a health issue in which a part of the stomach sticks upward through the diaphragm, pregnancy, and obesity, pregnancy, all may add to the pressure on the abdomen and can be contributory factors to the occurrence of GERD.
Unfortunately, Western modern medicine has no real cure for GERD. When treating it, the objective is to alleviate the symptoms and minimize the damage. Surgery can be performed to make the LES a bit tighter. Surgery is an option after all medical options have been tried. PPIs (proton pump inhibitors) such as Prevacid or Protonix are the most common drugs used for GERD. These drugs are designed to significantly decrease stomach acid production. They are more potent than the older generation of drugs (Histamine-2 blockers), which leads to a much better degree of healing.
Proton pump inhibitors are quite effective measures to relieve the painful symptoms of GERD; however, being pharmaceutical drugs, when taken for extended periods of time, they tend to bring about a number of health concerns. The environmental acidity needs to be lessened for at least a month to a month and a half in order to promote the healing of ulcers that develop in the esophageal lining. PPIs are excellent in addressing too much stomach acidity. However, in certain cases, these ulcers can turn chronic and may need constant and long-term PPI treatment. There now are studies that show that the long term intake of PPIs and the longstanding inhibition of stomach acid production may lead to an insufficient amount of stomach acid to help dissolve, digest, and absorb important nutrients such as calcium and vitamin B12. Eventually, the inadequate absorption of these nutrients may cause vitamin deficiency and affect the process of bone re-absorption and bone development leading to weak and fragile bones. A weak bone condition may be a huge problem particularly for women in menopause who already may be having a difficult time coping with the significant loss of bone density and production in their body due to their menopause. Prolonged usage of PPIs also has been associated to a rise in the number of gastric polyps in the body. Longstanding use of PPIs has also been linked to dependency to the drug with significant symptoms of rebound upon abrupt stoppage.
From the perspective of TCM (Traditional Chinese Medicine), GERD is a sign of a broader systemic imbalance in the body. Reflux and heartburn symptoms, in TCM, are usually attributed to be the result of a battle the liver and the abdomen. The liver in Chinese medicine is viewed as the organ responsible for keeping everything in the body (blood, digestions emotions, energy) smoothly flowing in their proper directions. An overworked or weakened liver can lead to severe and long term stress. The liver then becomes too week or stressed to perform its responsibilities normally. This affects the flow of energy, emotions, digestion, and blood causing the flow to “rebel” or go the opposite direction. Usually a counter flow occurs when the flow becomes directed sideways into the stomach. The proper energy flow of the stomach is southwards. When the stomach is affected by the rebellious energy flow of the liver, the flow goes northward or upward potentially resulting in chronic signs and symptoms such as reflux, heartburn, burping, and greasy thick tongue coating. One typical sign of qi liver stagnation is “plum pit qi” or dysphagia, a lumping feeling in the throat, usually accompanied by a throat-clearing cough.
The main dissimilarity in the way TCM and Western medicine treat GERD symptoms lies in their understanding of how stress affects the body and the evolution of pathology in TCM is firmly imbedded into its theory. In an acupuncture differential diagnosis, the practitioner will always look at how stress affects the relationships of the organ systems to each other. The imbalances that arise from this as well as the symptoms are then identified and then treated accordingly.
The treatment approach for reflux, heartburn and the other GERD symptoms will be determined on the specific presentation of the patient. Typically, the aim of the treatment for GERD is to normalize and calm the liver as well as relieve the stress that causes it to beat up on the abdomen, bring back the natural downward flow of stomach qi, remove the heat, and clear the dampness that often accumulates when the stomach qi is disturbed. Both Chinese herbal medicine and acupuncture in Louisville can provide answers to these objectives. Based on the severity of your symptoms, your lifestyle, and preference you might opt for one or both of these treatments. You can also opt for either treatment as an added therapy to Western modes of treatment to help better manage your symptoms, to lessen the dosage of your drugs or to decrease the side effects of those drugs.