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Gastroesophageal Reflux Disease (GERD)

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ZOU YAN—Senior Physician

Life Care magazine

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GERD is a chronic condition caused by stomach acid coming up from the stomach into the esophagus, throat, and mouth. It causes heartburn, acid taste in the mouth, sore throat, chronic cough, hoarse voice, swollen throat, difficulty swallowing, and dental erosion, etc.

 

The cause of GERD is failure of the lower esophageal sphincter, which surrounds the lower part of the esophagus at the junction between the esophagus and the stomach. Normally, the sphincter opens as we swallow, and closes as food enters the stomach to prevent regurgitation. However, when this mechanism fails, even partially, stomach contents, such as food and stomach acid, can come up into the esophagus. The acid can injure the linings of esophagus.

 

Causes: lifestyles are to blame

 

1) Big meal before bedtime

Irregular mealtime can upset gastrointestinal function. Eating within a couple hours before bedtime can cause gastroptosis, leading to failure of the lower esophageal sphincter and acid reflux.

 

2) Stress

Chronic stress, anxiety and depression negatively affect our cerebral cortex, which leads to decreased or lost of hypothalamic modulation to the autonomic nervous system and causes dysautonomia. The lower esophageal sphincter is controlled by the autonomic nervous system. Thus, dysautonomia most certainly will affect sphincter function.

 

3) Smoking

Smoking relaxes the lower esophageal sphincter, so smokers have a higher risk of developing GERD. Long-term and heavy smoking also weakens pyloric sphincter, leads to reflux of duodenum contents.

 

4) Overweight and obesity

Those who are overweight or obese often eat more, which increases pressure in the stomach. When the pressure exceeds a certain threshold that the sphincter can sustain, reflux occurs.

 

5) Overeating

Binging is not a problem exclusive to the overweight. Poor habits, such as overeating, inadequate chewing, frequent snacking, and snacking at night, can all increase pressure in the stomach, which increases the risk of developing acid reflux.

 

Consequences of GERD

 

Chronic acid reflux has the potential to injure the linings of the esophagus. Without proper treatment and lifestyle modification, acid reflux can lead to pathological changes, such as esophagitis, esophageal stricture, and esophageal cancer.

 

TCM Treatment for GERD

 

GERD is a chronic condition that is characterized by recurrent acid reflux. Long-term treatment is often necessary. Proton pump inhibitors are the most common medications prescribed for GERD. However, long-term use of the medications is not without side effects. On top of that, most people who experience acid reflux do not actually have excessive acid. Merely inhibiting acid production is not addressing the root cause, and it can hinder normal digestive function. TCM treats GERD based on each individual’s differential diagnosis pertaining to concepts in TCM—Yin, Yang, cold, warm, deficiency, and excess. Treatment plans to improve digestive function are individualized. As soon as gastrointestinal function normalizes, normal digestion and absorption return, the frequency of acid reflux will automatic reduce.

 

From a TCM perspective, GERD is often due to inflammation of the liver and stomach system caused by overeating and emotional trauma. It is categorized into five different types in TCM.

 

Type

Symptoms

Concomitants

Treatments

Inflammation of the liver and stomach system

Acid taste in the mouth, stomachache and bloating, abdominal bloating, and sour belch.

Dry mouth, bitter taste in the mouth, irritable, constipation.

Reduce inflammation in the liver system, and balance the stomach system to reduce reflux.

Desynchronization of the liver and stomach system

Acid reflux, belching, abdominal bloating and pain, epigastric fullness, chest pain/pain behind sternum.

Loss of appetite, constipation.

Soothe the liver to regulate Qi, and balance the stomach system to reduce reflux.

Qi stagnation due to deficiency of the spleen system

Acid reflux or vomiting clear fluid, epigastric fullness, dull pain behind the sternum that is relieved by belching.

Loss of appetite, irregular bowel movements.

Strengthen the spleen system to reduce bloating, and balance the stomach system to reduce reflux.

Deficiency of both the spleen and stomach system

Vomiting acid and/or clear fluid.

Relentless bloating relieved by warm or massage, loss of appetite, prefer warm drink, loose stools.

Strengthen the spleen system and warm the digestive system, and soothe the liver to regulate Qi.

Blood stasis due to Qi deficiency

Chronic acid reflux, excruciating pain behind the sternum, difficulty swallowing, sensation of having a foreign object in the throat.

Pale complexion, fatigue, weakness, weight loss.

Increase Qi and nourish Yin to improve circulation.

 

Case Study

 

Female, 40. Patient had frequent arguments with her mother. She reported chronic sore throat, the sensation of having a foreign object in her throat, acid reflux, stomachache, bloating, belching, and loose stools. She was taking medication for quite a while with limited success. Her TCM exam revealed taut pulses, and red tongue with normal coating. Taking her symptoms into consideration, she was diagnosed with liver Qi stagnation and inflammation of the liver and stomach system. Treatments focused on soothing the liver to regulate Qi, and reducing liver and stomach inflammation. Her prescriptions are formulas SiNi San and PingWei San, with baical skullcap root, cape jasmine fruit, nut grass, coptis root and dandelion, use daily. On her follow-up visit, her symptoms were significantly relieved. Her symptoms never returned, even after she stopped the prescriptions.

 

Source: Life Care magazine © Ma Kuang Chinese Medicine & Research Centre Pte Ltd. Reproduced with permission.

 

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