GERD stands for Gastroesophageal Reflux Disease.
It is a chronic condition where the stomach acid and/or bile flows back (refluxes) into the esophagus, causing irritation and inflammation of the lining of the esophagus.
This can result in a range of symptoms, such as heartburn, regurgitation, difficulty swallowing, and chest pain.
GERD can be caused by a weak lower esophageal sphincter (LES), a hiatal hernia, or other factors such as obesity, pregnancy, smoking, and certain medications.
Treatment may involve lifestyle changes, medications, or in severe cases, surgery.
In this article, we will discuss the definition, types, causes, symptoms, risk factors, diagnosis, and management of GERD.
GERD Types:
GERD can be classified based on pathology, severity, and frequency.
A.Based on pathology:
1. Non-erosive reflux disease (NERD):
This type of GERD is characterized by typical GERD symptoms, such as heartburn, regurgitation, and difficulty swallowing, but without evidence of esophageal inflammation or erosion on endoscopy.
2. Erosive reflux disease (ERD):
This type of GERD is characterized by inflammation and erosion of the lining of the esophagus, as seen on endoscopy.
In addition to typical GERD symptoms, patients with ERD may experience more severe symptoms, such as chest pain and difficulty swallowing.
B.Based on severity:
1. Mild GERD:
It refers to symptoms that occur less than once per week and do not significantly impact a person’s quality of life.
Mild GERD can often be managed with lifestyle modifications and over-the-counter medications.
2. Moderate GERD:
It refers to symptoms that occur more than once per week and may interfere with daily activities.
Treatment may involve prescription medications and lifestyle modifications.
3. Severe GERD:
It refers to symptoms that occur daily and significantly impact a person’s quality of life.
In addition to medication and lifestyle modifications, severe GERD may require surgical intervention.
C. Based on frequency:
1. Intermittent GERD:
Refers to symptoms that occur less than once per week.
2. Frequent GERD:
Refers to symptoms that occur one or more times per week but less than daily.
3. Daily GERD:
Refers to symptoms that occur daily.
GERD Causes:
The exact cause of GERD is not completely understood, but several factors can contribute to the development of the condition. Here are some common causes of GERD:
Weak lower esophageal sphincter (LES): The LES is a ring of muscle located at the bottom of the esophagus that helps keep stomach contents from flowing back up into the esophagus. A weakened or relaxed LES can allow stomach acid to reflux into the esophagus.
Hiatal hernia: A hiatal hernia occurs when part of the stomach protrudes through the diaphragm into the chest cavity, which can interfere with the function of the LES and increase the risk of acid reflux.
Obesity: Being overweight or obese can increase the pressure on the stomach and cause the LES to weaken, leading to acid reflux.
Pregnancy: The hormonal changes and pressure on the stomach during pregnancy can increase the risk of acid reflux.
Smoking: Smoking can weaken the LES and increase acid production in the stomach, leading to reflux.
Certain medications: Certain medications, such as aspirin, ibuprofen, and some muscle relaxants, can increase the risk of GERD by irritating the lining of the esophagus or weakening the LES.
Certain foods and beverages: Certain foods and beverages, such as citrus fruits, spicy foods, chocolate, alcohol, and caffeine, can trigger acid reflux symptoms in some people.
It is important to note that while these factors can contribute to the development of GERD, not everyone who experiences acid reflux has the condition.
It is always best to consult a healthcare professional for proper diagnosis and management of GERD.
GERD Symptoms:
GERD symptoms can vary from person to person, but the most common symptoms include:
Heartburn: A burning sensation in the chest that may spread to the throat or neck.
Regurgitation: The sensation of acid or food backing up into the throat or mouth.
Difficulty swallowing: A feeling of food sticking in the throat or chest, or a sensation of a lump in the throat.
Chest pain: A feeling of pressure or pain in the chest, which may be mistaken for a heart attack.
Nausea and vomiting: Some people with GERD may experience nausea or vomiting, particularly after eating.
Chronic cough: A persistent cough that may be worse at night or upon waking in the morning.
Hoarseness or sore throat: A hoarse or scratchy voice, or a feeling of irritation or inflammation in the throat.
These symptoms may be intermittent or chronic and may worsen after meals or when lying down.
It is important to note that not everyone with GERD experiences all of these symptoms, and some people may only experience mild or infrequent symptoms.
Risk Factors for GERD :
Several risk factors can increase a person’s likelihood of developing GERD, including:
Age: GERD is more common in older adults, as the muscles that help keep stomach contents from flowing back up into the esophagus can weaken with age.
Obesity: Being overweight or obese can increase the pressure on the stomach and cause the LES to weaken, leading to acid reflux.
Hiatal hernia: A hiatal hernia occurs when part of the stomach protrudes through the diaphragm into the chest cavity, which can interfere with the function of the LES and increase the risk of acid reflux.
Pregnancy: The hormonal changes and pressure on the stomach during pregnancy can increase the risk of acid reflux.
Smoking: Smoking can weaken the LES and increase acid production in the stomach, leading to reflux.
Family history: There may be a genetic component to GERD, as it can run in families.
Certain medications: Certain medications, such as aspirin, ibuprofen, and some muscle relaxants, can increase the risk of GERD by irritating the lining of the esophagus or weakening the LES.
Food habits: Certain foods and beverages, such as citrus fruits, spicy foods, chocolate, alcohol, and caffeine, can trigger acid reflux symptoms in some people.
It is important to note that having one or more of these risk factors does not necessarily mean that a person will develop GERD.
However, if a person has multiple risk factors, they may be at a higher risk for the condition and should take steps to reduce their risk.
Diagnosis of GERD:
The diagnosis of GERD is typically based on a combination of a person’s symptoms, medical history, and physical examination.
The following are some common diagnostic tests that healthcare professionals may use to confirm a diagnosis of GERD:
Upper endoscopy: A procedure in which a thin, flexible tube with a camera at the end is inserted through the mouth and into the esophagus and stomach to look for signs of inflammation or damage to the esophageal lining.
Esophageal pH monitoring: A test in which a small catheter is inserted through the nose and into the esophagus to measure the level of acid in the esophagus over 24 hours.
Esophageal manometry: A test in which a thin tube is inserted through the nose and into the esophagus to measure the pressure of the LES and other muscles in the esophagus.
Barium swallow: A test in which a person drinks a liquid containing barium, which coats the esophagus and stomach and allows for X-rays to be taken to look for abnormalities.
In some cases, doctors may also recommend additional tests, such as a CT scan or MRI, to rule out other possible causes of a person’s symptoms.
It is important to note that not everyone with acid reflux symptoms requires diagnostic testing for GERD.
If a person’s symptoms are mild and infrequent, they may be able to manage their symptoms with lifestyle modifications and over-the-counter medications.
However, if a person’s symptoms are severe, chronic, or not responding to treatment, they should seek medical evaluation for proper diagnosis and management of GERD.
GERD Management:
The treatment and management of GERD typically involve a combination of lifestyle modifications, medications, and in some cases, surgery. The following are some common approaches used to manage and treat GERD:
Lifestyle modifications:
Making changes to one’s diet and lifestyle can help reduce symptoms of GERD.
This may include avoiding trigger foods and beverages, eating smaller meals more frequently, avoiding lying down immediately after eating, losing weight, quitting smoking, and elevating the head of the bed.
Medications:
Over-the-counter medications such as antacids, H2 receptor blockers, and proton pump inhibitors (PPIs) can help reduce the amount of acid produced in the stomach and alleviate symptoms.
In some cases, prescription-strength medications may be necessary for more severe or persistent symptoms.
Surgery:
In cases where lifestyle modifications and medications are not effective, surgery may be recommended to strengthen the LES or correct a hiatal hernia.
Endoscopic therapies:
Endoscopic therapies such as radiofrequency ablation and transoral incisionless fundoplication (TIF) may be used to strengthen the LES and reduce reflux symptoms.
It is important to work with a healthcare professional to determine the most appropriate treatment plan for GERD based on individual symptoms and medical history.
Untreated or poorly managed GERD can lead to complications such as esophagitis, strictures, and Barrett’s esophagus, which can increase the risk of developing esophageal cancer.
Best Homoeopathic Medicines for GERD:
Homeopathy is a holistic medical system that treats not only the disease’s symptoms but also the person suffering from the disease.
So, after a complete detailed history of the current and past disease, as well as consideration of family history, a drug is prescribed based on the individualization of each patient.
The duration of treatment will differ from person to person and will be determined by the severity of the acid reflux.
Improvement in mild cases can be seen in 4-5 weeks, whereas in severe cases will take longer.
Some important remedies for GERD are as follows –
Iris versicolor
Kali carbonicum
Lachesis
Lycopodium
Magnesia carbonica
Natrum phosphoricum
Nux vomica
Phosphorus
Pulsatilla
Robinia
Sepia
Silicea
Sulphur
1. Arsenicum album -Gastric complaints better by warm drinks.
This remedy is indicated for individuals who have heartburn accompanied by a burning pain that is relieved by warm drinks. There may be a feeling of restlessness or anxiety.
Dose and potency: 6c or 30c potency, 6 pills three times a day.
2. Carbo Vegetabilis – gastritis with bloating of the abdomen.
This remedy is indicated for individuals who have heartburn accompanied by bloating, gas, and a feeling of fullness. There may be a cold sensation in the stomach and a desire for fresh air.
Dose and potency: 6 CH, 12 CH, and 30 CH potencies are repeated every 4 hours once.
3. Iris Versicolor: GERD with nausea and vomiting.
This remedy is indicated for individuals who have heartburn accompanied by nausea and vomiting and may experience a bitter taste in the mouth. There may be a tendency towards headaches or migraines.
Dose and potency: 6c or 30c potency, 3 pellets three times a day can be repeated according to the intensity of the symptoms.
4. Kali carbonicum: Heaviness of abdomen with desire for cold drinks.
This remedy is indicated for individuals who have heartburn accompanied by a sensation of heaviness or pressure in the chest. There may be a desire for cold drinks and a tendency towards constipation
Dose and potency: 200 CH twice a day until the heartburn subsides.
5. Lachesis: Heat flushed with heartburn and tightness of the chest
This remedy is indicated for individuals who have heartburn accompanied by a feeling of constriction or tightness in the throat. There may be a tendency towards hot flashes or menopausal symptoms
Dose and potency: 30 CH,200 CH potency twice a day to reduce heartburn.
6. Lycopodium: Distention of the abdomen better by burping and passing gas.
This remedy is indicated for individuals who have heartburn accompanied by bloating and gas and may experience relief from warm drinks. There may be a tendency towards constipation or flatulence
Dose and potency: 30CH can be repeated twice a day.
7. Magnesia carbonica: Gastric complaints are aggravated from taking milk and milk products.
This remedy is indicated for individuals who have heartburn accompanied by a sensation of fullness or bloating in the stomach. There may be a tendency towards constipation and a desire for fresh air.
Dose and potency: 12CH,30CH potency- 5 pills, three times a day.
8. Natrum phosphoricum: Heartburn from sour food.
This remedy is indicated for individuals who have heartburn after consuming acidic or sour foods and may experience belching or sour regurgitation. There may be a sensation of heaviness or tightness in the chest.
Dose and potency: 6X and 12X potency can be repeated every 2 hours
9. Nux vomica: gastritis from consuming alcohol and stimulants.
This remedy is indicated for individuals who have heartburn after overeating, drinking alcohol, or consuming spicy or fatty foods. There may be a feeling of nausea or vomiting, and the person may feel irritable or impatient.
Dose and potency: Potencies range from 6CH to 30 CH – 6 pills thrice a day.
10. Phosphorus -Burning sensation of stomach better by taking cold drinks.
This remedy is indicated for individuals who have heartburn accompanied by a burning sensation in the chest and throat. There may be a desire for cold drinks and a tendency towards anxiety or fear
Dose and potency: 6 CH,12 CH, and 30 CH potency – thrice a day will yield good results.
11. Pulsatilla: gastric complaints are better by walking.
This remedy is indicated for individuals who have heartburn after eating fatty or rich foods and may experience relief from walking or sitting upright. There may be a lack of thirst and a tendency towards weepiness or mood swings.
Dose and potency: 30 CH – 6 pills twice a day for 3 days.
12. Robinia: Burning in throat with sour burps.
This remedy is indicated for individuals who have heartburn accompanied by a sour or bitter taste in the mouth and may experience a burning sensation in the throat or esophagus.
Dose and potency: mother tincture- 5 drops in half a glass of water three times a day. 12 CH and 30 CH potencies should be given thrice a day to relieve the burning sensation.
13. Sepia: gastritis with excessive hunger and emptiness of the stomach.
This remedy is indicated for individuals who have heartburn accompanied by a feeling of emptiness or hunger in the stomach. There may be a tendency towards fatigue or depression.
Dose and potency: 30 CH, 200 CH potency – 6 pills once a day for 3-5 days.
14. Silicea: GERD with constipation.
This remedy is indicated for individuals who have heartburn accompanied by a sensation of pressure or tightness in the chest. There may be a tendency towards constipation and a feeling of weakness or exhaustion
Dose and potency: mother tincture, 6C, and 12C potency can be given 2 drops three times a day.
15. Sulphur: Heat in the stomach with a desire for spicy food.
This remedy is indicated for individuals who have heartburn accompanied by a hot, burning sensation in the chest and throat. There may be a desire for spicy or pungent foods and a tendency towards skin disorders.
Dose and potency: 12CH and 30 CH potency – 6 pills twice a day