Gastroesophageal reflux disease
GERD/Gastroesophageal reflux disease is a digestive disorder that occurs when acidic contents in the stomach flow back into the esophagus in retrograde motion and cause irritation in the oesophageal lining and the throat.
The sphincter is a lid like a muscular structure that opens/relaxes to allow food, drinks, and close after food intake. But, in cases where the sphincter (Lower esophageal sphincter) is weak or relaxes in an abnormal way, acidic contents in the stomach will flow back through the esophagus (retrograde motion), and this acid reflux can irritate the esophageal lining and even the throat.
Everyone may have experienced gastroesophageal reflux once or twice. Usually, when we burp, we feel a sour, acidic taste in the mouth. In a few people, it is accompanied by heartburn. In some, it occurs once or twice a week. If this happens quite often, it can be considered severe and is to be understood that it is pathological GER or GERD.
Obese people, expecting women, patients with hiatal hernia, IBS, patients with a history of Helicobacter pylori infection are more at the risk of GERD. It occurs in asthmatic people, especially during an asthmatic flare-up.
Usually, noticed symptoms are
🔸Heartburn/Acid indigestion usually after eating and which worsens during the night, lying down. It may last for about 2 hours.
🔸Bitter taste in the mouth.
🔸Pain, especially in the chest region. It is due to the acid stimulating the nerves of the area.
🔸 Difficulty in swallowing
🔸The feeling of a lump in the throat
🔸 Hoarseness of voice
🔸Few symptoms of asthma
Some people will experience nausea, vomiting, and bad breath.
Causes of GERD
The exact cause is not known. But in most of the people, it occurs due to:
🔸Parasites or helminths
🔸Too much gas formation
🔸 Tight-fitting clothes or belts around the abdomen.
🔸 Cigarette smoking
🔸Large meals at a time.
🔸 Eating on the go, i.e., eating while traveling, eating quickly.
🔸 Yoga poses involving inversions, headstands, crunches, and inverted rides in parks.
Acid reflux can adversely affect the esophagus’ structure and normal functioning, causing narrowing of the esophagus, esophageal strictures, esophageal ulcers, Barrett’s esophagus (precancerous change in the esophagus).
The diagnosis is by reviewing the symptoms and medical history of the patient.
The following techniques are employed nowadays for diagnosis.
🔸 X-ray of the esophagus
🔸Esophageal mobility test
🔸Barium swallow radiography
🔸Gastric emptying studies
🔸Esophageal PH monitoring/ acid testing
Treatment of GERD
Antacids are usually prescribed medications, but its long-term use may alter calcium metabolism and build-up of magnesium in the body.
H₂ blockers and proton pump inhibitors are also given.
In the case of poor response to medication, surgery is Fundoplication/ anti-reflux surgery is done nowadays.
In patients who suffer a condition called Barrett’s esophagus (precancerous changes in the esophagus), the periodic endoscopic examination to be done to identify premalignant changes.
Ayurvedic perspective on GERD
Usually, Individuals with Pitta aggravation are more prone to acid indigestion/heartburn. Therefore, there is an increased tendency to associate the hyperacidity and heartburn with pitta aggravation as the only cause. But a weak Agni (Mandagni or Vishamagni) can also lead to GERD symptoms. In most GERD cases, the patient is seen with a diminished Agni (digestive capacity).
Due to factors like aging, heavy meal, which is digestible beyond your Agni, low digestive capacity causes the regurgitation.
So rather than treating only to reduce pitta, treatment should be in such a way to kindle the Agni.
Mixed dosha imbalances should be treated as per the treatment protocol according to the classical texts of Ayurveda.
Here the reflux or backflow is due to the retrograde motion/ Prathiloma gathi of Vata. This factor should also be considered while treating.
According to Ayurveda, the treatment protocol of Amajirna, Paittika ama chikitsa, Udavartha chikitsa, Amlapitta chikitsa are followed as per the patient’s condition. But make sure to do Ama pachana and Vataanulomana as well.
Ousadha should be specifically Pittahara, Kledahara, Tiktarasa pradhana, Ruksha, etc.
Mrdu virechana (purgation), Ksheeravasthi, is also done according to the patient’s condition.
Kashayas given are Amrithothara, Guluchyadhi, Indukantha, Pachanamrita, etc.
But only take the above medicine under a physician’s prescription.
Avoid arista, asava, etc.
How to recognize GERD in your child ???
About 1 percent of babies under one year of old age suffer GERD. But usual regurgitation shouldn’t be confused with GERD. Usually, babies spit up/ vomit their food, especially after excessive feeding. If this is happening quite frequently, then GERD is suspected.
Other symptoms are refusal to eat, trouble swallowing, choking/ gagging, irritability after feeding, low growth, slow weight gain, recurring cough, difficulty sleeping, etc. In such cases, seek immediate medical attention. Babies with a condition called tongue-tie also show these symptoms.
So make sure not to confuse GERD with other conditions. If GERD is suspected, seek the consultation of a doctor for proper diagnosis.
Diet and lifestyle modifications for GERD.
🔸Try to avoid large meals at a time.
🔸Avoid eating late at night. Try to have your dinner 2 to 3 hours before going to bed.
🔸Avoid fried and fatty foods, alcohol, other beverages, carbonated drinks, chocolate, peppermint, citrus fruits juices in large amounts, spicy food, especially red chilly, pickles, and caffeinated beverages, tomato, onion, garlic, soda, dairy products, etc.
🔸According to Ayurveda, spicy food aggravates pitta in the body, is one of the causative factors of acid reflux. So spicy foods are to be avoided.
🔸 Avoid consuming non-vegetarian food and dairy products as they are heavy to digest.
🔸Avoid consuming NSAIDS frequently, such as Aspirin, Ibuprofen, etc.
🔸Too much water or liquid should not be consumed just after a meal or close to mealtime.
🔸Avoid eating on the go (eating while traveling) and eating quickly.
🔸Chew food thoroughly.
🔸Avoid drinking iced water and chilled drinks.
🔸Avoid combinations like alcohol mixed with soda or fruit juices.
🔸Avoid or stop smoking.
🔸Don’t go to sleep immediately after the meal.
🔸The head of your bed should be elevated a few inches.
🔸Avoid exercises and yoga poses, which involve inversions, headstands, crunches, etc.
🔸Avoid wearing tight clothes, especially around the abdomen, such as tight belts.
🔸Sleep on your left side.
🔸Practice relaxation techniques.
By following a proper diet and lifestyle pattern, GERD symptoms and the sufferings can be reduced to a large extent.
Dr. Anusree Muraleedharan
BAMS (Bachelor of Ayurvedic medicine and surgery)