Digestion, Age related illnesses | September 8, 2016 | Author: Naturopath
Gastro-Oesophageal Reflux Disease (GORD) is a common chronic digestive disease, defined as “a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications”
GORD typically manifests with heartburn and regurgitation. Less common symptoms include non-cardiac chest pain, chronic cough, asthma, chronic laryngitis, and other symptoms such as epigastric pain, difficulty swallowing, nausea, and bloating. Additionally, GORD has been associated with dental erosions, sinusitis, pulmonary fibrosis, pharyngitis, and recurrent otitis media.
The financial burden of GORD treatment is high. In Australia, the PPI drug esomeprazole, used to treat GORD symptoms, is currently in the top 10 prescribed medications, costing the Pharmaceutical Benefits Scheme more than $200 million in the 2013–14 financial year. Additionally, GORD has been found to significantly impact health-related quality of life (HRQL), manifested in increase in time off work, decrease in work productivity, sleep disturbances and decrease in physical and mental functioning.
Lifestyle and dietary modifications are usually recommended for the treatment of GORD, alongside the use of acid suppression. Medications used to treat GORD include over the counter antacids, histamine H2-receptor antagonists, and most commonly, proton pump inhibitors (PPIs).
However, despite the effectiveness of PPIs in reversing the symptoms of GORD by inhibiting gastric secretion, over-production of acid has never been shown to be one of the causes of GORD.
Long-term use of PPI’s is not without concern, and has been associated with potential adverse effects including reduced absorption of vitamins and minerals, osteoporosis, Pneumonia, gastric atrophy, and C. difficile colitis. Studies have shown that discontinuation of PPI therapy may result in rebound acid hypersecretion and it is estimated that 30% of patients fail to respond. A minority of patients chooses to undergo anti-reflux surgery, or endoscopic therapy, some of which result in long term side effects.
Low Carbohydrate Diet. Carbohydrates are the preferred energy source for bacteria. The bacterial fermentation of carbohydrates that have not been digested properly produces a lot of gas, which leads to bloating and increases the pressure in the stomach upstream into the oesophagus. Increased intra-abdominal pressure is one of the predisposing risk factors for GORD.
A small study showed complete resolution of GORD symptoms in patients adopting a low-carb diet. There are many ways to reduce carbohydrate intake. Ask a qualified Nutritional Practitioner for help in devising a strategy that will work for you. Also consider eating small meals often and eat slowly allows the digestive system to work efficiently.
There has been a growing focus in recent years on the impact of the microbiome on human health and disease, and few studies have attempted to characterise the oesophageal microbiome. These studies demonstrate that patients with GORD have altered oesophageal bacteria when compared with subjects with a normal oesophagus, suggesting that imbalanced state of human oesophageal bacteria (dysbiosis) may play a causal role in the initiation and progression of GORD.
Probiotics are beneficial bacteria that help to maintain the health of the intestinal tract and aid in digestion. They also help limit the abundance of potentially harmful organisms in the gut.
Probiotics can be taken in capsules or tablets form, beverages, powders, yogurts, and other foods.
Probiotics Lactobacillus and Bifidobacterium have been shown to significantly decrease harmful bacteria and improve gastrointestinal symptoms.
Melatonin is a natural hormone produced by the pineal gland in the brain and helps control sleep and wake cycles. The gastrointestinal tract secretes 400 times more melatonin than the pineal gland, and it has been found that patients with GORD have lower plasma concentrations of melatonin than healthy controls, suggesting that melatonin may be involved in GORD initiation. One study showed that 3 mg melatonin per day protected the oesophageal lining against reflux damage in GORD patients. Although this is a naturally occurring hormone, you will need to discuss this with your doctor or naturopath to obtain this in supplement form.
Slippery elm (ulmus fulva) has anti-inflammatory, soothing, cooling and healing properties. It can provide prompt relief of heartburn symptoms when taken as a powder mixed in a little water to form a paste.
When taken daily after meals or before bed it can help prevent the symptoms by reducing oesophageal inflammation and promotes the healing of any damaged tissue.
Results from a pilot study on curcumin (the active constituent from turmeric) indicate that it is effective in improving the symptoms of GORD. The participants were administered 2g/day of curcumin and 79% were asymptomatic after 8 weeks.
Chamomile (matricaria recutita) acts as an anti-inflammatory in the digestive tract but can also help if there are also symptoms of dyspepsia such as bloating, wind, nausea, vomiting and fullness after meals. It helps to calm the digestive system while also enhancing digestion.
Licorice root (Glycyrrhiza glabra) has been used traditionally in Ayurvedic medicine for gastrointestinal hyperacidity and ulcers due to its antioxidant, anti-inflammatory and demulcent properties. A clinical trial was conducted on Gutgard (a standardized deglycyrrhizinated extract of licorice root which is rich in flavonoids) to assess its efficacy in treating symptoms in 50 GORD patients. The individuals administered gutgard found a significant decrease in their total symptom score, with particular relief being found for those who suffered heartburn.
Other herbs helpful for GORD that are anti-inflammatory and promote healing include marshmallow (Althea officinalis), aloe vera(Aloe barbadensis) and meadowsweet (Filipendula ulmaria), which is also traditionally thought to reduce excess acidity.
The Digestive Health Foundation of the Gastroenterological Society of Australia, and the American Gastroenterological Association recommend:
The use of acupuncture has been associated with symptom improvement in GORD
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