GERD or Gastro esophageal Reflux Disease is a structural condition wherein the lower esophageal sphincter (LES), the valve separating the esophagus and the abdomen, fails to fully shut enabling stomach acid and contents to flow back into the esophagus.
In a normal functioning LES, the food travels down into the esophagus through a process called peristalsis. The LES relaxes so that food may pass from the esophagus into the stomach. When the food has passed, the LES closes again. Reflux happens when the LES relaxes when it shouldn’t or does not close completely. The reflux contains acidic contents and they cause pain and damage to the linings of the esophageal wall during reflux. Most people occasionally may get heartburn, but if the heartburn happens many times a week, it begins to wreak long-term irritation on the esophageal lining and can be an indication of a chronic condition known as GERD. Obviously, heartburn is the defining symptom of GERD. Other symptoms may include a feeling of lump in the throat that makes it hard to swallow and can cause chronic coughing, excess saliva production, a sour taste in the mouth, frequent burping, and regurgitation.
A staggering one third of Americans experience GERD each year according to the American Gastroenterological Association. The incidence of GERD increases after the age of 40 although this condition can strike anyone at any age.
The doctor observes the symptoms of GERD in order to diagnose it. There are diagnostic tests also for GERD such as pressure testing of the lower esophageal sphincter, test for esophageal acidity, endoscopy and x-ray with barium swallow. These tests are used for patients who do not respond to medicines or to help rule out esophageal cancer or Barrett’s esophagus.
Acidic foods such as citrus and tomatoes, alcohol, soda, coffee, fried foods, fatty foods, onions, garlic and other spic foods can trigger GERD symptoms. Hiatal hernia, pregnancy and obesity can exert added pressure on the abdomen and contribute to GERD’s development.
GERD has still no known cure and the goal of treatment is to minimize the symptoms and cut down on the damage as much as possible. Surgery can be done to tighten the LES but this is only considered after all kinds of non invasive treatment have been exhausted. PPIs or proton pump inhibitors like Nexium or Prilosec is the most commonly used therapy for GERD. PPIs cut down on the acid production of the stomach to lessen the risk of reflux.
Proton pump inhibitors are good modalities for relieving GERD symptoms but the problem with these drugs is the side effects after being used for a long period of time. To help facilitate the healing of ulcers in the esophagus, the acidity of the stomach needs to be curtailed for one to three months. PPIs are ideal for this but the ulcers can become longstanding and may need several courses of PPI medications. If used for a longer period, these medicines can bring about an abdominal environment of insufficient amounts of acid necessary for the proper absorption of nutrients such as calcium and vitamin B12 and also for the proper digestion of proteins. In the long run, the body becomes deficient in vitamins and can disrupt the cycle of bone re-absorption and bone creation leading to fragile bones. This problem is a more significant issue for women entering menopause who may already be having bone loss problems. Long term PPI use has also been connected with added rise of gastric polyps as well as growing dependency to the drug that can come with significant rebound symptoms when their intake is stopped abruptly.
GERD, according to TCM or traditional Chinese medicine, is seen more as a symptom than a condition itself. It specifically is a sign of a systemic imbalance in the body. Reflux and heartburn are seen as a conflict between the stomach and the liver. In TCM, stomach’s normal flow of energy direction is always downwards. When energy of the liver “clashes” with that of the stomach, the result is the forced re-orientation of the direction of the stomach’s energy flow and instead of a downward direction the flow goes upward. This leads to long term signs and symptoms such as reflux, heartburn, burping, and a greasy thick tongue coat. The lump in the throat sensation usually accompanied by a throat-clearing cough is known as “plum pit qi” and is considered an indication of liver qi stagnation. The liver is responsible for keeping everything in the body (digestion, emotions, energy and blood) normally flowing in their proper directions. When the liver becomes overworked due to severe stress, it loses control of the smooth flow and begins to dysfunction; in other words, the liver “rebels.” The direction of this rebellion is sideways into the stomach.
The main contrasting feature between the treatment of GERD symptoms of western medicine and TCM is the notion of stress in impacting the health of the body and the pathological consequences stress causes. This matters more in TCM than in western medicine. Diagnosing conditions using TCM leads to a consideration of the effects of stress in the association of the various organ systems with each other and the imbalances that stress brings about in these systems. Then upon knowing this association, the TCM practitioner will be able to treat those imbalances as well as the symptoms.
The course of treatment for symptoms like reflux and heartburn depends on the symptoms presented and the constitution of the patient. Typically, treatment entails the relaxing of the liver and the regulation of its functions as well as the relief of stress that causes it to “rebel” on its neighbor, the stomach; reestablishing the normal directional flow of stomach qi (downward flow); the removal of heat; and removing dampness that collects during the disruption of stomach qi. Chinese herbal medicine and acupuncture combined are excellent treatment choices for GERD. Your acupuncturist can choose either of the two or both depending on the seriousness of your symptoms, and your lifestyle. Chinese herbal medicine and acupuncture can also be used as adjunct therapy to Western medicine in order to get much better and quicker results. They can also help reduce the side effects of your medications.
Zuobiao (Roy) Yuan is a licensed acupuncturist and doctor of chinese medicine in Edina, MN.