Updated: Sep 29, 2019
Gastroesophageal reflux disease (GERD) is a condition “caused by the reversal flow of gastro-duodenal contents, including gastric acid, bile, pancreatic juice, and pepsin, etc., into the esophagus, which stimulate the esophageal membrane repeatedly and injure the barrier” (Zhang, Qin & Guo, 2010). The symptoms associated with GERD include “heartburn, acid regurgitation, dysphagia (difficulty swallowing), and chest pain, as well as extraesophageal manifestations such as nausea, chronic cough, asthma and hoarseness” (Kubo et al., 2014).
GERD has become an increasingly common gastrointestinal disease affecting 8.8 to 40% of the western population with a yearly cost per patient of $4,188 to $8,741 in the United States (Zhu et al., 2017). Conventional treatment consisting of proton-pump inhibitors (PPIs) poses several problems. With an average of 11 billion dollars spent on PPIs every year, the treatment is very costly, and due to frequent and long-term use, linked to many side-effects (Singh, Cresci & Kirby, 2018).
Risk factors of GERD
GERD is known to be caused by abnormal function of the lower esophageal sphincter, problems with acid clearing the esophagus, slowed emptying of the stomach contents, hernia, obesity or genetics (Argyrou, 2018). Populations considered at the highest risk for developing GERD include the elderly, women, cigarette smokers, obese, high body mass index (BMI), and lower socio-economic status. Psychological conditions have also been correlated with the symptoms of GERD. Studies have related the comorbidity of GERD specifically with insomnia, anxiety, depression and bipolar disorder (Lee et al., 2018).
Risks of Conventional Treatment
Proton-pump inhibitors (PPIs) such as omeprazole, are one of the most commonly prescribed drugs used in the treatment of GERD, yet their misuse and overuse is associated with a long list of unwanted and dangerous side-effects. “PPIs reportedly have been associated with community-acquired pneumonia (CAP), chronic kidney disease (CKD), dementia, osteoporosis and hypomagnesemia. With varying degrees of evidence, PPIs are linked with an increased risk of Clostridium difficile infection (CDI), small intestinal bacterial overgrowth (SIBO), spontaneous bacterial peritonitis (SBP) and possibly certain cancers by disrupting the normal gut microbiota” (Singh, Cresci & Kirby, 2018). Additionally, PPIs alter the stomach and duodenum’s absorption and bioavailability of nutrients, leading poor metabolism and subsequent deficiencies of vitamin B12, vitamin C, calcium, magnesium, and iron. Patients who are overprescribed PPIs, taking them unnecessarily, taking over a long time period, and/or taking larger doses than recommended, are at most risk of developing serious side-effects (Heidelbaugh, 2013).
With the enormous cost, overuse and risk of conventional PPI treatment associated with GERD, there is a definite need for better treatment options. Acupuncture and Chinese herbal medicine can provide patients with a safe, cost-effective, and successful treatment for GERD. A systematic review and meta-analysis of 1,235 patients and 12 clinical trials revealed that acupuncture plus western medicine outperformed western medicine alone in the treatment of GERD. In fact, studies have proved that “adding acupuncture to standard-dose PPI reportedly achieved better results than doubling the PPI dose in patients who had failed standard-dose PPIs” (Zhu et al., 2017). In addition, patients treated with acupuncture proved to have a better quality of life, a significantly decreased chance of symptoms recurring (RR 0.42), and a very low risk of adverse reactions compared to those taking PPIs (Zhu et al., 2017). Acupuncture points proven effective in the treatment of GERD (Ren-12, ST-36, SP-6 and P-6) work by improving circulation through the esophagus, throat and stomach and “effectively inhibit the intraesophageal acid and bile reflux” (Zhang, 2010).
Chinese Herbal Medicine
Several Chinese herbal formulas may be used in the treatment of GERD, each dependent upon the patient’s unique case, pattern differentiation and pulse diagnosis (as previously described). For example, Bao He Wan is used for patients with acid regurgitation accompanied by indigestion, nausea, vomiting, aversion to food and/or belching. For acid reflux peptic ulcer, h. pylori infection, gastritis, epigastric pain Zuo Jin Wan is indicated. Studies prove Zuo Jin Wan’s effectiveness rates: 64.7% for the treatment of h. pylori, 95.8% when modified for the treatment of erosive gastritis, and 96.4% for epigastric pain when combined with Ban Xia and Chen Pi. Ban Xia Xie Xin Tang “has effects on promoting gastrointestinal peristalsis, preventing reflux, protecting the gastric mucosa, invigorating the immune system, and improving the body’s ability to resist hypoxia” (Kang et al., 2018). Used for the hypersecretion of gastric acid, its effectiveness rate is 91.3% when modified for the treatment of reflux esophagitis (Chen & Chen, 2009).
Diet and Lifestyle Modifications
Symptoms of GERD can also be controlled by making diet and lifestyle modifications. Alcohol may reduce LES pressure, increase secretion of stomach acid, decrease movement in the esophagus and inhibit gastric emptying, while sodas and carbonated beverages predispose GERD patients to nighttime heartburn (Kubo et al., 2014). Greasy, spicy and acidic foods may also worsen symptoms. GERD patients should be advised to refrain from overeating, resist eating 2-3 hours prior to bedtime, avoid tight clothing that may squeeze the abdomen, maintain an upright position for 3 hours following meals, and sleep at an angle with the head raised. Smoking cessation, avoidance of second-hand smoke and weight loss can also decrease and prevent GERD symptoms (Treatment for GER & GERD, 2014).
In obese patients, a diet low in carbohydrates (less than 20 grams per day) can greatly reduce the exposure of distal esophageal acid and provide symptomatic relief in GERD patients (Austin et al., 2006). In contrast, a diet high in carbohydrates has been found to lengthen total reflux time and induce longer and more frequent reflux periods. Additionally, calorie-rich foods, large meals and fatty foods are known to trigger heartburn and increase acid regurgitation (Wu et al., 2018).
Acupuncture and Chinese herbal medicine are regarded as safe and effective treatment modalities for treating patients with GERD. The use of acupuncture and Chinese herbal medicine provides the additional benefit of helping patients reduce the need for harmful medications, prevents their overuse and incidence of dangerous side-effects, and reduces cost. In addition, recognizing the risk factors, diet, and lifestyle associated with GERD can help patients prevent the condition and reduce the severity and frequency of symptoms.
Argyrou, A., Legaki, E., Koutserimpas, C., Gazouli, M., Papaconstantinou, I., Gkiokas, G., & Karamanolis, G. (2018, August 16). Risk factors for gastroesophageal reflux disease and analysis of genetic contributors. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107529/
Austin, G. L., Thiny, M. T., Westman, E. C., Yancy, W. S., & Shaheen, N. J. (2006, July 27). A Very Low-Carbohydrate Diet Improves Gastroesophageal Reflux and Its Symptoms. Retrieved from https://link.springer.com/article/10.1007/s10620-005-9027-7
Chen, J. K., & Chen, T. T. (2009). Chinese herbal formulas and applications: Pharmacological effects & clinical research. City of Industry, Ca: Art of Medicine Press.
Heidelbaugh, J. J. (2013, June). Proton pump inhibitors and risk of vitamin and mineral deficiency: Evidence and clinical implications. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110863/
Kubo, A., Block, G., Quesenberry, C. P., Jr., Buffler, P., & Corley, D. A. (2014, August 14). Dietary guideline adherence for gastroesophageal reflux disease. Retrieved from https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-14-144
Lee, Y., Jang, B., Seong-Gyu, K., & Younbyoung, C. (2018, May). Comorbid risks of psychological disorders and gastroesophageal reflux disorder using the national health insurance service—National Sample Cohort: A STROBE-compliant article. Retrieved from https://journals.lww.com/md-journal/fulltext/2018/05040/Comorbid_risks_of_psychological_disorders_and.1.aspx
Singh, A., Cresci, G. A., & Kirby, D. F. (2018). Proton Pump Inhibitors: Risks and Rewards and Emerging Consequences to the Gut Microbiome. Nutrition in Clinical Practice,33(5), 614-624. doi:10.1002/ncp.10181
Treatment for GER & GERD. (2014, November 01). Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment
Wu, K., Kuo, C., Yao, C., Tai, W., Chuah, S., Lim, C., & Chiu, Y. (2018, January 12). The effect of dietary carbohydrate on gastroesophageal reflux disease. Retrieved from https://www.sciencedirect.com/science/article/pii/S0929664617305910?via=ihub
Zhang, C., Qin, Y., & Guo, B. (2010). Clinical study on the treatment of gastroesophageal reflux by acupuncture. Chinese Journal of Integrative Medicine,16(4), 298-303. doi:10.1007/s11655-010-0516-y
Zhu, J., Guo, Y., Liu, S., Su, X., Li, Y., Yang, Y., . . . Wei, W. (2017, October 01). Acupuncture for the treatment of gastro-oesophageal reflux disease: A systematic review and meta-analysis. Retrieved from https://aim.bmj.com/content/35/5/316.long