GERD

Acid Reflux or GERD or Gastritis or Acidity

GERD or gastro-esophageal acid reflux disease is quite common these days. Acid Reflux – commonly known as GERD (Gastroesophageal Reflux Disease) occurs when valve between the oesophagus ( food pipe) and stomach gets weak. Generally, this valve opens up when the food passes from food pipe to stomach and shuts tightly afterwards. In Gastroesophageal Reflux Disease, this valve remains open slightly and letting the stomach acids to flow in the oesophagus. This causes heart burns and much similar discomfort in the body. In this condition the liquid content of the stomach refluxes back into the oesophagus. If you are suffering from heart burn more than twice a week or it doesn’t show any signs of improvement even after taking antacids, then you must be suffering from GERD.
Oesophagus is a tube transporting food from mouth to stomach. The ring of muscle at the lower end of oesophagus is supposed to act like a valve, relaxing and shutting down the route. If the shutting down does not happen properly, the stomach contents would reflux or leak back in to the oesophagus, irritating its walls. This results in GERD (Gastro-oesophageal acid reflux disease). People of any age can suffer from GERD.

Ayurvedic Concept

As per the Ayurveda, GERD or Acid Reflux happens due to the aggravation of Pitta Dosha. In Ayurveda Pitta resembles heat or fire in the body. Person suffering from GERD suffers from hot, sharp, pungent, and acidic substance that comes from the stomach. It’s common in many individuals to have a reflux of liquid content in stomach through oesophagus.

GERD can be compared to Amlapitta explained in Ayurvedic texts due to very close resemblance of the symptomatic presentation. It is called Amlapitta because Pitta attains too much of Amlata i.e. acidic nature due to consumption of causative factors which aggravate Pitta. This Morbid Pitta causes symptoms like sour belching, heartburn, indigestion, tastelessness etc. Kapha and Vata get involved with the morbid Pitta in the later stages of the diseases making it more complicated.

Causes

If you are consuming foods that aggravates Pitta or foods which have unsuited nature (virudh aahar or incompatible food), this can lead to the unbalance of all kind of doshas in your body but the major affect is seen on the Pitta Dosha. These vitiated doshas produce certain kind of toxins which rise upwards in the food pipe leading to heartburn. Mostly this can happen when a person has increased the daily intake of beverages like tea or coffee, fried food or spicy food. This kind of imbalance eating habits intensifies Pitta in body and leads to acidity. Aggressive nature or hyperactivity can also be one of the reasons for this disease. Pitta aggravates in body because of wrong eating habits, drinking excessive alcohol, carbonated beverages, and working till late night hours. Even excessive intake of antibiotics can also cause heartburn and acidity.
What causes Amlapitta?
• Viruddha ahara – Mutually incompatible foods
• Dushta ahara – Contaminated food
• Amla – Sour foods
• Vidahi – Foods which cause burning sensation
• Pitta prakopaka anna- paana – Food and drinks which aggravate Pitta
• Svahetu upachitam pittam – Pitta which had already accumulated in the body due to various aggravating factors (consumption of pitta provoking foods, drinks, activities and medicines, Varsha ritu or rainy season)
Pitta getting aggravated in excessive quantity due to the above said causative factors will attain Amlata (excess sourness or acidic nature) and cause AmlaPitta

Other possible GERD triggers are
• Obesity
• Smoking
• Alcohol intake
• Caffeine intake
• Eating of citrus fruits
• Over-eating
• Stress
• Eating hurriedly
• Eating spicy food
• Wearing tight-fitting clothes
• Eating close to bedtime
• Anatomical defects like hiatus hernia etc.
• Conditions like hypercalcaemia

Diagnosis
Diagnosis is based on –
• The symptoms
• Esophago-Gastro-Duodenoscopy (EGD)
• Endoscopy – a flexible tube to look inside your oesophagus
• Biopsies performed under gastroscopy
• An X-ray of your upper digestive system (barium swallow or upper GI series)

Symptoms
• Burning sensation in the chest : An uncomfortable feeling of burning sensation behind the breastbone area, commonly referred as Heartburn.

• Sore throat : Feeling pain while swallowing food
• Some patients suffering for GERD experience lung manifestations like coughing, wheezing, asthma, and inflammation in vocal cord that creates hoarseness in voice.

• Sour taste in the mouth, due to Vomiting gastric acid or getting stomach contents in the mouth.
• Regurgitation of food or sour liquid (acid reflex)
• Difficulty swallowing (dysphagia)
• Hoarseness of the throat
• Choking or a sensation of a lump in your throat

In children:
• Repeated vomiting
• Effortless spitting up
• Coughing
• Other respiratory problems such as wheezing
• Inconsolable crying
• Refusing food
• Crying for food and then pulling off the bottle or breast only to cry for it again
• Failure to gain weight
• Bad breath
• Belching or burping

Signs and Symptoms of Amlapitta –in ayurveda
Avipaka – Indigestion
Klama – Fatigue
Utklesha – Water in the mouth, water brash
Tikta udgara – Bitter belching
Amla Udgara – Sour belching
Gaurava – Heaviness of the body
Hrit daha – Heart burn (burning sensation in the chest)
Kanta daha – Burning sensation in the throat
Aruchi – Tastelessness

GERD symptoms mimics like heart attack. They are 2 conditions confused with each other due to similarity in clinical picture.
Therefore don’t neglect heartburn
• Seek immediate medical attention if you experience chest pain, especially if you have other signs and symptoms, such as shortness of breath or jaw or arm pain. These may be signs and symptoms of a heart attack.
• Seek medical attention if you experience severe, frequent GERD symptoms

Some trigging factors that increases the risk of heartburn and GERD :
• Obesity
• Hiatus hernia (bulging of the top of stomach up into the diaphragm)
• Pregnancy
• Smoking
• Asthma
• Dry mouth
• Diabetes
• Delayed stomach emptying
• Connective tissue disorders like scleroderma

Home Remedies for GERD
• Take ginger root extracts mixed with honey. This is a proven home cure for GERD.
• Drink chilled skim milk to get rid of the burning feeling of severe acid reflux.
• Mix 1 teaspoon cumin powder with 1 glass luke warm water empty stomach early in the morning.. This controls gas formation and prevents GERD.
• Eat lots of papaya. It eases GERD discomforts.
• Intake of Aloe Vera juice, amla juice treats GERD effectively.
• Drink the juice of 2 raw potatoes daily to get rid of GERD.
• Eat bananas everyday. This will check GERD and make you feel better.
• Drink lots of water. It checks acid reflux.
• Stay away from consumption of onion, garlic, citrus fruits and sour sauces.
• Avoid caffeine intake like tea, coffee, alcohol and smoking.
• Do not take much spicy fried food, mustard, vinegar, pepper and chillies.
• Do not lie down immediately after meals. Wait for at least few steps after eating.
• Do not wear excessively tight fitting garments. They increase pressure on stomach and cause GERD.
• Do not eat much at a time, in stead go for frequent short meals.
• Sleep with head on an elevated position.
• Avoid tomato sauce
• Reduce chocolate intake
• Avoid carbonated drinks
• Maintain a healthy weight – because excess weight puts pressure on abdomen, pushing your stomach and causing acid reflux into oesophagus. If you are overweight, reduce a few calories.
• Take 1 tsp Amalaki powder (Indian gooseberry) with honey. Amalaki protects the stomach from acids, neutralizes acids and heal the stomach and oesophageal erosions. They can be eaten raw or used as tea. (Consult your doctor to know which form suits you the best)

  • Powder of Draksha (Vitis vinifera) and Haritaki (Terminalia chebula) mixed with old jaggery
    • Drink coconut water regularly
    • Warm water mixed with lemon juice and honey in the morning
    • Water boiled with Jeeraka (cumin seeds)
  • Dip 1- 1 ½ spoons Fenugreek in a glass of water and leave it for 2-3 hours (or overnight). Preferable you can put its coarse powder in warm water. Strain the seeds and drink the water.
    • Upavasa (fasting) for a day in a week or half a day is useful in curing acid reflux. Take care that you don’t overdo it. drink water and eat fruits while on fasting.
    • Take 2-3 cardamom and crush them. Boil them in ¼ litre of water. Filter it through a sieve and drink warm.
    • Take 5-6 Tulasi leaves (basil), crush them and boil in 250 ml of water on mild flame for 10-15 minutes, filter and take the filtrate (tea)

Lifestyle Guide & Recommended Diet
• Avoid consuming carbonated drinks, coffee, tea or any kind of alcoholic beverages.
• Stop eating fermented foods and processed items.
• Limit or Stop the use of spices like ginger, garlic, onions, tomatoes, and vinegar in daily cooking.
• Avoid consuming any kind of rich gravy dishes, salty, sour or spicy foods.
• Curd should be completely removed from daily diet.
• Consume meals at regular intervals in a relaxed ambience.
• Practice Yoga daily with Pranayama likeBhujangasana, Vajrasana, Bhastrika Pranayama, Salabhasana, Shitkari Pranayama and Shitali Pranayama.

Homemade Therapies
• Mix equal parts of basil leaves, coriander seeds, powdered fennel and licorice root. Take ½ teaspoon of this mixture and mix with ½ teaspoon of crushed rock candy or unrefined sugar. Consume this 15 minutes before lunch and dinner regularly.
• Prepare a mixture of powder rock candy, green cardamom and fennel in equal parts. Consume the mix of 1 teaspoon in cold milk when you suffer from heartburn.

Include the below said –
• Include Potatoes in your diet, they are alkaline and reduce acids
• Include lot of yoghurt in your diet. The probiotics in curds keeps your digestive system healthy. It also helps in absorption of proteins and nutrients in the body.
• Include Banana in your diet; it acts as a natural antacid. Banana has rich potassium which helps to reduce acid levels.
• Take a slice or two of papaya daily after food. It is found to soothe your stomach and helps in better digestion.
• Baking soda – Sodium bicarbonate neutralizes the acids in the stomach
• Apples after meals, especially after dinner prevents acid reflex
• Coconut water for cooking
• Lemons – create calcium carbonates which neutralizes the acids
• Moringa – Drumstick
Foods that are known to prevent acid reflux –
• Basil leaves
• Red apples
• Grape fruit
• Yellow mustards
• Herbal teas
• Vegetable juices
• Oatmeal
• Melon
• All vitamin and minerals
• Fennel
• All roots and green vegetables
• Celery
• Brown rice

Yoga for Acidity and Indigestion
Some yoga postures help to stimulate the digestive system to secrete appropriate levels of the digestive enzymes and also reduce the acid reflux. Few most effective yogas are:
1. Virasana (Hero Pose)
2. Vajrasana (Thunderbolt Pose)
3. Baddha Konasana (Cobbler Pose)
4. Makarasana (Crocodile Pose)
5. Mayurasana (Peacock Pose)
6. Padahastasana (Foot-Hand Pose)
7. Shavasana (Corpse Posture)
Along with all these measures, it is vital to remember that because the brain controls the secretion of gastric acid, stress plays an important role in deciding one’s state of digestive health.
In general, anxiety, nervousness, anger and being on edge tend to worsen the symptoms of acid reflux and therefore, one must try to stay calm at all times. Along with the recommended yoga postures, the regular practice of breathing techniques (pranayamas) and meditation to keep the mind calm, can therefore help greatly in combating chronic acid reflux.
With Ayurveda, one can combat the root cause of the acid reflux and thus, find a more lasting solution to your health problems.

Ayurvedic Panchakarma( sodhana chikitsa) Detoxification processes for Acid Reflux or Hyperacidity

Ayurvedic treatment of GERD is basrd on the lines of treatment of Amlapitta.
The main objective is to get rid of the morbid Pitta and protect the stomach and gut from getting damaged by the action of Pitta. After administration of Vamana (Therapeutic emesis) and Virechana (Therapeutic Purgation) to get rid of morbid Pitta and Kapha, oral medications based on the Prakriti (physical constitution) and Vikriti (quality and quantity of morbidity) are administered as follow up.
After the disease gets controlled, Rasayana’s (disease modifiers and rejuvenators) are administered to eliminate the residual disease and to provide a long-term immunity towards the disease.

Vamana

Vamana (therapeutic emesis) is the first line of treatment in Amlapitta..This is therapeutic emesis or induced vomiting to get rid of the waste products and mucous in the upper gastrointestinal tract. Water extracts of neem (Azadirachta indica) or snake gourd (Trichosanthes dioica) are used to induce vomiting.
Virechana
This is therapeutic purgation, where purgative substances that increase the Pitta dosha are given to the patient. Some of the commonly used purgatives include senna leaves, flaxseeds, castor oil or Triphala.
By this method, the toxins in the gastrointestinal tract are eliminated and helps to reduce the suffering from acid reflux.

Pathya in GERD (beneficial things)
Yava – Barley
Godhuma – Wheat
Mudga – Green grams
Purana rakta shali – Old Red Rice
Taptasheeta jala – Boiled and cooled water
Sharkara – Sugar
Madhu – Honey
Sattu – Flour
Karavellakam – Bitter gourd
Rambha pushpam – Flower of plantain
Vriddha Kushmanda – Old Ash gourd
Patola – Pointed gourd
Dadima – Pomegranate
Kapha-Pittahara Anna – Food and drinks which alleviate Kapha and Pitta
Apathya in GERD (unwholesome things):
Tila – Sesame
Tila bhakshanam – Food items prepared with sesame
Masha – Black gram or food stuff prepared from Black gram
Kulattha – Horse gram
Avidugdham – Goat milk
Dhanyamlam – Fermented liquids
Guru annam – Foods which are heavy to digest
Lavana ahara – Salt rich foods
Amla Ahara – Sour foods
Katu ahara – Hot and spicy foods (pungent)
Dadhi – Curds
Madhya – Alcohol
Ayurvedic medicines for heartburn and GERD:
Kashayam – Herbal decoctions:
• Guduchyadi / Guluchyadi Kashayam
• Tiktakam Kashayam
• Drakshadi Kashayam
• Patolakaturohinyadi Kashayam
• Indukantham Kashayam
• Balapunarnavadi Kashayam
• Mahatiktakam Kashayam
• Sukumaram Kashayam

Vati / Gulika (Tablets)
• Chitrakadi Vati
• Sutashekara Ras
• Shanka vati
• Mahashanka Vati
• Dhanwantaram Gulika
• Vayu Gulika
• Vilwadi Gulika
• Hingwadi Gulika

Ghritam (medicated ghee):
• Indukantham Ghritam
• Tiktaka Ghritam
• Dadimadi Ghritam
• Dhatryadi Ghritam
• Mahatiktakam Ghritam
• Shatavaryadi Ghritam
• Sukumara Ghritam

Leha / Rasayanam (Confections, Jams):
• Trivrit Leha
• Shukumara Leham
• Chyavanaprasham
• Amalaki Rasayanam
• Drakshadi Leham
• Kushmanda leham
• Vasavaleham
• Vilwadi Leham
• Gudardrakam / Gulardrakam
• Parushakadi Leham
• Hingutriguna leham

Churnam (Powder):
• Hingwashtaka Churna
• Bhaskara Lavana (Lavana Bhaskara) Churna
• Hinguvachadi Churnam
• Avipatti Churnam
• Didimastak churnam

Bhasma / Satwa:
• Guduchi / Giloy Satwa
• Shanka Bhasma
• Kaparda Bhasma
• Pravala panchamrit

Asavas/ aristas

• Aragwadharishtam
• Chandanasavam
• Draksharishtam
• Jeerakadyarishtam
• Pippalyasavam

Complications of GERD:
Oesophageal stricture (Narrowing of the oesophagus): Damage to the cells in the lower oesophagus from acid exposure leads to formation of scar tissue. This scar tissue narrows the food pathway. This further leads to difficulty in swallowing.
Oesophageal ulcer (open sore in the oesophagus): severe erosion of tissues in esophagus by stomach acid can cause open sores. Bleeding, pain and difficulty in swallowing are associated with esophageal ulcers.
Barrett’s esophagus (precancerous changes to the esophagus): In this condition, the tissues lining the lower esophagus changes. These changes are associated with an increased risk of esophageal cancer.