conditions heartburn

RECND4770

Heartburn

Condition:Gastroesophageal Reflux Disease (GERD)
Other:Heartburn
ICD-10 Codes:R12

Naturopathic Treatments

Lifestyle
• exercise
weight loss - obesity is a risk factor
• establish meal time routine - conditions the LES

Aggravating factors
• over-eating
coffee
• tobacco
• spicy foods (e.g. cayenne, ginger, fennel)
• lying down, post-prandial snooze

Diet
• increase soluble fiber - helps protect the mucosa
• elimination diet - eosinophilic esophagitis is often misdiagnosed as GERD

Botanicals
gentian (Gentiana lutea)
- increases LES tone but increase HCl & may aggravate ulcer, gastritis, etc.
marshmallow (Althea officinalis) - demulcent
slippery elm (Ulmus rubra) - demulcent
chamomile tea (Matricaria recutita) - decrease inflammation, increase healing
American ginseng (Panax quinquefolium)

Supplements
• deglycyrrhizinated licorice (DGL)
• digestive enzymes
calcium carbonate - antacid
melatonin

Acupuncture
• more effective than doubling PPI

Conventional Treatments

• proton pump inhibitors
- omeprazole
- lansoprazole
- dexlansoprazole
- esomeprazole
- pantoprazole
- rabeprazole
• H2 blockers
- cimetidine
antacids
• surgery

Signs & Symptoms

Typical symptoms
• epigastric pain
• indigestion
• dysphagia
• acid regurgitation
• sour taste
• bloating
• belching

Other
• dry chronic cough
• dental erosions
• odynophagia
• chest pain
• anemia

DDx

peptic ulcer
• duodenal ulcer
• unstable angina
• ischemic heart disease
• esophagitis
• esophageal cancer
• biliary tract disease (gallstones)
• hiatal hernia
• gastritis

Pathogenesis

Cause
• relaxed lower esophageal sphincter
• delayed gastric emptying
hypochlorhydria
• hyperchlorhydria
• food sensitivites
• medications
carminatives
• alcohol
coffee
• tobacco
pregnancy

Diagnostics

• based on ss/sxs and having r/o other potential disorders
• may have history of esophagitis
• can use diagnostic testing
• often normal respiratory and chest examination
• may have epigastric pain with abdominal exam

References

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Meletis CD, Zabriskie N. Natural approaches for gastroesophageal reflux disease and related disorders Altern Complement Ther. 2007;10:64-70.

Ferri Fred. 2006 Ferri's Clinical Advisor. Elsevier Inc.. USA. 2006.

El-Hashemy, Shehab. Naturopathic Standards of Primary Care. CCNM Press. Canada. 2007.

First Consult. Elsevier Inc. Taken from www.mdconsult.com

Natural Medicines Comprehensive Database. Taken from www.naturaldatabase.com

Rakel, David. Integrative Medicine 2nd Edition. Saunders-Elsevier. USA. 2007

Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective inpatients with gastroesophageal reflux disease? An evidence-based approach. ArchIntern Med. 2006 May 8;166(9):965-71. Review. PubMed PMID: 16682569.

Kolarski V, Petrova-Shopova K, Vasileva E, Petrova D, Nikolov S. [Erosivegastritis and gastroduodenitis--clinical, diagnostic and therapeutic studies].Vutr Boles. 1987;26(3):56-9. Bulgarian. PubMed PMID: 3617707.

Dickman R, Schiff E, Holland A, Wright C, Sarela SR, Han B, Fass R. Clinical trial: acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Aliment Pharmacol Ther. 2007 Nov 15;26(10):1333-44. Epub 2007 Sep 17. PubMed PMID: 17875198.

Patrick L. Gastroesophageal reflux disease (GERD): a review of conventional and alternative treatments. Altern Med Rev. 2011 Jun;16(2):116-33. Review. PubMed PMID: 21649454.

Kandil TS, Mousa AA, El-Gendy AA, Abbas AM. The potential therapeutic effect
of melatonin in Gastro-Esophageal Reflux Disease. BMC Gastroenterol. 2010 Jan
18;10:7. doi: 10.1186/1471-230X-10-7. PubMed PMID: 20082715; PubMed Central
PMCID: PMC2821302.

Pereira Rde S. Regression of gastroesophageal reflux disease symptoms using
dietary supplementation with melatonin, vitamins and aminoacids: comparison with
omeprazole. J Pineal Res. 2006 Oct;41(3):195-200. PubMed PMID: 16948779.

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