Again, this may inhibit the absorption of some medications.
This is another mucilaginous herb with similar properties to slippery elm. Marshmallow (Althea officinalis)ĭose: 2-3 tsp, in divided doses, as an infusion of leaves or root. This herb has an excellent safety profile, though it has the potential to bind to certain medications and decrease their absorption. To enhance flavor, consider adding a small amount of honey or maple syrup. The root bark powder needs to be carefully titrated with water to ensure a palatable consistency. Slippery Elm is also a demulcent that is useful for GERD. Slippery elm ( Ulmus fulva)ĭose: 1-2 tbsp powder mixed with 1 cup water after meals and before bedtime. Rather, use the lozenges, as they can be chewed and swallowed slowly to allow effective contact with the lower esophagus. The deglycyrrhizinated form of licorice (DGL), as the name implies, does not contain glycyrrhizin, which has mineralocorticoid actions, such as hypertension, hypokalemia, and edema. It enhances esophageal mucosal protection. This botanical medicine, like several others on this list, is a demulcent (or mucilaginous). Deglycyrrhizinated licorice ( Glycyrrhiza glabra)ĭose: 2-4 380 milligrams lozenges before meals.
Supplementing with melatonin may not only help with sleep initiation, but it may be as effective as a low dose PPI in treating GERD. Endogenous melatonin peaks in the evening, thus it may be one way that innate physiology can help to minimize gravity-dependent reflux. One of melatonins physiologic functions is to increase the LES tone. Creating this positive expectation through a therapeutic clinical relationship can therefore be an important aspect of developing a Personal Health Plan (PHP).ĭose: 3-6 mg, 30-90 minutes before bedtime. In a large meta-analysis, placebo rates averaged about 20% for pharmaceuticals, indicating that any GERD intervention that one expects benefit will provide a positive response for 1 in 5 people independent of the mechanism of action. This supports the notion that the mind has significant potential to affect GERD symptoms. Studies using proton pump inhibitors (PPIs) and histamine-2 (H2) antagonists show significant benefits in their placebo groups. Further, the significant overlap between GERD and dyspepsia (25% of those with GERD have both ) likely supports the fact that these two entities may not be discreet diagnoses but may have shared underlying mechanisms. This etiology is often overlooked one study showed that when acid is infused directly into the esophagus, 88% of those with GERD were symptomatic, whereas only 15% of controls without known GERD had symptoms. It may also be due to compromised esophageal mucosal barrier (e.g., from low saliva production). It may also be caused by poor GI motility (gastroparesis) or from forces that challenge normal forward motility (recumbent position, bending over). The problem may be downstream, due to increased intra-abdominal pressure (e.g., from obesity, pregnancy, restrictive clothing, ascites). Īlthough the LES itself may appear to be the site of dysfunction, it may not play the primary role in GERD pathogenesis. The quality-of-life burden is significant and may be greater than that of congestive heart failure, coronary heart disease, and diabetes.
There are many factors that cause GERD, and these should be systematically evaluated when creating a treatment plan that aims to cure rather than just treat this disease. With long-term acid exposure, the esophagus may become inflamed (esophagitis) and constrict (stricture), and it can also develop columnar metaplasia (Barretts esophagus) or adenocarcinoma. Otherwise, it has enough tone to limit retrograde flow of acidic contents into the esophagus. Normally, the LES only relaxes when one is swallowing food. Retrosternal discomfort (e.g., pain, burning).Symptoms of GERD occur due to esophageal irritation from acidic stomach contents (including pepsin and sometimes bile acids) contacting the esophagus through the lower esophageal sphincter (LES). It affects women more commonly than men, and the peak ages are 30 to 60. adults at least weekly and nearly 1 in 10 daily. Gastroesophageal reflux disease (GERD) is an extremely common condition, affecting nearly 1 in 5 U.S.
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