ABSTRACT :
This clinical review explores Gastroesophageal Reflux Disease (GERD), discussing its epidemiology, and prevalence in different age groups and among individuals with obesity. The pathology, clinical manifestations, and both allopathic and homoeopathic management strategies are examined. Special emphasis is given to the role of causa occasionalis in GERD development, and a comparative analysis of Carbo Vegetabilis and Natrium Phosphoricum in GERD treatment .
KEWORDS : Carbo Vegetabilis ,GERD, Natrium Phosphoricum, Sour Eructation.
EPIDEMIOLOGY :
GERD is recognized as the most prevalent esophageal disorder. Its origins can be traced back to medical records from the 1400s when early physicians began understanding digestive system functions. Over time, medical advancements have enhanced awareness and comprehension of GERD. This review evaluates the increasing prevalence of GERD across various regions, including Europe, the West, and Asia.[1,2]
A key focus is to identify factors contributing to the rising incidence of GERD, which accounts for approximately 75% of esophageal conditions. Research indicates that GERD affects 15–20% of the Western population, whereas its prevalence in Asia is significantly lower (2.3–8%). This disparity is attributed to factors such as the presence of Helicobacter pylori, lower body mass index (BMI), reduced fat intake, and genetic variations. In Western countries, heartburn is the predominant symptom, often accompanied by complications like Barrett’s esophagus and esophageal adenocarcinoma, which is increasing in incidence and closely associated with GERD. .[1]
GERD PREVALENCE AND RISK FACTORS :
- A) Age:
Advancing age is a significant factor in GERD prevalence, with older individuals experiencing an increased risk. GERD is most frequently observed in adults over 18, with its incidence peaking in the elderly. This correlation is due to an age-related decline in esophageal acid clearance and weakened mucosal defence.
- B) Obesity
Obesity (BMI >30) has been linked to a higher prevalence of GERD. Studies indicate that excessive body weight, particularly a BMI exceeding 35, elevates the likelihood of experiencing reflux symptoms. The mechanism involves increased intra-abdominal pressure from excess adipose tissue, leading to relaxation of the lower esophageal sphincter. Weight management plays a crucial role in reducing GERD symptoms.
PATHOLOGY:
The esophageal mucosa presents a spectrum of changes in GERD, ranging from normal appearance to varying degrees of mucosal injury, including erosions and ulcers. Electron microscopy reveals dilated intercellular spaces, reversible upon proton pump inhibitor therapy. Histological findings include increased papillary height, thickened basal layers, and inflammation with neutrophils and eosinophils.
A significant pathological development is Barrett’s esophagus, where normal squamous mucosa is replaced by columnar epithelium, increasing the risk of esophageal adenocarcinoma..[1]
CLINICAL FEATURES :
- Typical symptoms: Heartburn and acid regurgitation.
- Atypical symptoms: Dysphagia, Globus sensation, non-cardiac chest pain, and dyspepsia.
- Extraesophageal manifestations: Chronic cough, hoarseness, laryngitis, otitis media, sinusitis, asthma, and dental erosions.
- Sleep-related GERD: Nocturnal reflux symptoms include frequent awakenings, substernal burning, and a bitter taste in the mouth.
- Malignancy risk: GERD is associated with esophageal adenocarcinoma and head and neck cancers.[1,3]
MANAGEMENT :
- Conservative measures :
- Avoid eating within two hours of bedtime.
- Elevate the head of the bed.
- Sleep in the left lateral position.
- Restrict intake of caffeine, nicotine, alcohol, chocolate, carbonated drinks, and high-fat foods.
- Avoid medications that aggravate GERD, such as anticholinergics, calcium channel blockers, and theophylline.
- Weight loss is essential for overweight individuals.
- Consider nasal CPAP therapy if obstructive sleep apnea is present.
- Acid Suppression Therapy :
- Proton pump inhibitors (PPIs): Provide rapid symptom relief and promote healing.
- Prokinetic agents: Medications like tegaserod and levosulpiride improve motility and enhance esophageal acid clearance. H. pylori Testing & Treatment
If GERD symptoms persist, testing for H. pylori is advised. In cases of distal gastritis, eradicating H. pylori reduces gastric acid production. Conversely, atrophic gastritis may worsen post-eradication.
- Surgical Intervention :
Recommended for patients with refractory GERD. Fundoplication surgery strengthens the reflux barrier by wrapping the gastric fundus around the lower esophagus. .[1,3]
HOMOEOPATHIC MANAGEMENT:
Homoeopathy offers effective treatment for GERD by stimulating the immune system and promoting holistic healing. The concept of causa occasionalis (identifying individual-specific disease triggers) is essential in prescribing remedies.[6]
Both Carbo vegetabilis and Natrium phosphoricum have main action on GI tract mucosa with aggravating factors related to that of GERD.
Comparative study of Carbo veg and Natrium phosphoricum.
POINTS : | Carbo vegitabilis. | Natrium phosphoricum.
|
Ailments from
| Salt, meats, spoiled fish, meats, or fats, suppressed intermittent. Bad effects from loss of vital fluids.
| It is the remedy for conditions arising from excess lactic acid, often resulting from too much sugar, with excess acidity.
|
Head
| Vertigo with nausea.pressive headache, with tears in the eyes; they are painful when moving Headache from being overheated . Nocturnalheadache.─Cramp-like tension in the brain, or sensation, as if from contraction, ─Heaviness of the head.─Pressive headache, esp. above the eyes, in the temples and the occiput.─Drawing pain in the head, commencing at the nape of the neck, with nausea. | Fullness in the head; flushes of heat, afterward sweat.—Fulness in the forehead, over eyes; in the morning; while studying; With cutting in r. temple.─Sharp cutting r. side of the head with, at times, dull aching over the eyes. |
Symptoms:
| It is indicated when there is bloating and heartburn.
| Indicated in Sour eructations and taste. Sour vomiting.
|
1) Tongue : | Coated brown or yellow white
| Yellow creamy coating at the back of the roof of the mouth and tongue
|
2) Desire for :
| For salt food or food sweetened with sugar, coffee,
| For strong-tasting things eggs, fried fish, and beer which ameliorate complaints |
3) Aversion to : | Meat, milk, and fat
| Bread and butter.
|
4) Eructation :
| Sour eructation after eating gives temporary relief | Sour eructation after eating
|
5) Sensation as if :
| Heaviness and fullness in the stomach and as if scraping & trembling in the stomach | Heaviness and pressure in epigastrium.Goneness in stomach and abdomen.
|
6) Appetite : | Want of appetite and an immoderate hunger.
| Canine hunger with gone feeling in the stomach.
|
7) Pain as if :
| Colic with the sensation of a burning, pressure at a pit of the stomach.also cramps in the abdomen. | Sharp cutting in a hypochondria Colic and pressure with acidity, colicky pains while walking. Soreness. |
8) Vomiting :
| Vomiting of food in the evening.
| Vomiting of sour cheesy masses.
|
9) Stool and Anus : | Flatus hot, moist, offensive. Itching, gnawing, and burning in the rectum. Acrid, corrosive moisture from the rectum. A musty, glutinous moisture exudes. Soreness, itching moisture of the perineum at night. Discharge of blood from the rectum. Burning at the anus, burning varices (Mur ac). Painful diarrhœa of old people | Burning contracting pain in the anus and lower rectum.─Sticking as from splinter in the anus on walking. Sore, raw feeling soreness; must scratch.─Must bring the will to bear to prevent the escape of fæces.—Diarrhœa with colic; fears to pass flatus for fear fæces should escape. |
10) Urinary organs | Urine scanty and frequently urgent inclination day and night.Urine red with a dark cloudy appearance. Constriction of the urethra every morning. | Burning during micturition, passed a large quantity of urine in the morning. Urine was scanty, pale dark, and increased.(Diabetes, hepatic form) |
Mind
| Anxiety, esp. in the evening (4-6 p.m.).─Fear of specters, esp. at night.─Timidity, irresolution, embarrassment in society.─Despair with lachrymose humor, and discouragement, with desire for death, and tendency to suicide.─Disposition to be frightened.─Irascibility and passion.─ Sudden, and periodical weakness of memory.
| Melancholy, esp. after emissions.─Despondent; could not study; imagined he was going to have typhoid fever.─Fears bad news.─Nervous fears on waking.─Easily startled.─Irritable.─Memory lost.
|
Modalities : | Aggravation: From butter, pork, fatty food, abuse of quinine bark and mercury; from singing or reading aloud, in warm, damp weather.
Amelioration: From eructation; being fanned,in evening.[4,5,7,8,9]
| Aggravation: worse in the morning, evening, and night, and after midnight. Many symptoms come from fasting, and he is aggravated by any physical exertion. He is disturbed by butter, cold drinks, fats, fruit, milk, sour things, and vinegar. Amelioration: Generally ameliorated after eating , by cold .[4,5,7,8,9]
|
Dr.Hahnemann considered man as a composite being, a multidimensional entity, a unit of life, consciousness with intelligence, and stated that it is the patient who is sick and not the organs‟. Considering the psychosomatic relationship in GERD, detailed and careful case-taking is necessary, which helps in personal diagnosis, disease diagnosis, and management of the case, both in general as well as therapeutic planning. Thus, Homoeopathy has a vital role in treating GERD.
CONCLUSION: Natrium Phosphoricum and Carbo Vegetabilis both are beneficial in management of GERD.
REFERENCES :
- Yash Pal Munjal -API Textbook of Medicine – 9th Edition –Page no -801-803
- Davidson’s Principles and Practice of Medicine 23rd edition –Page no- 791-794
- A.F. Golwalla – Golwalla’s Medicine for students .25 th edition- Page no- 11-12
- W. Boericke -Pocket Manual of Homoeopathic Materia medica.-Page no- 147-149 & 388-389
- Dr. Burt -Physiological Materia medica- 6th edition– Page no-253
6.Dr.Samuel Hahnemann – Organon of medicine 6th edition- Aphorism no. 5 & 7
- Dr.S.R.Phatak.-Materia Medica of Homoeopathic Medicines.- 2nd Edition Page no-150-155 &420-423
- Dr.H.C.Allen-Allen’s Keynotes – 10th edition- Page no- 85
- Dr.J.H.Clark -A Dictionary by Practical Material Medica – 1st Edition – Page no-397-405 &565-568
Author 1,
Dr Lata Mallannavar, MD Hom, Associate Professor and HOD, Dept of Practice of Medicine, Late Mrs Housabai Homoeopathic Medical College and Hospital Nimshirgaon MH.
Author 2,
Miss Shweta.C.Parit, Internee, Late Mrs Housabai Homoeopathic Medical College and Hospital Nimshirgaon MH
