Gastroesophageal Reflux Disease (GERD) is commonly seen in western society, and is “present in around 5% of the adult population” in the world (1). However, it is becoming more and more common in babies. Reflux occurs because chyme from the stomach travels to the oesophagus one to two hours after eating, causing the dilation of the lower oesophageal sphincter (LES). Usually the acid which is refluxed into the oesophagus is cleared by peristaltic movement in one to three minutes, however, in some individuals, “a combination of factors cause an inflammatory response to reflux called reflux oesophagitis”(2).
The pathophysiology of the condition can be a number of factors. The tone of the LES usually maintains a zone of high pressure that prevents gastroesophageal reflux. This pressure seems to be low in individuals who suffer from GERD. Contributing factors to this mechanism are “vomiting, coughing, lifting, or bending” (3), these increase the pressure in the oesophagus and create an overflow of chyme. Other relevant factors are “LES relaxations, LES tone fails to increase when intra-abdominal pressure is increased by tight clothing or pregnancy, there is an increased oesophageal mucosal sensitivity to acid, there is reduced oesophageal clearance of acid because of poor oesophageal peristalsis, (the reduced acid clearance is exacerbated with hiatus hernia owing to trapping of acid within the hernial sac), delayed gastric emptying occurs, which may increase the chance of reflux, and prolonged episodes of gastro-oesophageal reflux which occur at night and post prandially.” (2) The persistence of reflux is due to an alteration of any of these pressure involved mechanisms. This results in an irritation to the mucous membrane by acidic gastric contents which leads to degeneration of the “oesophageal epithelium and stimulating of the vomiting reflex.” (3) The severity depends on the contents in the stomach; if it is more acidic then a greater irritation will occur. It can also last longer in the oesophagus in people or babies with particularly poor peristalsis creating a more severe case. Gastric emptying also plays a major role in the development of GERD.
Heartburn is the major clinical feature of GERD. The pain obtained from this is due to the irritation of the oesophagus mucosa from regurgitation of the stomach contents within one hour of eating. It is also partially due to a spasm which occurs of the distal oesophageal muscle. The symptoms worsen if the individual lies down, bending, or if the intraabdominal pressure increase. This is usually relieved by antacids. This may persist when there is nothing in the stomach. Alcohol, hot drinks, citrus foods can cause discomfort swallowing so a mother who is breast feeding should stay clear of these. There is also an “association between reflux, asthma and a chronic cough.” (3) The potential consequences in severe cases are “bleeding, development of a stricture, and a tendency to develop Barret oesophagus, with its attendant risks”. (1)
Orthodox treatment is based on the evaluation and diagnosis using the clinical manifestations of reflux oesophagitis, regurgitation of acid and pain. AN Endoscopy shows oedema and erosion and shows any further changes in the epithelium. Antacids are the main treatment protocol for babies. They relieve the symptoms of burning and lower the acid level. Other treatment strategies are raising the head at night, and breast feeding mothers are encouraged to decrease alcohol intake and stop smoking. The management of the disease is based on using the already mentioned treatments. In many cases however when treatments are discontinued, the symptoms return.
A naturopathic perspective is aimed at a different treatment approach. It is not too much acid which is the problem but not enough. So the approach is to enhance the acid production and not suppress it. By taking antacids to decrease reflux, this will create a long term imbalance in the stomaches acidity. GERD usually results from overeating and other factors such as cigarette smoke and consuming chocolate, fried foods, carbonated drinks, wheat, dairy, sugar, alcohol or coffee. Also a premature or hard birth can contribute to this problem as can feeding babies formula. A goats milk or rice milk formula could be used as an alternative or a naturopath can make a specific formula for your baby. Both parents immune system and allergy response should be looked at to determine no reactions to food or the mothers milk are being passed through to the baby. The first step in the naturopathic treatment is to prevent the disease getting any worse and eliminating any of these causative factors. Raising the head during sleep is also a recommended option as to allow gravity to keep the reflux down.
Herbs which are mucous membrane restoratives, demulcents, mucilages, mucous membrane tonics and anti-inflammatories are used to help heal and maintain good cell health. Common herbs which are used are Goldenseal, Licorice, Meadowsweat, Calendula, Slipper Elm and Marshmallow. Bitter herbs are also important to stimulate acid production and effectively digest food. These include Globe Artichoke, Gentian, Dandelion, Golden Seal and Yarrow. These coat the oesophagus and create a repairing environment. Other actions, which may be implemented, are Nervines, as they have shown a connection with nervous system and reflux. These include, Oats, Bacopa, St Johns Wart, Schizandra, Baical Skullcap, Valerian, and Vervein. They are also good for improving energy, as nutrient intake is usually poor due to the poor breakdown and assimilation of food. Antispasmodics are also good to look at as they help to relax the distal oesophageal muscle. These are Licorice, Chamomile, Peppermint, Valerian, and Cramp Bark. None of these herbs should be given without consulting a Naturopath for correct dosage and safety when treating babies and children.
Nutritionally, a diet low in refined foods, sugars and flours, no soft drinks, alcohol, or caffeine should be consumed. Fatty foods should be limited and fresh fruit and vegetables, water, essential fats, and whole grains increased. Red meat, wheat and dairy should be reduced as they have high acidity. A good multi vitamin for children can be helpful to support the nervous system and replace any nutrients. Lemon or apple cider vinegar in water first thing in the morning or 15 minutes before a meals helps to stimulate digestive juices.
Flower essences are also good to help support emotional wellbeing, which could be a factor in the manifestation of the disease. These would have to be developed individually depending on a persons circumstance.
Lifestyle advice is to relax. Yoga, meditation, Thai Chi, regular exercise, and hobbies are useful for the parents. Babies and children are very susceptible to the anxieties and stress felt by their parents.
Naturopathy can offer a safe and effective treatment for reflux. With simple changes to the mothers and babys lifestyle, this problem usually is eradicated and life returned to normal.
(1) Cotran, Kumar, Collins, 1999, Robbins Pathological Basis of Disease, 6th Edition, W.B. Saunders Company, South America.
(2) Kumar and Clarke, 2002, Clinical Medicine, 5th Edition, W.B. Saunders, UK.
(3) McCance K. and Huether S. 2002, Pathophysiology – The Biological Basis for Disease In Adults and Children, Mosby, USA.
Haas, 1992, Staying Healthy with Nutrition, Celestial Arts, USA.
Mills and Bone, 2000, Principles and Practice of Phytotherapy, Churchill Livingstone, China.
Murray and Pizzorno, 1998, Encyclopaedia of Natural Medicine, Little Brown and Company, Great Brittan.