Gastroesophageal reflux disease (GERD) develops when there is a frequent backwash of stomach acid into the esophagus. Acid reflux or heartburn refers to the burning sensation felt behind the sternum (retrosternal burning) due to the backflow of stomach acid into the food pipe. Homeopathy for acid reflux and GERD helps treat the condition and manage the symptoms effectively. The top three medicines for treating GERD, acid reflux, and heartburn are Robinia, Iris Versicolor, and Natrum Phos.
Gerd if left untreated can lead to a more serious complication called Erosive esophagitis; which in turn can lead to ulceration, bleeding and narrowing of the food pipe.
The Main Cause of Heartburn
To understand GERD, one will have to first understand how our esophagus (food pipe) and stomach handle food and acid. As the food reaches the lower end of the food pipe, a circular muscle (the LES or lower esophageal sphincter) present around the food pipe opens up and allows the food to enter the stomach. Once it enters the stomach, this muscle closes the lower end of the food pipe. This actually behaves like a one-way valve stopping the food and the acid in the stomach from moving back into the esophagus. In Gerd, this valve relaxes abnormally or weakens, so the stomach acid flows back up into your esophagus very frequently, causing repeated attacks of heartburn.
– Heartburn, which is a burning sensation in the chest behind the breastbone. It gets worse after eating, lying down and on bending.
– Burning in the throat
– Chest pain
– Sour, bitter belching or waterbrash (sudden flow of saliva due to indigestion) from regurgitation of food or sour liquid
– Sour taste in the mouth
– Difficulty in swallowing
– Sensation of a lump in the throat
– Bad breath
– Feeling of Abdominal bloating
– Worsening of asthmatic complaint
Homoeopathic Medicines for Acid Reflux, Heartburn, and GERD
The conventional treatment for GERD involves the use of antacids, which work by changing the pH of the stomach acid to make it less acidic. This helps decrease the irritation caused by the acid to the stomach, esophagus or duodenum.
Use of antacids for an extended duration can cause side effects like gas, belching, constipation, diarrhoea, and swelling of the hands, feet, and ankles. Antacids also interfere with nutrient absorption. Proton pump inhibitors (PPIs), which are used to reduce the production of stomach acid are known to deplete vitamin B12 in the body. This can further affect the nervous system, cause fatigue, shortness of breath, and loss of vision.
The number of antacids used, and the duration of their use can affect the electrolyte balance in the body. Any changes in the levels of different electrolytes (like calcium, potassium or sodium) can adversely affect muscle and nerve function.
Further, aluminium-based antacids can weaken the bones by flushing out salts like phosphate and calcium.
Homeopathy, on the other hand, works gently to minimize the symptoms of GERD and treats the root cause of the problem. Homeopathy can be of great help to those who do not show much improvement even after lifestyle modifications. The top medicines that are used to treat GERD are:
1. Robinia – For Acid Reflux and GERD
Robinia is a top-listed medicine for treating GERD. Robinia is prepared from a plant named ‘yellow locust.’ The natural order of this plant is Leguminosae. The key indication to use this medicine in GERD is intense heartburn, constant sour belching, and sour vomiting due to the regurgitation of acid from the stomach. The symptoms of heartburn and acidity tend to get worse at nighttime, lying down and can cause sleeplessness.
Key indications for using Robinia for GERD:
– Sour belching and vomiting
– Heartburn and acidity worse at night
2. Iris Versicolor – For Sour, Bitter Belching
Iris Versicolor is a natural medicine for treating GERD. It is prepared from a plant commonly named ‘blue flag.’ The natural order of this plant is Iridaceae. Sour, bitter belching is the key feature to use this medicine. Vomiting of sour bitter fluid that burns the throat, vomiting with weakness, a smarting, burning sensation in the throat, and heartburn are the key symptoms. There may be burning distress and pains in the epigastric region (the part above the stomach) at frequent intervals. Constant nausea may be present with these symptoms.
There is excessive indigestion, and the food is vomited after an hour or so of eating a meal. Iris Versicolor is also a well-indicated medicine for a headache arising from acidity.
Key indications for using Iris Versicolor:
– Sour bitter belching
– Sour bitter vomiting
– Heartburn; burning in throat
3. Natrum Phos – For Heartburn and Difficulty Swallowing
Natrum Phos is another prominently indicated medicine for GERD treatment. It is useful when heartburn is attended with difficulty swallowing. Other symptoms include sour belching, waterbrash, and vomiting of sour fluid or cheesy, curdled masses. A lump sensation in the throat may also be present, along with a loss of appetite.
Key indications for using Natrum Phos for GERD:
– Heartburn and difficulty in swallowing
– Vomiting of sour, cheesy or curdled matter
Other Important Medicines for GERD
4. Arsenic Album – For Burning Pain in Throat
Arsenic Album is a medicine for GERD that is accompanied by a burning pain in the throat. The burning gets worse upon swallowing. Swallowing is difficult and painful. Other symptoms include regurgitation of acrid matter, water brash, heartburn, intense nausea, and weakness. Arsenic Album is also a well-indicated medicine for inflammation of the esophagus (esophagitis).
5. Calcarea Carb – For Sour Taste in Mouth
Calcarea Carb is a well-indicated medicine for GERD where there is a sour taste in the mouth. There is a regurgitation of sour substances with the flow of sour, watery fluid from the mouth. A foul odour from the mouth may be present with nausea. Sour, bitter belches, vomiting of sour, bitter slime (of food eaten), and heartburn are some other symptoms that may be present. The burning from the food pipe extends to the throat. Along with this, continued loud belching may appear especially after eating, with a cough and nausea.
6. Carbo Veg – For Bloating and Heartburn
Carbo Veg is an excellent medicine for GERD treatment. It is useful when there is bloating along with heartburn. Sour, offensive belching that gets worse after drinking or eating, a burning sensation in the throat and difficulty in swallowing are other symptoms. Even the simplest of food tends to trigger the condition.
7. Nux Vomica – For Acid Reflux with Cough
Nux Vomica is a highly effective medicine for GERD accompanied by a cough. Nux Vomica is one of the best-indicated medicines for a gastric cough that gets worse at nighttime and prevents sleep. Vomiting usually appears from coughing. The throat is sore and raw, and swallowing may be painful. Burning in the throat, especially at nighttime is present. There is a regurgitation of food with heartburn and sour belching.
8. Phosphorus – For Acid Reflux with Laryngitis (Hoarse Voice)
Phosphorus is a medicine for GERD where there is hoarseness of voice. The hoarseness may be worse during the evening. A hard, dry, racking cough may appear. Gastric symptoms like heartburn, sour belching, sour taste in the mouth, vomiting of food or sour, acidic liquid may also be present.
9. Pulsatilla Nigricans – For Acid Reflux from Fatty Food
Pulsatilla Nigricans is a natural medicine prepared from a plant named ‘windflower.’ The natural order of this plant is Ranunculaceae. It is used in cases of GERD where the consumption of fatty food worsens the complaint. Greasy, fatty food like creams, pastries, and ice creams trigger acid reflux. The symptoms include heartburn and water brash. Belching of food, bitter taste in the mouth, nausea and a sensation of having a lump in the throat may be present.
10. Sulphuric Acid – For Acid Reflux with Sour Belching
Sulphuric Acid is a medicine for GERD where intensely sour belching is present. Heartburn, sour vomiting and nausea are other symptoms. The sour vomiting mostly appears after eating.
Risk Factors: GERD
Obesity and being overweight are risk factors that contribute to the development of GERD. The reason is that the excess fat in the abdomen compresses the stomach and raises its internal pressure. This increased pressure leads to the backing up of stomach acid contents to the food pipe. This is known as acid reflux. Even a small increase in the body weight of a person is likely to increase the risk of GERD. Overweight and obese people are three times more at risk to develop GERD as compared to people who are at a healthy weight. The severity of symptoms of GERD and the risk of developing associated complications is also more pronounced in overweight and obese people.
People having hiatus hernia are at risk of developing GERD. A hiatus hernia is the bulging of the upper part of the stomach through the hiatus opening in the diaphragm (muscle partition between chest and abdomen). Hiatus hernia leads to weakening of the LES that allows easy reflux of stomach contents into the esophagus.
Smokers are at high risk to develop GERD. This is because nicotine present in tobacco tends to relax the lower esophageal sphincter. This allows the reflux of acid contents to rise into the food pipe.
The risk of GERD and heartburn is high in pregnant women. There are two reasons for this. One is that the hormonal changes that occur during pregnancy tend to cause the relaxation of esophageal muscles and LES. The second is that the growing fetus tends to put pressure on the stomach. Both these factors cause the pushing of the stomach acid into the esophagus. The heartburn usually develops in the second and third trimester of pregnancy.
Type of Exercise
Strenuous exercise right after eating a meal is not advised. Those who indulge in heavy exercise with a focus on the core muscles of the abdomen are at an increased risk of developing GERD. Certain activities can decrease the blood flow to the gastrointestinal area, causing the gastric fluids to get collected. (1) This can further lead to irritation and inflammation.
Exercises that involve hanging upside down or bending are some examples that can worsen GERD symptoms. People also tend to gulp air during high-impact workouts. This can relax the lower esophageal sphincter, forcing stomach acid into the esophagus. Eating immediately before a workout also increases the risk of acid reflux.
Some high-impact exercises that can cause heartburn are:
Factors that can Trigger or Worsen GERD Symptoms
– Food: Fatty foods, fried food, chocolates, spicy food, tomatoes, garlic, onions, and citrus fruits are known to worsen GERD symptoms.
– Medications such as NSAID’s, antibiotics (such as tetracycline), pain relievers (such as ibuprofen and aspirin), birth control pills, hormone replacement therapy steroids, antidepressants like amitriptyline, asthma medication like beta-adrenergic agonists or bronchodilators, iron supplements, and quinidine (a heart medication) are some medications that tend to worsen the symptoms of GERD and cause acid reflux.
– Carbonated drinks, caffeinated drinks: These are often sweetened and contain excessive air which can cause gas, contributing to GERD.
– Late-night eating
– Eating food in large quantity
– Immediately lying down after eating food
Classification of GERD
GERD is classified into two types. Erosive reflux disease (ERD) and non-erosive reflux disease (NERD). This classification is not based on the symptoms, but rather on the findings derived from an endoscopy.
In the case of erosive reflux disease, stomach acid damages the esophageal mucosa.
In non-erosive reflux disease, the esophageal mucosa is not damaged by acid reflux.
The Link Between Acid Reflux and Heartburn
Acid reflux causes heartburn because of underlying irritation and inflammation in the food pipe from stomach acid. Several layers of tissue line the stomach. These are mucosa (inner lining), submucosa (it covers the mucosa), muscularis propria (next layer to submucosa and serosa). The stomach stores food temporarily for approximately 2 hours; the acid and enzymes help break down the food and digest it. There are specialized cells in the mucosa layer that produce hydrochloric acid (HCl) and digestive enzymes to enable the digestion of food.
The stomach can hold this acid without being damaged since the goblet cells in the mucosa secrete large quantities of protective mucus. This helps protect the stomach lining from being corroded by stomach acid.
However, the lining of the esophagus does not share this protective feature, and the throat is not designed to handle such acidic contents. Therefore, when reflux of stomach acid goes into the esophagus, it damages, irritates, and inflames the food pipe. This is the reason for the burning sensation felt behind the sternum, known as heartburn.
Complications / Long-term Effects of GERD
Long-standing uncontrolled or untreated GERD carries a risk of developing certain complications. These include inflammation of the esophagus (esophagitis), Barret’s esophagus, Ulcers/erosions in the esophagus, and stricture of the esophagus from a scar.
Inflammation of the Esophagus (Esophagitis)
The esophagus is a tube that connects the mouth to the stomach. Frequent backup of acid into the throat leads to its inflammation. If inflammation is left untreated, it carries a chance of forming ulcers in the esophagus and scarring that leads to the formation of a stricture. Its symptoms are difficulty in swallowing, painful swallowing, burning behind the sternum (heartburn), nausea and vomiting.
Stricture of Esophagus
Stricture of esophagus means narrowing of the esophagus. A stricture forms as a result of damage to the lining of the esophagus (from the acid contents of the stomach). As a result, there is inflammation and the development of scar tissue, which leads to narrowing and obstruction of the esophagus. The symptoms arising in esophageal stricture include:
– difficulty in swallowing
– chest pain
– regurgitation of food or liquids
– a sensation of having something stuck in the chest after eating
– unintended weight loss
Complications of esophageal stricture: Choking or difficulty in breathing due to the lodging of solid food in the esophagus, dehydration, malnutrition, and pulmonary aspiration causing aspiration pneumonia.
Ulcers/Erosions in Esophagus
Long-term backing up of stomach acid can damage the lining of the esophagus causing ulcers. These can lead to difficult/painful swallowing, heartburn, pain behind the sternum, and there may be bleeding.
Barret’s esophagus is a serious complication of GERD. In this condition, the squamous type of cells present in the lining of the esophagus change from squamous type to columnar epithelial type. Back up of acidic stomach contents into the esophagus lead to damage to esophageal tissue. During the process of healing this damage, the original kind of cells naturally present can change form. People with Barret’s esophagus are at risk to develop esophageal cancer. The symptoms of Barret’s esophagus include heartburn, dysphagia (difficulty swallowing) and chest pain (although rare).
Investigations in GERD
GERD is primarily diagnosed with the help of an upper endoscopy. An endoscopy helps rule out a hiatus hernia and the complications of GERD, like inflammation, and ulcers in the esophagus.
A biopsy of the tissue from the esophagus may be conducted in case of suspected Barrett’s esophagus.
Acid Reflux and GERD in Infants
Acid reflux is very common among infants. Spitting up of milk is a part of their daily activities and can occur several times a day. It is usually not a reason for concern as long as the baby has a healthy weight and has no respiratory difficulty. It usually resolves on its own at around 18 months of age. Rarely is acid reflux indicative of GERD in the case of infants. Frequent vomiting, feeding refusal, weight loss, difficulty feeding, high irritability, and long-term wheezing are a few indications of GERD in infants. An evaluation by a paediatrician is essential to rule out whether it is normal reflux or GERD.
Managing Acid Reflux and GERD
Some tips that can help minimize acid reflux and manage GERD include:
Drink More Water
Increasing the consumption of water helps reduce the symptoms of GERD and also improves overall digestion. This is because in most cases, water replaces other drinks that may include alcohol, sweetened beverages or caffeine.
Avoid Smoking and Alcohol
Smokers have a drastically higher risk of developing GERD and other inflammatory conditions as compared to non-smokers.
Alcohol can also trigger GERD, and lead to the development of symptoms like increasing inflammation and stress, weight gain, and dehydration. It is also known to worsen symptoms like nausea, bloating, gas and sleep issues.
Eat Small, Regular Meals
Instead of the usual 3-large meals a day, it is preferable to eat 4-6 smaller meals throughout the day to facilitate better digestion. Also, food must be eaten slowly and chewed thoroughly before swallowing. Eating mindfully also helps prevent overeating (which can cause an increased release of stomach acid). While drinking a beverage, one must take small sips instead of gulping down large amounts of fluid, since that can trap gas in the stomach.
GERD tends to be more common in people who lead a sedentary lifestyle with little or no exercise. Those who have a poor nutritional diet or are overweight are more susceptible to developing GERD. Exercise helps improve physiological functions like digestion, and circulation, and maintain body weight. It also helps reduce inflammation and enhance the quality of sleep.
Certain medications like NSAIDs (non-steroidal anti-inflammatory drugs) and hormone replacement drugs can contribute towards the development of GERD. Their use should be minimized and discontinued (after consulting a physician) if they contribute towards the symptoms of GERD.
Exercising before bedtime or lying down soon after dinner can worsen the symptoms of GERD. The last meal of the day should ideally be consumed 2-3 hours before bedtime, and the system should be relaxed before it is time to sleep. Doing so helps ease digestion.
It is important to eat small, easily digestible meals and not burden the digestive system with a large amount of food in a single sitting. This helps prevent acid reflux as well as gastrointestinal disorders.
Maintain a Healthy Weight
It is essential to maintain healthy body weight to reduce the chances of developing GERD.
Wearing restrictive clothing that put pressure on the stomach should be avoided. Loose, comfortable clothing that does not restrict movement helps keep the digestive system functioning properly.
Raised Head Position
Keeping the head slightly elevated while sleeping helps reduce acid reflux. The head should ideally be 6 to 8 inches higher than the feet while sleeping. The upper body needs to be uniformly raised.
Stress can disturb digestion due to the production of stress hormones. Stress can further cause a person to turn to alcohol, smoking, bad eating habits and more.
It is important to manage stress and find time for relaxation. Light exercise, indulging in hobbies and getting adequate rest are important factors that help reduce the chances of developing GERD.
GERD: Foods to Eat
Whole foods that are prepared fresh and do not have too many added preservatives or chemicals are generally good for health, and more so for those dealing with GERD. A plant-based diet that is rich in antioxidants, nutrients, water content, and fibre can help manage the problem and also treat it. Some examples of foods that help address GERD include:
Fresh vegetables of different colours like green leafy vegetables, sweet potatoes, peas, cucumber, carrots, etc.
Fermented products like apple cider vinegar can help balance stomach acid and reduce the tendency of acid reflux.
Foods that have a high amount of fibre, like whole grains, nuts, seeds, vegetables, and fruits.
Foods that contain healthy fats, like coconut milk, olive oil, coconut oil, almonds, flaxseeds and chia seeds.
Low-fat, lean proteins like wild fish and soaked beans.
Probiotics like yoghurt or fermented vegetables also increase the healthy gut bacteria in the system, thereby aiding digestion.
GERD: Foods to Avoid
Animal products and dairy products, in general, are difficult to digest and should be limited or avoided by people dealing with GERD.
Caffeinated drinks like energy drinks and coffee or tea.
Allergy-causing foods or foods that lead to a sensitivity in the body, like gluten, certain nuts, or synthetic ingredients.
Fatty foods like processed meat, cereals, cheese and fast food.
Alcoholic drinks like wine, beer, or liquor are difficult to digest and can worsen the symptoms of GERD, especially if consumed too close to bedtime.
Overly spicy foods.
Foods that are high in sodium, like chips, salted products, etc.
Tomatoes and tomato-based products are also known to worsen the symptoms of GERD in some people.
Chocolates contain a substance called methylxanthine, which is known to relax the smooth muscles in the lower esophageal sphincter, thereby increasing the chances of acid reflux.