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Reflux disease

MagazineApril 2009 (Vol. 20 Issue 1)Reflux disease

Q) I suffer from gastro-oesophageal reflux disease (GORD), which causes me to have a constantly hoarse voice, cough, a lump-in-the-throat sensation, indigestion and bloating-amongst other symptoms

Q) I suffer from gastro-oesophageal reflux disease (GORD), which causes me to have a constantly hoarse voice, cough, a lump-in-the-throat sensation, indigestion and bloating-amongst other symptoms. I've been prescribed omeprazole, which works, but the side-effects (dizziness, nausea, depression, sweat-ing, abdominal pain) are almost as bad as the disease itself. Are there any effective alternative treatments that can help?-C.P., via e-mail

A) Gastro-oesophageal reflux disease (GORD) is one of the most common prob-lems seen by general practitioners. It occurs when the lower oesophageal sphincter (the ring of muscle that sits at the lower end of the oesophagus, where it joins the stomach) has become abnormally relaxed, thereby allowing the stomach's contents, which contain gastric acids that aid digestion, to flow back, or 'reflux', up into the oesophagus.

Most of us experience acid reflux from time to time-when it's referred to as 'heartburn' or 'indigestion'. However, when reflux is chronic, it can damage the sensitive mucosal lining of the oesophagus and lead to GORD.

The usual first line of treatment for GORD is a proton-pump inhibitor (PPI) such as omeprazole. But, as you already well know, the drugs are associated with a raft of unpleasant side-effects-ranging from nausea, vomiting and constipation to an increased risk of pneumonia, and Campylobacter stomach and gastro-intestinal infections, or food poison-ing (Arch Intern Med, 2007; 167: 950-5; BMJ, 1996; 312: 414-5). Also, long-term PPI therapy can increase your risk of hip fracture (JAMA, 2006; 296: 2947-53). What's more, nearly 30 per cent of GORD patients still suffer from symptoms despite taking PPIs (Minerva Gastroenterol Dietol, 2003; 49: 277-87).

Antireflux surgery is another conventional treatment option. However, with this treatment, nearly two-thirds of patients still need to take antireflux medications after-wards. More worrying, the 10-year survival rate among those who undergo the operation compared with those given only the drug treatment is significantly worse, with more deaths due to heart disease (J Am Med Assoc, 2001: 285: 2331-8).

Treatment alternatives

As for alternative treatments, the first-and simplest-thing you could try to do is to make changes to your diet. Certain foods are known to worsen GORD, including alcohol, carbonated beverages, caffeine, chocolate, citrus juices, milk and peppermint (Cir Esp, 2007; 81: 64-9; Pediatrics, 2002; 110: 972-84).

Nevertheless, there is little evidence that avoiding these foods-or stopping smoking or avoiding alcohol-will improve symptoms (Arch Intern Med, 2006; 166: 965-71).

What may be a more effective alternative treatment is avoiding high-calorie and high-fat meals (Z Gastroenterol, 2007; 45: 171-5; Clin Gastro-enterol Hepatol, 2007; 5: 439-44), and opting instead for a low-carbohydrate (less than 20 g/day) diet, especially if you are obese (Dig Dis Sci, 2006; 51: 1307-12). However, more research is needed to determine whether this type of diet would be safe and effective in the long term.

Another simple intervention is chewing gum for one hour after a meal, proven in a small American study to ease symptoms of GORD for up to three hours after eating (Aliment Pharmacol Ther, 2001; 15: 151-5).

Certain supplements may also provide relief. In one trial of nearly 400 GORD sufferers, taking a dietary supplement containing melatonin, l-tryptophan, vitamin B6, folic acid, vitamin B12, methionine (an amino acid) and betaine was found to be more effective than omeprazole for treating GORD symptoms.

After 40 days, 100 per cent of the patients taking the supplement reported being completely free of symptoms-and without any side-effects-compared with 66 per cent in those taking omeprazole (J Pineal Res, 2006; 41: 195-200).

It may also be worth your while to increase your intake of antioxidants. Korean researchers found that giving an antioxidant herbal extract to rats-so these findings may not necessarily apply to humans-was helpful for preventing and treating oesophagitis, an inflammation of the oesophagus that can arise with GORD (Gut, 2001:

49: 364-71).

In China, acupuncture has been used to treat gastrointestinal prob-lems for thousands of years. In a recent review, American scientists from Duke University in Durham, North Carolina, concluded that acupuncture (using acupoint ST-36) may be effective in GORD patients because it stimulates gastrointestinal motility (the filling and emptying of the stomach and colon), which is often impaired in GORD sufferers. In addition, stimulation of the acupoint CV-12 may inhibit stomach-acid secretion, which would also be bene-ficial to these patients (J Gastroenterol, 2006; 41: 408-17).

Another traditional Chinese remedy-a herbal decoction known as jiangni hewei-has been found to be as effective as omeprazole in treating reflux oesophagitis in a small trial of 75 patients. But, in addition, it was also associated with a lower rate of symptom recurrence and no adverse effects (Zhongguo Zhong Xi Yi Jie He Za Zhi, 2005; 25: 876-9).

Other herbs that have been traditionally used to treat reflux and heartburn, and which may be helpful, include liquorice, aloe vera, slippery elm, bladderwrack and marshmallow.

Finally, try the following simple lifestyle changes. Avoid lying down within three hours of having a meal, and elevate the head of the bed to prevent symptoms during sleep (BMJ, 1998; 316: 1720-3). If you enjoy exercise, try activities such as cycling, walking or weight-training, which are less jarring than more vigorous activities such as running and, thus, produce fewer reflux symptoms (J Am Med Assoc, 1989; 261: 3599-601). Also, avoid running or rowing especially after eating (Aust

J Sci Med Sport, 1996; 28: 93-6).


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