Acid reflux disease or Gastro esophageal Reflux Disease is a gastric disorder which causes stomach acids to back up in the esophagus (chronic mucosal damage produced by the abnormal reflux in the esophagus).

It is a condition in which the liquid contents of the stomach regurgitates (refluxes) into the esophagus. These contents can inflame and damage the lining of the esophagus. The regurgitated or refluxed liquid usually contains acid and pepsin and sometimes even bile (that, which has backed up by the duodenum into the stomach). Acid is the most injurious component present in the liquid.

Causes

Two conditions must be met for a reflux episode to occur. The gastrointestinal contents must be “ready” to reflux, and the antireflux mechanism at the lower end of the esophagus must be compromised. Gastrointestinal contents are most likely to reflux (1) when gastric volume is increased (after meals, with pyloric obstruction or gastric stasis syndrome, and in acid hypersecretory states), (2) when the gastric contents are located near the gastro esophageal junction (due to recumbency or bending), and (3) when gastric pressure is increased (with obesity, pregnancy, ascites or tight binders or girdles).

Reflux occurs only when the LES – gastric pressure gradient is lost.

The other causes include incompetence of the lower esophageal sphincter, transient lower esophageal sphincter relaxation, impaired expulsion of gastric reflux from the esophagus, and delayed emptying of the stomach or a hiatus hernia.

Incompetence of lower esophageal sphincter

• the LES is located at the very bottom of the esophagus, where the esophagus joins the top of the stomach. The LES normally opens or relaxes (lowers its pressure) as food is moved down the esophagus by esophageal contractions. These esophageal contractions are started by swallowing. As soon as the swallowing stops, LES closes to keep the food in the stomach.
  
  If it weakens and loses tone, the LES cannot close up completely after food empties into the stomach. In such cases, acid from the stomach backs up into the esophagus. Certain factors such as improper diet, lack of activity, drugs, and nervous system factors can weaken it or impair its function.

Impaired stomach function

• the stomach muscles sometimes do not contract properly and delays in emptying of the stomach; which is also another cause of acid back up. The slower emptying of the stomach prolong the distension of the stomach with food after meals. Therefore the slower emptying prolongs the period of time during which reflux is more likely to occur.

Abnormal esophageal contractions

• swallowing is important in removing the acid from the esophagus. Swallowing causes a ring like contraction that begins from the upper esophagus and travels to the lower esophagus. When the contraction is defective, the acid is not pushed back into the stomach. Such abnormalities of contraction reduce the clearance of acid from the esophagus, are found frequently in patients with GERD. This condition is worsened at night when gravity is not helping to return reflux acid to the stomach.

Hiatus hernia

• hiatus hernia also contributes to reflux. Hiatus hernia is a herniation of a part of the stomach into the thoracic cavity through the esophageal hiatus in the diaphragm. Most of the patients with GERD have hiatal hernia, but many do not. Therefore it is not necessary to have a hiatal hernia for all those who are suffering from GERD.

Symptoms

Heart burn is most often associated with gastro esophageal reflux disease. here, heart burn typically occurs after a large meal, with stooping or bending, or when the patient is supine.

It may be accompanied by the spontaneous appearance in the mouth of fluid which may be salty (‘water brash’), sour (gastric contents), or bitter and green or yellow (bile). Heartburn may arise following the ingestion of certain foods (e.g. citrus fruits) or dugs (e.g. alcohol and aspirin). Characteristically, heart burn is alleviated promptly, even if only temporarily, by antacids.

Angina like or atypical chest pain may occur in some patients, while others may experience no heart burn or chest pain. Dysphagia suggests development of peptic stricture. In one-third of the patients, dysphagia may be the presenting symptom.

Reflux in the absence of esophagitis is usually asymptomatic. Severe reflux may reach the pharynx and mouth and result in laryngitis, morning hoarseness and pulmonary aspiration.

Treatment

The goals of treatment are to decrease gastro esophageal reflux, renders the refluxate harmless, improve esophageal clearance and protect the esophageal mucosa. These goals can be achieved by certain general measures and specific drug treatments.

The management of uncomplicated cases generally includes weight reduction, sleeping with elevation of the head of the bed by about 4 to 6 in with blocks, and elimination of factors that increase abdominal pressure.

Patients should avoid smoking, fatty foods, coffee, chocolate, alcohol, mint, orange juice, ingestion of large quantities of fluids with meals and certain medications (such as anti-cholinergic drugs, calcium channel blockers and other smooth muscle relaxants). In mild cases, H-2 blocking agents or antacids to neutralize acidity usually are successful.

The acid reflux disease requires prolonged therapy for 3 to 6 months or longer, if the disease recurs quickly.

Lifestyle changes

Smoking is another factor that triggers the disease. Elevating the head during the bed also prevent the symptoms during sleep. Also lying down soon after a meal is not advisable. A number of studies have revealed that GERD is more commonly seen in obese people.

Ayurvedic Medicines useful for acid reflux

The Ayurvedic Medicines useful in treating acid reflux are Maha Shankh vati, Triphala churna, Trikatu etc.

Herbal Pack for Acid reflux

• Maha Shankh vati – 2 tablets twice daily before meals

• Yakritplihantak Churna – 1 teaspoon twice daily before meals