Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD)

Chapter 31 Gastroesophageal reflux disease (GERD) Summary Type 1: Lower esophageal sphincter Essence: Hypervagal tone on the lower esophageal sphinct...

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Chapter 31

Gastroesophageal reflux disease (GERD) Summary Type 1: Lower esophageal sphincter Essence: Hypervagal tone on the lower esophageal sphincter results in reflux of gastric content with normal gastric pressure Summary: (1) Hyperparasympathetic tone leads to (2) relaxed lower esophageal sphincter tone and (3) reflux of gastric content

Type 2: Pyloric sphincter Essence: Hyper-alpha-sympathetic spasmophilia of pyloric sphincter with increased gastric pressure resulting in retrograde flow of gastric content Summary: (1) Spasmophilia of pyloric sphincter, leads to (2) increased intragastric pressure to overcome resistance to dilation resulting in (3) reflux of gastric content into esophagus

Treatment goals Symptomatic: antacids, proton pump inhibitors Terrain: Type 1: Lower esophageal sphincter: ● ANS: reduce parasympathetic tone ● GI: improve efficient of production of digestive juices and motricity Terrain: Type 2: Pyloric sphincter: ● ANS: spasmolysis ● GI: biliary-pancreatic competency

Sample treatment Type 1: Lower esophageal sphincter 1. Neuro-GI-fatigue: 1 cup 15–30  min before meals (Table 31.1): Carum carvi seeds ¼–½ tsp, Thymus vulgaris ¼ tsp steep 6–8 min in 150 mL water 2. Diet: eat lightly cooked (steamed, baked, broiled, lightly sautéed) foods, boiled eggs, fish, fowl; if red meat, grass

The Theory of Endobiogeny. https://doi.org/10.1016/B978-0-12-816965-0.00031-7 © 2020 Elsevier Inc. All rights reserved.

fed and marinated and tenderized before cooking. Eat in a calm environment, focusing on chewing until liquefaction, placing utensils down on table while chewing. Avoid acidic, fatty or fried foods, poor-quality red meat, acidic food and beverage, rapid or high-volume consumption of food

Type 2: Pyloric sphincter 1. Neuro-digestive-anxiety/anger: 3–4  mL with meals (Table 31.5): Matricaria recutita MT 60 mL, Plantago major MT 60 mL, Cinnamomum zeylanicum EO 2 mL 2. Diet: see GERD type 1

Terrain in detail: Type 1 GERD: Lower esophageal sphincter Precritical terrain The precritical terrain is one in which the demand for vagal activity at the level of the digestive tract is adapted to local requirements. It can be in response to regional or global autonomic activity, to the quality or quantity of food, or, to calibrate or adapt the quality or quantity of digestive juices: 1. ANS a. Vagotonic patients b. Systemic hyper parasympatheticism with secondary elevation of local vagal tone c. Reactionary elevation of vagal tone to regional or global elevation of alpha-sympathetic tone 2. Alimentation a. Chronic consumption of foods that strain the digestive capacity of the organism 3. Digestion a. Oversolicitation of digestive juices: salivary, gastric, exocrine pancreatic b. Loss of absorptive capacity: denudation of intestinal villi

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214 SECTION | C  Assessment and treatment of common disorders

Agent

History and BoF findings

Solicitation of sufficiently elevated parasympathetic tone that expresses itself on the lower esophageal sphincter:

During acute GERD type 1, the patient will complain about the symptoms noted under “Results.” Inquire about diet and dietary hygiene, and the presence of the various aggressors noted earlier.

1. Quality of meal: animal protein, fatty or fried foods, acidic foods or drinks, caffeinated beverages 2. Quantity of meal: large portions 3. Rate of consumption: rapid 4. Decrease in production or expression of digestive juices a. Elevated cortisol: suppresses excretion b. Elevated somatostatin activity: ends production 5. Elevation of sympathetic tone (with reactionary rise in parasympathetic tone) 6. Chronobiologic demand for increased parasympathetic tone (e.g., physiologic vagotonia of childhood) 7. Restorative adaptation states requiring increased parasympathetic tone (e.g., recovery from injury)

Critical terrain ANS: hypervagal tone on the lower esophageal sphincter (LES).

Mechanisms Diminished resting (closed) tone of the LES.

Result During contraction of the stomach, with normal intragastric pressure, there is retrograde movement of chyme and acid into the lower esophagus causing a feeling of (one or more of the following): 1. Retrosternal burning, pain or discomfort 2. Recurrent asthma, especially cough-variant 3. Aspiration pneumonia (especially in the elderly) 4. Arching of the back with wincing and/or crying (in infants)

Physical exam and BoF findings During presentation with acute GERD Type 1, a number of physical exam findings may be present, with some possible Biology of Functions correlations (Table 31.2) In the Biology of Functions, the Parasympathetic index may be elevated or low as an indicator of the general parasympathetic tone of digestion and nutrition.

Treatment 1. Alimentation a. Specific: avoid known offending foods, e.g., nightshades (e.g., potatoes, tomatoes), pizza, etc. b. General: avoid acidic, fatty, or fried foods, poorquality red meat, acidic food and beverage, rapid or high-volume consumption of food 2. Terrain a. ANS/GI: parasympatholytics with digestive, eupeptic activity (Table 31.1) b. General endocrine terrain, address according to comorbidities related to onset of GERD type 1

Exemplary prescriptions Based on an Endobiogenic approach to type 1 GERD, a number of prescriptions can be derived. One example is presented here: 1. Neuro-GI-fatigue: 1 cup 15–30 min before meals: Carum carvi seeds ¼–½ tsp, Thymus vulgaris ¼ tsp steep 6–8 min in 150 mL water

TABLE 31.1  Polyvalent medicinal plants for type 1 GERD. Parasympatholytics

Other properties

Comorbidities

Thymus vulgaris: EO, BH

Adrenal cortex stimulant Emmenagogue

Depression, fatigue, insomnia, amenorrhea, infertility

Ocimum basilicum: EO, BH

Adrenal cortex stimulant FSH/LH stimulant, Estrogenic

Carum carvi: EO, BH

Reduces adrenal androgens

Key: BH, bulk herb; EO, essential oil; MT, mother tincture.

Irritability, acne on jawline

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2. Diet: a. Eat: lightly cooked (steamed, baked, broiled, lightly sautéed) foods, boiled eggs, fish, fowl; if red meat, grass fed (not grass finished), and, marinated before cooking b. Hygiene: eat in a calm environment, focusing on chewing until liquefaction, placing utensils down on table while chewing c. Avoid: acidic, fatty, or fried foods, poor-quality red meat, acidic food and beverage, rapid or high-­ volume consumption of food

Terrain in detail: Type 2 GERD: Pyloric sphincter Precritical terrain Timing of release of chyme from the stomach is related to the rate and quality of release of bile and digestive enzymes and bicarbonate from the gallbladder and exocrine pancreas, respectively. In the precritical terrain, there is a chronic oversolicitation of these digestive glands due to the consumption of fatty, fried, and acidic foods (c.f. Type 1 GERD for details) with a compensated vagal tone for production and excretion of digestive juices. 1. Biliary-pancreatic strain: oversolicited due to diet 2. ANS: adapted (often elevated) parasympathetic (vagal) tone

Agent The inciting agent may be (1) level of dietary consumption that exceeds the threshold of digestive competency, (2) sympathetic tone that installs a spasmophilia, or (3) some combination. 1. Biliary-pancreatic: insufficiency or deficiency of timing or quantity of digestive juices 2. ANS: hyper alpha-sympathetic a. Emotional stress b. Physiologic stressors c. Overadapted to chronically elevated vagal tone d. Chronobiologic adaptation (transition to spring, autumn, etc.: (c.f. Chapter  12 and The Theory of Endobiogeny, volume 2, Chapter 11: Spasmophilia)

Critical terrain 1. ANS: spasmophilia (hyper alpha>hyper para, beta blocked or delayed) on pylorus

Mechanisms Insufficiency of bile and/or pancreatic juices makes an appeal to the stomach to delay passage of chyme, resulting in an elevated tone on the pyloric sphincter (spasmophilia). The stomach must develop supraphysiologic pressure to overcome pyloric tone.

Result During contraction of the stomach, with supraphysiologic intragastric pressure, there is retrograde movement of chyme and acid into the lower esophagus causing a feeling of (one or more of the following): 1. Retrosternal burning, pain or discomfort 2. Recurrent asthma, especially cough-variant 3. Aspiration pneumonia (especially in the elderly) 4. Arching of the back with wincing and/or crying (in infants)

History and BoF findings During acute GERD type 2, evaluate for the presence of the symptoms noted earlier, as well as the possible aggressors, and address them as indicated. A general evaluation of spasmophilia symptoms can also be explored, such as anxiety, depression, muscle cramps, etc. Symptoms related to dyspepsia rooted in biliary-pancreatic insufficiency can include: 1. Gallbladder a. Intolerance of fried or fatty foods: prolonged feeling of gastric fullness, burping, and “tasting” the foods for hours b. Subhepatic pain with or without movement toward the back related to consumption of fried or fatty foods c. Clay-colored stool 2. Exocrine pancreas a. Bloating within 20 min of eating b. Floating stools (steatorrhea) c. Intolerance of specific types of foods (legumes, red meat, fat, carbohydrates)

Physical exam and BoF findings During presentation with acute GERD type 2, a number of signs can be noted with correlation with certain BoF indexes. Some are specific to biliary-pancreatic oversolicitation or insufficiency, others may be related to spasmophilia (Table 31.2).

216 SECTION | C  Assessment and treatment of common disorders

TABLE 31.2  Critical terrain signs and Biology of Functions correlations. Area

Finding

Terrain

BoF

Neuro

Chvostek

Spasmophilia

⇑/⇓ LMI + ⇓PMI

Mouth

Dilated opening of canal of Stensen

Insufficient pancreatic amylase

↑/↓ Somatostatin

Mouth

Saliva stringy

Alpha>para

↑/↓ Leukocyte mobilization

Pancreas

Tender, above umbilicus Tender, right of umbilicus Tender, left of umbilicus

Congestion: general Oversolicitation: exocrine Oversolicitation: endocrine

N/A ⇑/⇓ Somatostatin ⇑/⇓ Insulin

Gallbladder

Murphy’s point tender (midpoint umbilicus to right costal margin)

Gallbladder congested

Treatment GERD type 2 is a spasmophilia; thus, there is hyperfunctioning alpha greater than hyperfunctioning vagal tone. The goal of treatment is three-fold: 1. ANS (Table 31.3) a. Spasmolysis

b. Relaunch or restore the proper sequencing of beta 2. Digestive (Table 31.4) a. Assure choleresis and cholagogy where required b. Assure adequate production of digestive enzymes where required 3. Diet: see Type 1 GERD

TABLE 31.3  Polyvalent medicinal plants with autonomic properties. Plant

ANS

Other properties

Comorbidities

Matricaria recutita

Parasympatholytic Alphasympatholytic

Anti-inflammatory, eupeptic, hepatosplanchnic drainer, neurotropic antispasmodic

Anxiety, anger, inflammatory conditions, dyspepsia

Salvia sclarea

Parasympatholytic Alphasympatholytic

Supports adrenal cortex and thyroid, estrogenic, eupeptic, pancreatic drainer

Nervous asthenia, fatigue, amenorrhea, hypothyroidism, etc.

Lavandula angustifolia

Parasympatholytic Alphasympatholytic

Reduces adrenal cortex activity, hepatobiliary drainer, antiallergic, antispasmodic

Insomnia, chronic fatigue, allergies, migraines, etc.

Cinnamomum zeylanicum

Beta-mimetic

Eupeptic, regulates intestinal flora, antimicrobial with tropism for digestive tract

Intestinal candidiasis or intestinal parasites, dysbiosis with bloating and gas, asthma

Menyanthes trifoliata

Beta-mimetic

Anti-inflammatory, antiandrogenic, estrogenic, beta-sympathomimetic

Inflammation, acne, prostatic hypertrophy, uterine leiomyoma, etc.

TABLE 31.4  Polyvalent medicinal plants with biliary-pancreatic tropism. Medicinal plant

Exocrine pancreas

Gallbladder

Other

Agrimonia eupatoria

General stimulation of enzyme production



Dual pancreatrope and drainer, digestive astringent

Arctium lappa

General stimulation of enzyme production



Dual pancreatrope, immunomodulator

Plantago major

Amylase, disaccharidase



Digestive antispasmodic, hepatobiliary drainer

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Exemplary prescriptions Based on an Endobiogenic approach to type 2 GERD, a number of prescriptions can be derived. One example is presented: 1. Neuro-digestive-anxiety/anger: 3–4  mL with meals (Table 31.5) Matricaria recutita MT 60 mL, Plantago major MT 60 mL, Cinnamomum zeylanicum EO 2 mL 2. Diet: see GERD type 1

TABLE 31.5  Treatment of GERD, type 2, DOSE: 2 mL three times per day before meals. Plant

Replacements and alternatives

Matricaria recutita MT 60 mL

Salvia sclarea MT

Plantago major MT 60 mL

Agrimonia eupatoria MT

Cinnamomum zeylanicum EO 2 mL

Lavandula angustifolia EO

Key: MT, mother tincture; EO, essential oil.