GERD or gastro-esophageal reflux disease is a dysfunction of an organ known as the lower esophageal sphincter (LES) in the digestive tract. The LES is a valve located between the abdomen and the esophagus. When this organ opens when it shouldn’t or does not shut in the right way, it allows stomach acid as well as stomach contents to flow back to the esophagus and even at times, all the way to the throat and mouth.

When the digestive system and LES function the right way, food moves down the esophagus through peristalsis, when the food is ready to pass through the stomach, the valve relaxes to allow food to pass; it then immediately closes fully again. If the LES cannot completely close or if it relaxes in the wrong time, reflux happens. When food and stomach acid backflow, it can cause damage to the lining wall of the esophagus as well as pain. Virtually everyone has or will experience heartburn from time to time; however, when it happens frequently (many times a week), the esophageal wall becomes chronically irritated and this is an indication of GERD. Heartburn is the most the most common symptom of GERD and frequent burping, regurgitation, dysphagia, increased salivation, and a sour taste in the mouth are its other less occurring symptoms.

Based on statistics provided by the American Gastroenterological Association, GERD affects about 33% of people in the United States. The likelihood of the occurrence of this condition increases after a person reaches 40 years of age and over.

Doctors often diagnose GERD based on the patient’s symptoms although in instances when the patient does not respond well to drugs or to rule out esophageal cancer or Barrett’s esophagus diagnostic tests such as x-ray with barium swallow, pressure testing of the LES, testing of esophageal function and/or endoscopy may be done on the patient.

Typical foods that can cause reflux and heartburn include citrus, tomatoes, fried or fatty foods, onions, garlic and other spicy foods. Alcohol, soda and coffee make the stomach more acidic which can aggravate GERD. Tobacco smoking, alcohol, chocolate and peppermint can all lead the lower esophageal sphincter to relax which can worsen the reflux. Hiatal hernia, pregnancy and obesity can add to the pressure on the abdomen adding to the rise of GERD.

GERD has no known cure and so treatment is aimed at reducing symptoms and minimizing damage to the esophagus. An operation may be performed to tighten the LES. Intake of Nexium or Prilosec and other PPIs (proton pump inhibitors) is the standard treatment for GERD. PPIs help decrease the acidity of the stomach.

These drugs significantly provide relief but their side effects concern people who need to take them on a long term basis. In order to make the healing process of ulcers in the esophagus successful, the environmental acidity in the stomach need to be significantly lessened for one to three months. PPIs do perform their work quite well but the problem starts when the ulcers turn chronic and may need repeated intake of the medications. Recent studies have now shown that the long term use of PPIs may not be really that good for the body. These studies showed medicated long-term inhibition of stomach acid can lead to a stomach environment wherein there is not enough acid to help digest proteins and absorb important nutrients such as calcium and vitamin B12. This eventually can result in vitamin deficiency affecting the bone re-absorption and bone creation cycle and thus lead to increased bone fragility. Menopausal women may be more affected with this problem since their menopause already causes bone loss. Extended intake of PPIs has also led to the increased development of gastric polyps. Some studies also have revealed that extended use of PPI may lead to dependency that can cause rebound symptoms if the drugs are abruptly stopped.

TCM or Traditional Chinese Medicine sees GERD as an indication of an internal imbalance. The reflux and heartburn symptoms are often considered as a conflict between the abdomen and liver. The liver in TCM theory, is an organ responsible for keeping everything in the body (digestion, emotions, blood and energy) smoothly flowing smoothly in the proper directions. A tired liver can lead to severe stress making it hard for this organ to keep everything flowing smoothly which may cause the direction to “rebel;” when the flow rebels, its direction turns sideways into the stomach. Downward is the normal flow direction of the abdomen. The rebelling of the liver energy affects the abdomen causing the stomach energy to rebel upward. This can lead to chronic signs and symptoms such as reflux, heartburn, burping and a tongue that has a greasy and thick coating. GERD can also cause a sensation of a lump in the throat, usually accompanied with a throat-clearing cough. This condition is termed “plum pit qi” and is an indication of stagnation of liver qi.

Western medicine and TCM have a fundamental difference in the way they treat GERD. They have very different notions in the way stress impacts the body. Acupuncturists utilize a differential diagnosis that considers the effects of stress on the connection between organ systems and the imbalances that occur consequentially. After that, they treat the imbalances including the manifested symptoms.

The plan of treatment for symptoms such as reflux and heartburn may differ based on the particular manifestation of the patient. In general, the aim of treatment is to calm and regulate the liver, relieving the stress that makes this organ turn hostile on its neighbor the abdomen, bring back the proper downward flow of stomach qi, and remove heat and dampness that tend to amass when the stomach qi is disturbed. Both Chinese herbal therapy and acupuncture provide potent treatments for these ends. Based on the severity of the patient’s symptoms and his/her lifestyle and preference, the patient can decide to use acupuncture and Chinese herbal medicine as adjunct therapies to his/her Western drugs in order to resolve the symptoms, lessen the intake of drugs and prevent their side effects.

John Frink holds a Master’s Degree in Traditional Chinese Medicine and is a licensed acupuncturist in Davis, CA., with special training in Chinese herbal medicine.