GORD

Question 1

Gastro-oesophageal reflux disease (GORD)

Answer 1

Gastro-oesophageal reflux disease (GORD) = the reflux of gastric juice (HCl, bile, pepsin) back into the oesophagus.

• The most common symptom is heartburn (retrosternal pain).
• GORD is associated with transient lower oesophageal sphincter (LOS) relaxation episodes and a decreased lower oesophageal sphincter pressure.
• Often treated conventionally with chronic PPI use.

Question 2

GORD risk factors

Answer 2

• ↑ intra-abdominal pressure: Obesity, pregnancy.
• Hiatus hernia (stomach protrudes through the diaphragm into the thoracic cavity).
• Eating large amounts of fatty foods (acid remains in stomach longer).
• Smoking, alcohol, coffee; peppermint, tomatoes and chocolate relax the LOS.
• Certain medications: Calcium channel blockers, nitrates, NSAIDs, diazepam.
• Stress, anxiety and family history.

Question 3

Natural approach to GORD

Answer 3

• Consider testing for H.pylori.
• Consider low stomach acid (test it!):

‒ Poor gastric digestion due to low HCl leads to fermentation of undigested food creating gas in the stomach and increasing pressure on the LOS.

‒ Correct low stomach acid using digestive bitters, ACV, bitters, betaine HCl. Consider digestive enzymes.

• Avoid trigger foods / drinks and any foods associated with a food sensitivity or allergy, e.g., wheat.
• A Mediterranean diet has been shown to be protective.
• Slow down, chew thoroughly, eat mindfully, don’t overeat (or too late — within 3 hours of bed), do not drink with meals.
• Avoid lying down post meals; when sleeping elevate the head of the bed (by up to 20 cm).
• Address stress and anxiety. Lose weight if applicable.
• Visceral manipulation of hiatus hernia. Also ↑ fibre to ↓ straining.

Use demulcent herbs to soothe and coat the oesophageal mucosa. Slippery elm (2–3 tsps. daily; mix into water (1 tsp:250 ml water). Can also use: marshmallow root, liquorice, meadowsweet.