https://orcid.org/0000-0002-6684-6266
Abstract
This article’s primary goal is to draw attention to the persistent issues Gastroesophageal reflux disease (GERD) sufferers experience and the ways that contemporary medicine and technology are addressing the condition’s treatment. This article’s primary goal is to present some traditional medicine, primarily Chinese medicine, and its treatments for this illness.
A literature survey was done using different search databases like SpringerLink, PubMed, Google Scholar, Science Direct, and Web of Science. Keywords “Gastroesophageal reflux disease,” and “Traditional Chinese medicine” were used.
The prevalence of GERD varies among populations and geographical places. It is more common in Western countries where obesity and nutrition are important lifestyle factors. However, obesity is becoming more commonplace worldwide due to changes in lifestyle, nutrition, and obesity rates.
This review discusses the use of Chinese medicine and lifestyle changes for treating GERD, despite the initial treatment of proton pump inhibitors. Nonetheless, up to 50% of the patients say their reflux symptoms are still present. Traditional herbal decoctions, such as modified Xiaochaihu decoction, Sini Zuojin decoction, and Hewei Jiangni decoction, have been found to reduce and even eliminate GERD symptoms. However, there is limited research and evidence-based therapeutic trials.
Introduction
Gastroesophageal reflux disease (GERD) is triggered by stomach acid reflux that causes uncomfortable symptoms or issues, according to the definition provided by the Montreal Consensus Meeting [1]. According to reports, as much as 20% of the 13% of adults worldwide of the adult population in the United States report having GERD symptoms at least once a month, with the majority of patients reporting chronic symptoms [2–5]. With an increase of 2.5% to 8.5% in Asian nations and 18.1% to 27.8% in North America, GERD is a significant global health issue. The estimated overall cost of esophageal diseases indicates that GERD is associated with a large economic burden [6, 7]. Events related to GERD can occur day or night. This means that symptoms might appear at any time of day. It’s important to note while the majority of GERD patients experience symptoms both throughout the day and at night, a tiny minority (13%) exclusively experiences symptoms during the day. GERD has been demonstrated to impact patients when they sleep [8–12]. Transient lower esophageal sphincter (LES) relaxation is the primary cause of 81% to 100% of gastroesophageal reflux disease (GER) episodes in adults, children, and newborns [13]. A malfunctioning esophagogastric junction, the antireflux barrier made up of the LES and crural diaphragm, decreased esophageal clearance, and changes in the integrity of the esophageal mucosa are all part of the path physiology of GERD. The generation of cytokines and chemokines from refluxed gastric juice attracts inflammatory cells and may worsen reflux esophagitis symptoms reduce salivation, postponed stomach emptying, and hypersensitivity of the esophagus are potential additional factors contributing to symptoms of GERD. As a result, GERD is no longer a single disease that needs to be addressed but rather one with various phenotypic manifestations and diagnostic variables.
The two main signs of GERD are regurgitation and heartburn. The most typical GERD symptom is heartburn, which is defined as a burning feeling that rises from the epigastrium toward the neck at a substernal location. The facile return of stomach contents to the mouth, known as regurgitation, is sometimes accompanied by an acidic or bitter taste. While both regurgitation and heartburn are common symptoms of GERD, their causes are different, and different treatment modalities are used depending on which symptom is more prevalent. Distinguishing between chest pain and cardiac discomfort, chest pain can manifest alone or in association with refluxing and burning in the chest [14].
There is no standard for diagnosing GERD. As a result, the diagnosis is made using a combination of the patients symptoms, the esophagus mucosa’s endoscopic examination, reflux monitoring, and the patient’s reaction to treatment. Refluxing and burning of the chest are still the most precise and sensitive signs of GERD, despite popular belief to the contrary. Heartburn and regurgitation had varying degrees of sensitivity (30%–76%) and specificity (62%–96%) for erosive esophagitis (EE), according to a well-conducted but older systematic study [6]. The underlying premise is that a majority of consensus statements and guidelines suggest a therapeutic trial of treatment with a proton pump inhibitor (PPI) as a diagnostic “test” in patients with the typical symptoms of regurgitation and heartburn. The PPI reaction confirms the GERD diagnosis [15, 16]. A class of drugs known as PPIs lowers the production of stomach acid. One noninvasive diagnostic method for GERD is the PPI test, sometimes referred to as a brief treatment trial. To determine whether symptoms improve, a high dose of PPI is administered briefly, usually between one and 28 days. Patients with GERD-like symptoms, such as heartburn and noncardiac chest pain, benefit most from this test [17].
Balloon Mucosal Impedance (BMI) Measurement is an innovative technique based on a balloon catheter equipped with sensors to detect mucosal impedance during endoscopy. It is a recently authorized tool for GERD evaluation. This method has demonstrated potential in distinguishing GERD from Eosinophilic esophagitis (EoE) and could prove to be a helpful supplement to endoscopy in the diagnosis of GERD [18].
Esophagus mucosa
To diagnose GERD, the esophagus mucosa must be examined. This test offers crucial information about the state of the esophagus and directs treatment plans, assisting in assessing the degree of damage brought on by acid reflux and choosing the best course of action. High-resolution manometry (HRM) and pH impedance monitoring are two common treatments. These diagnostic techniques are crucial for assessing acid reflux and esophageal function. To guarantee an empty stomach for HRM, patients are usually advised to fast for a few hours before the operation. Through the mouth or nose, a thin, flexible catheter equipped with many pressure sensors is advanced into the esophagus. The LES and other pressures along the esophagus are measured by the catheter.
A computer that records the pressure data is attached to the catheter. To find any motility problems, like achalasia or inadequate esophageal motility, the results are evaluated.
A pH impedance catheter is typically inserted in conjunction with HRM during the pH Impedance Monitoring technique. Multiple electrodes on this catheter measure the esophageal pH and impedance changes.
Comprehensive data collection is made possible by the catheter’s 24-h esophageal monitoring. With the catheter in place, the patient is usually sent home with instructions to keep a journal of their activities, food consumption, and symptoms throughout the observation period.
Acid exposure and the occurrence of acidic and nonacid reflux episodes are continuously recorded by the pH impedance catheter. The information is downloaded and examined following the observation period. The findings reveal the frequency and length of acid reflux episodes as well as the relationship between reflux symptoms and symptoms. Understanding the esophageal function and detecting disorders like GERD need the use of both pH impedance monitoring and HRM [19].
Endoscopic examination
An upper gastrointestinal endoscopy is the most popular objective test for assessing the esophagus mucosa. EE and Barrett’s esophagus endoscopic findings are unique to the diagnosis of GERD [20]. Endoscopy is advised following PPI treatment in patients with Los Angeles (LA) grade C and D EE to monitor for healing and to check for Barrett’s esophagus, which can be hard to find in cases of severe EE. Grade C describes one or more mucosal breaks that span less than 75% of the esophageal circumference and are continuous between the tops of two or more mucosal folds, whereas grade D describes severe esophagitis is indicated by mucosal breaks that cover at least 75% of the esophageal circumference.
The most frequent finding on endoscopies for people with typical GERD symptoms is normal mucosa. Although the frequency of EE discovery in patients undergoing endoscopy while taking PPIs is not well-documented, it is clear that underlying EE may be missed in this case because PPIs are particularly effective at treating EE. Consequently, nonerosive reflux disease (NERD) should be the only diagnosis made with an endoscopy while using PPIs. To optimize the diagnosis of GERD and evaluate for EE, diagnostic endoscopy should ideally be carried out following 2 weeks, and preferably 4 weeks, cessation of PPI use. In small prospective research, stopping PPI medication resulted in the recurrence of EE in as little as one week for individuals with LA grade C EE that was treated with PPIs [21]. Esophageal biopsies are necessary to confirm an Eosinophilic esophagitis (EoE) diagnosis, even if they are not very useful as a GERD diagnostic tool. If endoscopy is done on a patient using PPIs, the diagnosis of EoE cannot be ruled out since PPIs can erase the endoscopic and histologic characteristics of EoE. Patients should be informed that during this 2- to 4-week period of PPIs, patients can take antacids to relieve their symptoms [22].
Reflux monitoring
By measuring esophageal acid exposure to confirm or deny a GERD diagnosis, ambulatory reflux monitoring (pH or impedance-pH) enables the correlation of symptoms with reflux episodes through the use of the symptom index (SI) or symptom association probability (SAP). Transnasal catheter-based and wireless telemetry capsule-based reflux testing are used during endoscopy. The latter can monitor pH and pH/impedance catheters for up to 96 h [23, 24]. Reflux testing measures acid exposure duration, episodes, and symptoms. Imp impedance-pH testing evaluates bolus clearance and proximal reflux extent. The correlation between symptoms and impedance-pH testing aids in diagnosing hypersensitivity and predicting treatment response. An SI of 50% or above is regarded as positive. The probability that reflux and symptom episodes are randomly distributed is measured using a Fisher exact test to get a P-value. The SAP is then derived by deducting the obtained P-value from 1 and multiplying the result by 100%; an SAP > 95% is regarded as positive. Reflux monitoring and impedance monitoring are effective in detecting mildly acidic and nonacidic reflux in GERD patients with EE, but their validity is questioned. Impedance monitoring can identify those requiring antireflux surgery [25]. Esophageal pH monitoring is recommended after stopping PPIs for seven days, if an unclear GERD diagnosis is present, and before antireflux surgery or endoscopic therapy [26].
Mechanism of gastroesophageal reflux
When intra-abdominal pressure surpasses both the LES barrier and intrathoracic pressure, reflux of the stomach and esophagus occurs. The normal function of the LES prevents GER.
Abdominal pressure causes the intra-abdominal part of the esophagus to constrict. Furthermore, one of the elements of the barrier at the gastroesophageal junction is the sharpness of the angle of His, which is where the esophagus enters the stomach.
GER is triggered by a compromise in this area, as demonstrated by the hiatal hernia [27]
Types of GERD
Based on endoscopic and histopathological appearance, GERD is classified into three different phenotypes
(i) Nonerosive reflux disease
(ii) Erosive esophagitis
(iii) Barrett’s esophagus
Nonerosive reflux disease
Heartburn and regurgitation—two symptoms of pathological acid reflux—that are characteristic of GERD are present in NERD, but there is no esophageal erosion [28, 29].Roughly 70% of GERD patients present with NERD [30, 31]. PPIs and acid-suppressive medication are a cornerstone in the management of NERD [32, 33]. Recent research has cast doubt on the notion that NERD and EE constitute a single, continuous illness within the GERD spectrum. These studies have shown that these conditions differ in terms of their epidemiological traits, pathophysiological makeup, and responses to treatment [30, 34–36]. When opposed to EE, NERD exhibits several differential pathogenic features, such as comparatively poor mucosal permeability, strong visceral sensitivity, and common psychological co-morbidity [36].
Erosive esophagitis
When stomach acid refluxes into the esophageal mucosa, T-lymphocytes infiltrate the mucosa, causing mucosal breaks and EE. PPI medication is currently the accepted standard of care for EE. Over 80% of patients showed endoscopic healing after 8 weeks of treatment, higher than 80% at 4 weeks for EE healing with PPIs, with comparable rates for obese and non-obese patients. Treatment for EE complications such as esophageal stricture and gastrointestinal hemorrhage is expensive and hurts the quality of life [37, 38]. The most feared consequence, esophageal adenocarcinoma (EAC), which arises from Barrett’s esophagus (BE) development from intestinal metaplasia to higher severity of dysplasia and is linked to high mortality, is also a possibility for patients with EE [39, 40].
Barrett’s esophagus
BE is a metaplastic alteration of the distal esophagus in which goblet cells containing specialized columnar epithelium replace the usual squamous epithelium. Chronic GERD is linked to this metaplastic alteration; as a result, 5%–12% of people with GERD symptoms over time will also have BE [41, 42]. The only recognized precursor lesion for EAC, a disease that has been steadily rising in prevalence in the USA and other Western nations over the past 40 years, is BE [43].
Materials and methods
Search strategy
The following resources were used without regard to publication status, date, language, or source: PubMed, Google Scholar, SpringerLink, and National Institute Library. To implement search techniques, a combination of Medical Subject Headings and free-text terms, including text words and database-specific restricted vocabularies was used. Additionally, reference lists of included research and earlier pertinent reviews on GERD alternative therapies will be searched. Keywords used were “GERD,” “Alternative medicine,” and traditional Chinese medicine.
Drug treatment for GERD
When Helicobacter pylori is present, PPIs work better to treat esophagitis. GERD is treated pharmacologically using H2 receptor antagonists. Similar to PPIs, H2 receptor antagonists are not recommended for long-term use in young patients due to their adverse effects. Prolonged use of acid suppression, prokinetic medications, gastric acid secretion inhibitors, and medications can result in hypergastrinemia, a disease where the endocrine cells in the stomach proliferate [44].
Histamine-2 receptor antagonists
Histamine-2 receptor antagonists (H2RAs) reduce acid production within the stomach by inhibiting the gastric parietal cells histamine-2 receptor. H2RAs help treat episodic symptoms and have a comparatively fast onset of effect. Adult and pediatric patients do develop resistance to the H2RA class of drugs. Every H2RA is partially metabolized in the liver and partially removed by the kidneys. As a result, patients with renal impairment or liver dysfunction may require dose modifications. Furthermore, suppose the estimation technique is impacted by the inhibition of tubular secretion of creatinine caused by cimetidine, a particular H2RA. In that case, it may result in a misleading underestimation of the glomerular filtration rate. Additionally, H2RA may cause several adverse consequences, especially in patients who are very sick, such as A low platelet count is the hallmark of thrombocytopenia. This disorder is especially common in children. It should be noted that the development of a hapten, which is necessary for H2RA-induced thrombocytopenia, takes many days. Therefore, unless the patient was already using H2RAs before admission, it is unlikely that these drugs are the source of thrombocytopenia that develops soon after admission. Interstitial Nephritis is yet another uncommon side effect linked to H2RAs. Renal impairment may result from this inflammation of the kidney interstitium. Similar to bewilderment, this side effect is peculiar and rare. H2RAs are, therefore, not the best option for long-term GERD treatment in pediatric patients. A list of H2 RAs used for the treatment of GERD is shown in Table 1 [51].
List of Histamine-2 receptor antagonists (H2RAs) used for the treatment of GERD
List of Histamine-2 receptor antagonists (H2RAs) used for the treatment of GERD
Proton pump inhibitors
Despite being among the safest pharmacological classes out there and having been used for almost 30 years globally, PPIs are the mainstay of treatment for several disorders associated with acid reflux. Although PPIs are typically safe, within the past ten years, there have been more and more potential side effects linked to their use [52]. PPI use is known to be linked to a higher risk of Clostridium difficile Infection (CDI), a dangerous infection that can cause colitis and severe diarrhea. Acid-suppressing medications, such as PPIs, have been identified by the Infectious Diseases Society of America as potential risk factors for CDI. Common PPI omeprazole has been linked to neurologic side effects, such as seizures and problems with hearing and vision, when administered in high doses intravenously. In severely ill patients who may already be dealing with neurological issues, these effects are especially worrisome [51]. The most commonly used PPIs are listed in Table 2. While some are peculiar and uncommon, others are believable and expected [51].
List of PPIs used for the treatment of GERD
| Drug | Bioavailability | Onset of action | Half-life | Duration of action |
|---|---|---|---|---|
| Omeprazole | 30%–40% (20–40 mg) [53] | 1 h [54] | 0.5–1 h [55] | 72 h |
| Lansoprazole | 80% (15–60 mg) [56] | 1.7 h [54] | 0.9–1.5 h [54]. | <24 h [57] |
| Pantoprazole | 77% (40 mg) [58] | 2–2.5 h [58] | 1.1 h [58] | 24 h [58] |
| Rabeprazole | 46% (2 mg) [59] | 5 min | 1 h | 3.5 h |
| Esomeprazole | 50%–68% (20 mg) [60] | 1.5 h [60] | 1.2–1.3 h [60] | 24 h [60] |
| Dexlansoprazole | 25% (30 mg) [61] | 1–2 h [62] | 1–2 h [62] | 8 weeks |
| Ilaprazole | 55.2% (5–20 mg) [63] | 0.25 h | 4.7–5.3 h | 48 h |
| Tenatoprazole | Two-fold greater in the (S)-tenatoprazole sodium salt hydrate [64] | – | 4.8–7 h | 48 h |
| Drug | Bioavailability | Onset of action | Half-life | Duration of action |
|---|---|---|---|---|
| Omeprazole | 30%–40% (20–40 mg) [53] | 1 h [54] | 0.5–1 h [55] | 72 h |
| Lansoprazole | 80% (15–60 mg) [56] | 1.7 h [54] | 0.9–1.5 h [54]. | <24 h [57] |
| Pantoprazole | 77% (40 mg) [58] | 2–2.5 h [58] | 1.1 h [58] | 24 h [58] |
| Rabeprazole | 46% (2 mg) [59] | 5 min | 1 h | 3.5 h |
| Esomeprazole | 50%–68% (20 mg) [60] | 1.5 h [60] | 1.2–1.3 h [60] | 24 h [60] |
| Dexlansoprazole | 25% (30 mg) [61] | 1–2 h [62] | 1–2 h [62] | 8 weeks |
| Ilaprazole | 55.2% (5–20 mg) [63] | 0.25 h | 4.7–5.3 h | 48 h |
| Tenatoprazole | Two-fold greater in the (S)-tenatoprazole sodium salt hydrate [64] | – | 4.8–7 h | 48 h |
List of PPIs used for the treatment of GERD
| Drug | Bioavailability | Onset of action | Half-life | Duration of action |
|---|---|---|---|---|
| Omeprazole | 30%–40% (20–40 mg) [53] | 1 h [54] | 0.5–1 h [55] | 72 h |
| Lansoprazole | 80% (15–60 mg) [56] | 1.7 h [54] | 0.9–1.5 h [54]. | <24 h [57] |
| Pantoprazole | 77% (40 mg) [58] | 2–2.5 h [58] | 1.1 h [58] | 24 h [58] |
| Rabeprazole | 46% (2 mg) [59] | 5 min | 1 h | 3.5 h |
| Esomeprazole | 50%–68% (20 mg) [60] | 1.5 h [60] | 1.2–1.3 h [60] | 24 h [60] |
| Dexlansoprazole | 25% (30 mg) [61] | 1–2 h [62] | 1–2 h [62] | 8 weeks |
| Ilaprazole | 55.2% (5–20 mg) [63] | 0.25 h | 4.7–5.3 h | 48 h |
| Tenatoprazole | Two-fold greater in the (S)-tenatoprazole sodium salt hydrate [64] | – | 4.8–7 h | 48 h |
| Drug | Bioavailability | Onset of action | Half-life | Duration of action |
|---|---|---|---|---|
| Omeprazole | 30%–40% (20–40 mg) [53] | 1 h [54] | 0.5–1 h [55] | 72 h |
| Lansoprazole | 80% (15–60 mg) [56] | 1.7 h [54] | 0.9–1.5 h [54]. | <24 h [57] |
| Pantoprazole | 77% (40 mg) [58] | 2–2.5 h [58] | 1.1 h [58] | 24 h [58] |
| Rabeprazole | 46% (2 mg) [59] | 5 min | 1 h | 3.5 h |
| Esomeprazole | 50%–68% (20 mg) [60] | 1.5 h [60] | 1.2–1.3 h [60] | 24 h [60] |
| Dexlansoprazole | 25% (30 mg) [61] | 1–2 h [62] | 1–2 h [62] | 8 weeks |
| Ilaprazole | 55.2% (5–20 mg) [63] | 0.25 h | 4.7–5.3 h | 48 h |
| Tenatoprazole | Two-fold greater in the (S)-tenatoprazole sodium salt hydrate [64] | – | 4.8–7 h | 48 h |
Laparoscopic Nissen fundoplication and Toupet fundoplication
A laparoscopic Nissen fundoplication is a surgical treatment used to treat hiatal hernias and GERD that is carried out by laparoscopic surgery. It is typically used for GERD when lifestyle modification and medical therapy have failed. Fundoplication strengthens the LES shutting action by wrapping or placating the upper portion of the stomach around the lower end of the esophagus and sewing it in place. The esophagus is sealed off by the stomach during contractions, rather than stomach acids being forced into it, which is the mechanism of relief in this case of Nissen fundoplication. This stops stomach acid from refluxing (in GERD). Successful surgical treatment provides the advantage of removing drug side effects and harmful effects from other components of reflux, such as bile or gastric contents, even though antacids and PPI prescription therapy can lessen the effects of reflux acid [65]. With a mortality risk of less than 1% and many of the most frequent postoperative problems reduced that are now more often performed, Nissen fundoplication is generally regarded as safe and effective. Research indicates that 89.5% of individuals still have no symptoms ten years later.
By reconstructing the esophagogastric barrier, a surgical procedure known as a “Toupet fundoplication” is performed to treat GERD. As an alternative, magnetic sphincter augmentation (MSA) was examined in a study, and the results are comparable about reflux management and adverse effects. On the other hand, compared to Toupet fundoplication, MSA is linked to a higher risk of dysphagia and reoperation rates. The decision between both operations is based on the desires of the patient and the surgeon; MSA is a less invasive and reversible option. In patients with GERD, the largest outcome report on Toupet fundoplication evaluated the results of MSA versus systematic crura repair in combination with Toupet fundoplication. Both treatments significantly reduced GERD-HRQL scores, according to the 199 patients in the study; however, MSA patients experienced a greater frequency of dysphagia and reoperation rates than Toupet patients. The MSA group experienced a much shorter hospital stay and operation duration. The research emphasized the necessity of conducting randomized clinical trials to better compare the results of MSA and fundoplication [66].
Alternative medicine
A wide range of medical methods are included under the umbrella phrase of “alternative medicine.” They are rarely taught in a Western medical context and are usually backed by tradition. As the name suggests, alternative medical systems encompass a broad range of theories and practices that emerged independently of traditional medicine, extending beyond a particular modality. These systems include homoeopathy, naturopathy, Ayurveda medicine, and traditional Chinese medicine (TCM). For modern healthcare providers, researchers, and consumers, the extensive use of alternative medicine is crucial. Besides the ideas and beliefs that are inherent in the dominant health system of a given civilization or culture during a specific historical period, alternative medicine is a large sphere of resources that includes health systems, modalities, and practices together with their supporting theories and beliefs. By practicing integrative medicine, which combines suitable allopathic and alternative treatments based on the patient, symptoms, and situation, many doctors today are embracing the positive parts of both medical specialties [67].
Traditional Chinese medicine
Analysis of data and 122 cases that have been documented in China, TCM has gained international attention for its efficacious use of Chinese herbs in the treatment of GERD.
Li et al. [68] have mentioned in their article the herb chai hu (Bupleurum falcatum), which may balance digestive issues by regulating qi-flow and has been used for thousands of years to treat GRED. Research demonstrated that Modified Xiaochaihu decoction (MXD), in addition to PPIs, MXD is an optional treatment for GERD. A prospective, double-blinded, double-simulation study was conducted by the researchers to determine the effectiveness of MXD. About 288 GERD patients were recruited for the study, the treatment group received omeprazole plus MXD simulation for 4 weeks; however, the circumstances lacked detailed information regarding the study design, including the duration, control measures, and patient demographics. Nonetheless, the research sought to assess the safety and clinical effectiveness of altered TCM formulations. The findings demonstrated that, in patients with mild-to-moderate GERD, MXD was equally efficient as omeprazole in raising the pressure at the LES and decreasing ineffective swallowing. The absence of documentation of side effects and rescue drugs was one of the study’s limitations. Reports of adverse effects from herbal remedies are becoming more prevalent as traditional Chinese treatments gain popularity. The primary ingredient in MXD, bupleurum, has been shown to raise the risk of chronic hepatotoxicity [67, 68]. Long-term oral MXD use resulted in interstitial pneumonia, cholestatic liver damage, and even fatalities.
Based on an analysis of data and 122 cases that have been documented in China, indicated intervention effects of Sini Zuojin Decoction (SNZJD), which is a blend of Zuojin pills and Sini powder, in patients with GERD in their report. This study assessed the safety and efficacy of the concoction used to treat GERD and described the law of medication based on the compilation of numerous medical records. This was the first systematic assessment using data mining for a particular kind of TCM decoction; the meta-analysis comprised 13 trials [69].
According to a meta-analysis, SNZJD may be used to treat GERD by influencing associated targets and pathways like hormone regulation, inflammation, and so forth. When used to treat GERD disorders, SNZJD affects a variety of biological processes that are involved in numerous biological regulatory processes, including activating conversion factors, modulating receptor activation, and boosting factor binding [70].
Feng Li et al. [71] aim to assess the efficaciousness and underlying mechanisms of Hewei Jiangni Decoction (HWJND), Rhizomes of Pinelliae, Scutellaria, Coptis, dried ginger, Zhejiang fritillaria bulb, dandelion, gentian root, unripe bitter orange, Trichosanthes fruit, and liquorice root are the 10 herbs that makeup Hewei Jiangni Decoction. Chinese herbal remedy in treating NERD. A total of 128 NERD patients were randomized to the Treatment and Control groups at random. Patients in the Treatment group received HWJND (81 g) with dummy omeprazole (20 mg) for 8 weeks and the control group was given Hewei Jiangni Decoction (81 g) with omeprazole (20 mg). Using the gastroesophageal reflux disease questionnaire (GERD-Q) scale, patient-reported outcomes scale, and short-form health survey 36, the clinical efficacy was assessed at week four. Furthermore, using network pharmacology and molecular docking, its pharmacological and molecular mechanisms were clarified. The results showed that in NERD patients, HWJND dramatically lowered GERD-Q scores by improving nausea, heartburn, regurgitation, discomfort in the epigastrum, and sleep disruption. HWJND’s primary active components comprised kaempferol, beta-sitosterol, naringenin, baicalein, and quercetin.
Acupuncture
The idea of TCM states that the fundamental concepts used in the prescription of acupuncture points and the choice of herbal formulas. Both options address the disorders underlying cause and its symptoms. Acupuncture and electroacupuncture, both of which are forms of TCM, are beneficial in treating a range of gastrointestinal conditions, including GERD [54]. The researchers’ chosen acupuncture treatment procedure was discovered to be congruent with standard TCM primary acupuncture point prescriptions by qualified acupuncturists from the Healthcare Medicine Institute. The prescribed list of acupuncture points did not include any proprietary or off-channel acupuncture points. The prescription for acupoints was the same for every patient in the trial and was not dependent on differential diagnosis, which is the primary distinction between the acupuncture points that patients received in the study and those that patients received in a typical acupuncture clinical session. The acupoints listed below were administered to each patient individually.
• PC6 (Neiguan) • ST36 (Zusanli) • CV12 (Zhongwan) • BL18 (Ganshu) • BL19 (Danshu) • LV3 (Taichong) Patients received acupuncture treatments while positioned laterally on the right side. Zusanli is an acupuncture point chosen to support the health of the stomach, spleen, and LES, increase the frequency of gastric motility and facilitate gastric emptying. Zhongwan was selected to encourage the transformation of turbidity and to quicken blood and qi circulation Zhongwan enhances the gastric mucosa, inhibits the production of acid, and promotes blood and fluid flow at the stomach’s fundus. Taichong, Ganshu, and Danshu ease stomach distention and qi counterflow while regulating the liver and bladder. Neiguan calms the flow of qi and eases nausea. Acupuncture with herbs is more advantageous than using herbs as a stand-alone treatment or when administering a PPI medication. This indicates that treating reflux esophagitis with acupuncture is both safe and successful [54].
Lifestyle changes
A multimodal strategy is necessary to treat GERD, taking into account the presentation of symptoms, endoscopic results, and probable physiological abnormalities. The size and form of the hiatal hernia, the presence of BE and/or EE, the body mass index (BMI), and any concomitant physiologic abnormalities such as gastroparesis or inefficient motility without contractile reserve can all influence the management choices. Medical management consists of pharmacologic therapy, mostly with drugs that lower stomach acid secretion, and lifestyle changes. Options for surgery and endoscopy are covered in other pages. Recommendations for nonpharmacologic lifestyle adjustments include controlling weight, eating and sleeping positions, and diet composition and time [14].
Weight loss
Weight loss for overweight patients, raising the head of the bed, quitting smoking and alcohol, avoiding late-night meals and bedtime snacks, remaining upright during and after meals, and giving up foods like coffee, chocolate, fizzy drinks, spicy foods, acidic foods like citrus and tomatoes, and foods heavy in fat are common recommendations [72]. It has been demonstrated that losing weight helps both to avoid and cure GERD [73] prospectively enrolled 29 610 patients and discovered that losing weight enhanced the effectiveness of medical treatments in addition to reducing symptoms. After receiving a systematic weight loss program, 332 individuals who were overweight or obese who participated in an interventional trial showed a substantial reduction in the prevalence of GERD and symptom scores after six months. Several studies have assessed the impact of different foods on LES pressure to identify which foods may be associated with GERD. Citrus, spicy food, coffee, and caffeine had minimal to no influence on LES pressure in laboratory tests [74].
Raising the head of the bed while you sleep
However, several studies—including several randomized controlled trials—have demonstrated that sleeping on a wedge or raising the head of the bed might lessen esophageal acid exposure at night and ease the symptoms of gastroparesis (GERD). Furthermore, after meals and at night, lying on one’s right side induces more reflux than when lying on one’s left. This is likely because lying on one’s right side puts the esophagogastric junction (EGJ) in a dependent position on the pool of stomach contents, which promotes reflux [75, 76]. Therefore, physicians may advise patients not to sleep on their right side [77–80].
Tobacco cessation
Participants in a study on quitting smoking had their GERD symptoms assessed using a validated questionnaire; those who were successful in quitting for a year saw a 44% improvement in GERD symptoms, whereas those who persisted in smoking only saw an 18% improvement [81].When compared to patients who quit smoking for a year saw significant increases in their general quality of life and GERD symptoms compared to those who kept smoking [82].
Food choice
TCM principles state that stomach, liver, and spleen dysfunction is frequently the cause of reflux esophagitis. TCM principles also state that emotional fluctuations or abnormal eating patterns damage the stomach’s capacity to keep the balance of upward and downward bearing qi, weaken the liver’s ability to control the free coursing of qi and impair the spleen’s ability to transport and transform water and grain. Some of these products, meanwhile, may have irritating properties that aggravate GERD symptoms without improving reflux. While there is evidence that chocolate, peppermint, alcohol, tobacco use, and high-fat foods all lower LES pressure in the lab, there is scant evidence of the advantages of abstaining from these behaviors and foods. In a sizable cohort trial, quitting smoking was found to alleviate GERD symptoms [83]. An analysis of data from the prospective Nurses’ Health Study II revealed a correlation between the use of coffee, tea, or soda and an increased risk of GER symptoms. Water, juice, or milk consumption, on the other hand, did not appear to be linked to GER symptoms. The chance of developing GER symptoms was decreased by substituting water for coffee, tea, or soda [84]. The Trial was evaluated for the safety and effectiveness of Gaviscon double action in treating GERD patients’ upper gastrointestinal symptoms in comparison to matching placebo tablets. When compared to placebo, a notably higher percentage of patients receiving Gaviscon DA therapy achieved the primary goal. It was determined that Gaviscon DA, an alginate-antacid combination, is a safe, efficient way to help symptomatic GERD patients with their reflux symptoms and related dyspepsia.
Conclusion
As everyone is aware, GERD is becoming more common worldwide, has limited treatment options, and is becoming increasingly commonplace globally. People with gastric reflux disease (GERD) frequently have coughing fits and laryngitis in addition to heartburn, easy regurgitation, dyspepsia, bloating, and abdominal pain or discomfort. These symptoms can significantly reduce their quality of life. Since the 1990s, PPI medication has been recognized as the gold standard for treating GERD. However, it is now evident that even after receiving continuous PPI therapy, up to 40% of patients continue to have GERD symptoms, and PPI therapy increases the risk of infections, osteoporosis, pancreatitis, hepatic failure, jaundice, and chronic gynecomastia. According to the review done by McKinlet et al. [85]. Slightly increased complication rates in surgically treated individuals, particularly when compared to low-risk bias studies, were the main drawbacks or downsides of surgical treatments for GERD.
Nevertheless, when combining the data from these investigations, the complication rates did not differ significantly. Furthermore, the long-term dysphagia rates for surgical patients were comparable to those for medical patients. Research indicated that surgical intervention was more costly than PPI treatment and that surgical treatment was generally more expensive than medicinal treatment. An additional drawback pertains to the possibility of requiring extended PPI usage following surgery since individuals receiving PPI treatment had a considerably higher likelihood of needing prolonged PPI use than those undergoing surgery. Therefore, multivariable treatment beyond PPIs is urgently required. The human race is endowed with the ability to heal from within, and when we combine this ability with our ancestors knowledge of traditional medicine, we can quickly combat and recover from diseases and illnesses. However, modern solutions come with pricey side effects and complications. Therefore, according to earlier literature reviews and traditional Chinese medical theory, herbs and a healthy lifestyle can have a significant impact on illnesses, including GERD symptoms. There aren’t many studies on the effectiveness of Chinese herbal decoctions for GERD, but this research also reviews the minimal negative effects of herbal treatment. However, the overall use of herbal decoctions and lifestyle changes can enhance the quality of life and alleviate reflux symptoms with the use of TCM.
Acknowledgements
The authors sincerely acknowledge the University of North Bengal, West Bengal, India.
Author contributions
S.P.: Concepts and Ideas, Definition of intellectual content, Manuscript review. B.R.S.: Design, Literature search, Data acquisition, Data analysis, Statistical analysis, Manuscript preparation, Manuscript editing.
Conflict of interest
None declared.
Funding
None declared.
Data availability
The data underlying this article are available in the article and its Supplementary Material.
