What is Reflux disease, Gastritis, Gastroduodenal Ulcers, Dyspepsia Clinical Considerations?

What is Reflux disease?
-is acknowledged by the symptomatic in reverse movement of the stomach contents (particularly gastric acid) into the esophagus due to weakness or inadequacy of the gastroesophageal sphincter.

How do you get a stomach ache? (acute gastritis)
-can be induced by a variety of factors, like simple overeating, stress, alcohol, medications, acids, alkaline substances, and bacterial infections. Acute stomach diseases can become chronic. The superior layers of the gastric mucosa are affected.
– Indications: Upper abdominal pain, anorexia, nausea, vomiting, bleeding.
– Gastroduodenal ulcers develop when there is an imbalance of protective and aggressive factors. Erosions extending into the deep layers of the stomach wall can be found on the mucous membrane of the stomach and or duodenum.
– Functional stomach disorders (diagnosis of exclusion) play a very essential role, as they are found in 30–50 % of all patients with upper abdominal complaints.
– Nervous disorders are suspected if no natural variations can be discovered. It is hard to recognize nerve-related problems from typical upper abdominal problems pursuing meals (dyspeptic syndrome). The stomach and duodenum (nausea, belching, upper abdominal discomfort) as well as the small and large intestine (flatulence, cramplike abdominal pain, diarrhea) can be involved.
-Ulcer-like dyspepsia - Nocturnal pain, episodic pain, pinpoint pain.
-Dysmotility dyspepsia - Nausea or vomiting, premature satiation, belching, gas, upper abdominal tension, flatulence.
– Reflux dyspepsia or Heartburn.
– Aerophagia or Flatulence and belching

Clinical value of herbal medicine and herbal treatment measures
– Reflux: Herbal remedies are used for adjunctive treatment only.
– Gastritis
• The effectiveness of herbal remedies for autoimmune gastritis (type A) is still unclear.
• Treatment for Helicobacter pylori-related gastritis (type B) consists of eradicating the pathogen by way of acid blockade and antibiotic treatment.

Herbal remedies can be prescribed as adjuvant measures.
• Drug-induced gastritis (type C) caused by salicylates, nonsteroidal anti inflammatory drugs, and other medications responds well to mucoprotective herbal remedies. Their use is, however, limited to adjuvant therapy.
– Ulcers: Antacids, mucoprotective drugs, and antisecretory drugs (e. g., H2-antagonists and proton pump inhibitors) are normally used. In this case, herbal remedies are limited to adjuvant therapy.
– Non-ulcer-related dyspepsia: A variety of herbal remedies are used to treat
dyspeptic syndrome.

Recommended Herbal Remedies

Antiphlogistics
➤ Chamomile flower (Matricariae flos); peppermint leaf (Menthae piperitae folium); balm leaf (Melissae folium); licorice
root (Liquiritiae radix); fennel seed (Foeniculi fructus).
– Action: Anti-inflammatory. Aromatic herbs also have bacteriostatic effects and increase the local blood circulation.
• Chamomile flower: Chamomile alone is not a very effective ulcer treatment. Because of its general efficacy and virtual lack of side effects, it is still commonly recommended for adjunctive treatment at the onset of and during acute ulcer episodes. The greatest strength of chamomile lies in prevention.
• Licorice root: Because of its antiphlogistic effects, the herb is mainly prescribed for treating ulcer-related conditions, but is also indicated in gastritis and dyspeptic syndrome.
– Contraindications
• Licorice root: Cholestatic liver diseases, cirrhosis of the liver, hypertension, hypokalemia, severe liver failure, and pregnancy.
• Chamomile flower, dried and in alcoholic extracts: Known allergy to chamomile.
• Peppermint leaf and its preparations: Reflux.
– Dosage and administration: Licorice preparations should not be used for more than 4–6 weeks at a time unless directed by a physician. Standardized licorice root extracts made with diluted ethanol and containing no less than 4.0 % and no more than 6.0 % glycyrrhizin should preferably be used.
• Deglycyrrhinated licorice extract (DGL) is very commonly recommended and available in capsules or tablets in North America. The preparation is nearly as effective as whole licorice, but with fewer side effects. The daily dosage is based on the equivalent to 200–600 mg glycyrrhizin.
– Side effects: Undesirable mineralocorticoid effects occur after a weekly dose of ≥3.5 g glycyrrhizin (from licorice root). Rare cases of myoglobinuria have also been reported.

Demulcents
➤ Flaxseed (Lini semen).
– Action: Soothing.
– Contraindications: Bowel obstruction.
Important: Flaxseed may impair the absorption of other drugs. The patient using flaxseed should drink plenty of fluids, at least 150 ml after taking the herb.
Anticholinergics
➤ Belladonna (Atropa belladonna).
– Action: Parasympatholytic. Alkaloids of the atropine group inhibit vagus nerve activity, reduce gastric juice secretion, and diminish intestinal motility. They are therefore used to relieve spasms, gastrointestinal colic, and gallbladder colic.
– Contraindications: Narrow-angle glaucoma, mechanical gastrointestinal tract stenosis, benign prostatic hypertrophy with residual urine formation, acute pulmonary edema, and tachycardiac arrhythmias.
– Dosage and administration
• Belladonnae radix: Single dose 0.05 g; maximum single dose 0.1 g (equivalent to 0.5 mg total alkaloids). Maximum daily dose 0.3 g, equivalent to 1.5 mg total alkaloids calculated as L-hyoscyamin.
– Belladonna extract: Single dose 0.01 g; maximum single dose 0.05 g, equivalent to 0.73 mg total alkaloids calculated as L-hyoscyamin.

Note: Belladonna is dispensed by prescription only.
– Side effects: Dose-dependent side effects, such as dry mouth, blurring of vision, micturition disorders, headaches, and stupor.

Range of Applications in Acute Clinical Pictures
Acute Gastritis and Esophagitis (in viral infection)
➤ Chamomile.
– Dosage and administration
• Special chamomile therapy: The patient should drink 2 to 3 cups of fresh, hot chamomile tea (see p. 47), then lie on the back, left side, stomach, and right side for 5 minutes each. As an alternative to the tea, this therapy can also be performed using 30 to 50 drops of chamomile fluid extract or an appropriate commercial preparation, taken in a glass of hot water. The tea or diluted extract should be taken on an empty stomach in the morning.

Important
• This therapy should be continued for a few days after the symptoms have ceased.
• Recovering alcoholics should not use chamomile extract because it contains alcohol.
– Clinical value: Useful and effective treatment measure without side effects. Ulcers with Nocturnal Pain and Localized Epigastric Hunger Pain
➤ Chamomile; licorice root.
– Dosage and administration
• Chamomile: see Acute Gastritis and Esophagitis.
• Licorice root fluid extract (with 4–6 % glycyrrhizinic acid): 1 teaspoon diluted in a small quantity of water, up to 4 times daily.
• Deglycyrrhizinated licorice (DGL) chewable tablets. Take 2 to 4 380 mg chewable tablets before meals for acute symptoms, 1 to 2 tablets as a maintenance dose.
Note: Should be taken under medical supervision and for no more than a few weeks.
– Clinical value: For adjunctive treatment.

Gastric Colic (Ulcerlike Pain without an Organic Finding)
➤ Belladonna (Atropa belladonna).
– Dosage and administration
• Tincture Rx: Tinct. Belladonnae with 0.02–0.03 % total alkaloid content, Tinct. Valerianae, Spir. Menthae pip., aa ad 30.0. Take 8 to 10 drops in water, 3 times a day.
– Clinical value: Useful for alleviating pain. Range of Applications in Chronic Esophageal and Gastric Diseases Chronic Esophagitis
➤ Flaxseed.
– Dosage and administration: Grind flaxseed before use. Place 2 tablespoons of flax seed in 1⁄2 liter of water and bring to a boil. Strain and drink the liquid. The use of commercial products is recommended. Take 3 to 4 sips of the gruel, several times a day.
– Clinical value: For adjunctive treatment.

Chronic Gastritis
➤ Fennel seed; peppermint leaf; lemon balm leaf; calamus rhizome (Calami rhizoma).
➤ Tea Rx: Foeniculi fructus, Menthae piperitae folium, Melissae folium, Calami rhizoma, aa 20.0.
➤ Flaxseed (see p. 66).
– Dosage and administration
• Tea mixture: Steep 1 teaspoon in a cup of boiled water for 10 minutes. Take 1 cup, 2 to 3 times a day. Sip slowly while hot.
• Flaxseed gruel: Soak 1 to 2 tablespoons ground flaxseed (daily portion) in 1⁄4 to 1⁄2 liter of water overnight in the refrigerator. Drink lukewarm before breakfast or in portions distributed throughout the day.
– Clinical value: For adjunctive treatment.

Chronic Gastritis in Very Underweight or Weak Patients
➤ Olive oil; flaxseed.
– Dosage and administration
• Olive oil: Sip 1 tablespoon slowly each morning.
• Flaxseed: see above
– Clinical value: For adjunctive treatment. Non-Ulcer-Related Dyspepsia (cf. Dyspeptic Symptom Complex)
➤ Licorice root.
– Dosage and administration
• Dried licorice root: Chop and steep 1⁄2 teaspoon in 1 cup boiled water for 15 minutes. Take 1 cup, 3 to 4 times a day. Can be taken for several months because the glycyrrhizinic acid content is very low.
• Licorice fluid extract (4–6 % glycyrrhizinic acid): 1 teaspoon in 1 cup water, 3 to 4 times a day.
• Deglycyrrhizinated licorice (DGL) chewable tablets: take 1–2 before meals.
Note: The use of licorice fluid extract and commercial licorice products should be medically supervised. These preparations should not be taken for more than a few weeks at a time.
– Clinical value: For adjunctive treatment.

Posted in: Disease and Complications of the Digestive Organs