Can Complementary and Alternative Therapies Relieve GERD Symptoms?

Désirée A. Lie, MD, MSEd

Disclosures

July 03, 2014

Case Presentation

Christine, a healthy, 65-year-old retired teacher with a body mass index of 29 kg/m2, has been treated for gastroesophageal reflux disease (GERD) for the past 4 years. Initially, she took twice-daily, full-dose proton pump inhibitors (PPIs) for a year after an upper endoscopy showed erosive esophagitis. She then changed to on-demand PPIs after healing was demonstrated. She does not have extraesophageal symptoms of asthma, cough, or chest pain. Her last endoscopic biopsy was negative for Barrett esophagitis. However, she continues to experience heartburn symptoms interfering with her daily life despite lifestyle changes that include elevating the head of her bed by 8 inches and avoiding fatty foods, acidic juices, alcohol, and caffeine. Occasional antacids and H2-receptor antagonists have not been effective. She has tried eating ginger, licorice, and artichokes because she read that these foods could be of benefit, but they have also not helped. The prospect of requiring lifelong maintenance therapy is making her feel anxious. Rather than consider surgery, she would like to try alternative therapies. She has heard about acupuncture for the treatment of GERD. What is your advice?

GERD: Relief From Meds?

GERD is considered to be one of the most common gastrointestinal diseases.[1] Management options[2,3] include chronic treatment with PPIs and H2-receptor antagonists for erosive esophagitis and on-demand PPIs for nonerosive esophagitis, with fundoplicative surgery reserved for persistent and resistant cases or nontolerance of PPIs. The condition is not considered lethal, and treatment approaches have focused on symptom control and maintenance therapy to prevent recurrence in the case of erosive esophagitis.[3,4] However, long-term use of the drugs has been associated with such adverse effects as osteoporosis and fractures. Lifestyle modification is recommended, although the efficacy of weight loss, diet adjustment, and head-of-bed angle adjustment have not been fully proven in randomized controlled trials.[3]

Among complementary and alternative medicine (CAM) modalities, herbal therapies including ginger,[5] peppermint oil, artichoke, and licorice[6] have been tested for dyspepsia rather than for GERD, and the evidence for these agents remains inconclusive.[7]

A potential intervention for GERD, a type of abdominal breathing that can be taught by a vocal coach or a physical therapist trained in the technique, was recently tested in a small, prospective, randomized clinical trial.[8] Patients with nonerosive or healed esophagitis (mean age, 48 years) were provided with 1 hour of training, followed by coaching using a recording. They were instructed to practice abdominal breathing daily for 1 month. In comparison with a control group, the trial participants were found to have an improved quality of life and reduced PPI usage, which persisted when the abdominal breathing was continued over 9 months.

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