Can CAM Therapies Relieve GERD Symptoms?

Acupuncture for GERD

Acupuncture has been purported to be of benefit for several gastrointestinal disorders including dyspepsia, GERD, and emesis.^[9] Several trials have found it to be specifically of use in patients with functional dyspepsia.^{[10,11,12,13,14]} In one study,^[10] patients who satisfied Rome III criteria for functional dyspepsia and tested negative for Helicobacter pylori responded to daily specific acupuncture compared with sham (no qi effect) acupuncture, both given with drug therapy, on both symptoms and quality-of-life measures at 4 weeks. The effect persisted even 3 months after cessation of acupuncture treatment. In another study,^[11] treatment with specific acupuncture points (5 sessions weekly for 4 weeks) compared with sham acupuncture points was associated with improved dyspepsia symptoms and quality of life at 4 and 12 weeks. A larger randomized trial that includes 200 patients is now underway^[13] to confirm findings from the earlier smaller studies.

Preliminary studies among patients with GERD^[15,16] suggest a similar benefit from point-specific acupuncture for patients with GERD. In a study of 60 patients with GERD,^[15] 6 weeks of daily treatment with specific acupuncture was comparable in efficacy to daily treatment with a combination of PPI and H2-receptor antagonists on measures including 24-hour esophageal pH and bile reflux, endoscopic grading, and symptom score. Electroacupuncture at specific acupoints given daily for 6 weeks together with Zhizhukuanzhong capsules 3 times daily was found to be equivalent in effect to oral daily therapy with PPIs and superior to electroacupuncture alone in a larger trial involving 480 patients.^[16] This effect was observed to persist at 1 year after treatment. The investigators suggested that the benefits of electroacupuncture and acupuncture might be mediated through inhibition of intraesophageal acid and bile reflux because the 24-hour esophageal pH and bile reflux measures improved. Other proposed mechanisms suggested by animal studies include stimulation of vagal activity and reduction in gastric motility.^[9]

Case Resolution

Maintenance PPIs have been shown to be superior to on-demand PPIs for healed erosive esophagitis,^[17] but there remain concerns about adverse effects such as osteoporosis associated with long-term use of PPIs.^[18] This patient may first benefit from further weight loss to achieve a healthy BMI, which is associated with improved symptoms^[19] and avoidance of surgery with its associated complications and limited efficacy.^[20,21] Although studies are needed to demonstrate the value of relaxation techniques (eg, guided imagery) and meditation for GERD symptoms, these techniques may help reduce her overall anxiety about her condition, which may be exacerbating her symptoms.

Evidence from well-conducted clinical trials is insufficient to recommend herbal products for GERD symptoms. However, preliminary studies that follow on studies of dyspepsia suggest that acupuncture and electroacupuncture at specific points are at least as effective as pharmacotherapy. However, the frequency of treatment that has been used in these clinical trials (daily to 5 times a week for 4-6 weeks) requires commitment and expense by the patient. The modality may be worth trying for 6 weeks for this patient who wishes to avoid surgery and chronic maintenance therapy. Moreover, she may wish to learn about abdominal breathing as that technique incurs a low cost overall and can be maintained over the long term.

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