Digestive Enzymes and acid reflux

Digestive Enzymes

Supplemental digestive enzymes may reduce GERD symptoms. Delayed gastric emptying and a large volume of food in the stomach are associated with GERD symptoms, and supplementation using digestive enzymes may reduce these factors. Digestive enzymes are commonly included in combination products, including lipase, amylase, protease, maltase, lactase, sucrase, phytase, and cellulase. Clinically, some patients actually benefit from hydrochloric acid and pepsin supplementation, including individuals who have low levels of stomach acid and delayed gastric emptying. ( Mahmood A,,2007)

Alternative Treatment for acid reflux

Alternative Treatment

1-Antioxidants

Antioxidants have been shown to be protective in numerous diseases, such as GERD, gastric ulcers, and GI cancers. Oxidative stress of the esophageal mucosa is a contributing factor in the pathology of GERD. A study was performed with individuals with both erosive and nonerosive GERD pre- and post-antireflux surgery measuring oxidative stress. This study showed that individuals with GERD have lower glutathione levels in the distal esophagus compared with controls. In addition, myeloperoxidase activity in the distal esophagus decreased after antireflux surgery but never returned to levels found in the control group. Supplementation to increase glutathione levels with the precursors N-acetyl-cysteine and selenium may be beneficial. Additional studies have shown that oxygen-free radicals measured by arachidonic acid peroxidation metabolites are significantly higher in patients with GERD compared with controls.( Modzelewski B. et al , 2004)

Studies have also indicated that free-radical oxidative damage plays a role in gastric and duodenal ulcers as well in as gastric carcinoma. Although studies directly supporting antioxidant supplementation with GERD are lacking, ubstantial evidence supports using antioxidant therapy for patients with gastric ulcers and cancer, and shows that the therapy may also provide benefit for patients who have GERD. Research has shown that the hormone and potent antioxidant melatonin prevented gastric ulceration and reduced endogenous hydroxyl radicals by 88%. In fact, melatonin was shown to be more effective than ranitidine for preventing stress-related ulcers in animal models. Fish oil supplementation has also been shown to protect gastric mucosa and decrease the severity of gastric ulceration in animal studies. Fish oil increased antioxidant enzyme activity,decreased acid-pepsin secretion, increased mucin secretion, and decreased lipid peroxidation in the gastric mucosa.( Bhattacharya A, et al ,2006)

A study was performed with an antioxidant dietary supplement containing melatonin,  tryptophan, vitamin B6, folic acid, vitamin B12, methionine, and betaine. The supplement or omeprazole was given to individuals with GERD. In this study, 100% of individuals who took the supplement had complete regression of their GERD symptoms within 40 days compared with less than 66% of individuals who had regression of symptoms treated with omeprazole.( Pereira R de S., 2006)

2-D-Limonene

D-limonene is a monoterpene in citrus oil. Numerous studies have shown that D-limonene exerts anti-cancer, antimicrobial, and anti-inflammatory effects. In particular, studies have shown that this constituent of citrus oil is protective against GI cancers, including cancers of the stomach and colon, decreasing both growth and metastasis.Although direct evidence of D-limonene’s effects on esophageal cancer is lacking, it is certainly possible that this monoterpene may be protective against Barrett’s esophagus and esophageal adenocarcinoma. Alternative practitioners often recommend D-limonene for treatment of GERD with generally good results, although studies are lacking.

Licorice

Glycyrrhiza glabra (licorice) root has historically been used as a demulcent and anti-inflammatory botanical for treating conditions such as gastric and duodenal ulcers. Studies have shown that ingestion of deglycyrrhizinated licorice (DGL) may increase mucous production   and accelerate healing of duodenal and gastric ulcers. In addition, a small study showed that DGL also accelerates healing of aphthous ulcers. Although studies that correlate DGL with GERD directly are lacking, it is reasonable to assume that DGL may provide symptom relief in patients with GERD. Clinically, alternative health care providers often prescribe additional demulcent herbs for their healing and soothing properties, including such herbs as loe vera (aloe), Ulmus fulva (slippery elm), and Althaea officinalis  marshmallow).( Paraschos S,, , et al ,2007)

Mastic

Pistacia lentiscus (mastic) resin is used medicinally for treating duodenal and gastric ulcers. Animal studies show that it decreased H. pylori colonies thirtyfold. Research has also indicated that mastic resin oral supplementation protects gastric mucosa from experimentally induced damage as well as decreasing free acidity.In addition, a small study showed that mastic supplementation provided symptomatic relief of duodenal ulcers in 80% of individuals who were treated with the supplement, and 70% experienced healing with endoscopy. The antisecretory and cytoprotective activity of mastic may provide benefit for individuals with GERD, although direct evidence is lacking. (Nishiwaki H,, et al , 1999)

Minerals

Calcium carbonate, magnesium, aluminum, and phosphate salts are frequently used in overthe- counter antacids. Studies have indicated that antacids are effective for treating GERD symptoms, reducing acid regurgitation, and relieving both daytime and nighttime heartburn.74 Mineral supplementation, using calcium and magnesium, may reduce GERD symptoms, although direct evidence is lacking.( Mahmood A,,2007)

surgical treatment of GERD

7-Surgical Intervention Anti-reflux surgery may be of benefit in children with con-firmed GERD who have failed medical therapy or who have life-threatening complications of GERD. Fundoplication reduces GERD by increasing the LES baseline pressure, de-creasing the frequency of TRLES, accentuating the angle of His, tightening the crura, and lengthening the intra-abdominal portion of the esophagus. However, it does not change any underlying esophagogastric dysmotility nor does it improve esophageal or gastric clearance time.[88,89] Given the reports of high short- and long-term failure and morbidity associated with surgery, thorough specialist evaluation by a pediatric gastro-enterologist should occur to ensure other possible explanations for clinical symptoms have been excluded and that medical therapy has been maximized prior to anti-reflux surgery.( Maclennan S, et al ,2010)