Acupuncture versus acid reflux: In recent research, a 40% cut in sphincter relaxations brings hope for relief, says a study, "Inhibition of transient lower esophageal sphincter relaxations by electrical acupoint stimulation," appearing in the August 2005 issue of the American Journal of Physiology-Gastrointestinal and Liver Physiology, published by the American Physiological Society.
Even the U.S. National Institutes of Health doesn't know what causes gastroesophageal reflux disease, or GERD. And NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says there's an unclear relationship between GERD, heartburn and hiatal hernia (HH).
Patients may have only one out of three, any two out of three, or all three. Researchers in this study are Duowu Zou, Wei Hao Chen, Katsuhiko Iwakiri, Rachael Rigda, Marcus Tippett and Richard H. Holloway of the Department of Gastroenterology, Hepatology, and General Medicine, Royal Adelaide Hospital; Holloway also is at the Dept. of Medicine, University of Adelaide, South Australia, Australia.
Nevertheless, clinicians know that all three often occur together and that a variety of lifestyle changes, medication, surgery and recently approved devices and an implant are imperfect solutions.
An encounter between a Taiwanese gastroenterologist wanting to study acupuncture and an opening at the Royal Adelaide Hospital resulted in two experiments looking into how the traditional Eastern approach might affect transient lower esophageal sphincter relaxations (TLESRs). Since TLESRs are "the most important mechanism of acid reflux in normal subjects and patients with GERD," they were targeted for study, according to the "August 30, 2005 news release, "Acupuncture versus acid reflux: 40% cut in sphincter relaxations brings hope for relief."
The paper describing the study, "Inhibition of transient lower esophageal sphincter relaxations by electrical acupoint stimulation," appears in the August issue of the American Journal of Physiology-Gastrointestinal and Liver Physiology, published by the American Physiological Society. Research was performed by Duowu Zou, Wei Hao Chen, Katsuhiko Iwakiri, Rachael Rigda, Marcus Tippett and Richard H. Holloway of the Royal Adelaide Hospital, Australia.
The Neiguan connection
"It was an out-of-left-field approach, without any real expectations that it might work," according to Richard H. Holloway, in whose Royal Adelaide Hospital laboratory the work was done, "but we had well-defined technology and measurements for studying GERD." The protocol utilized electrical acupoint stimulation, a high-tech type of acupuncture, with a GERD model imposed on normal subjects by inflating a balloon in their stomachs.
In two separate studies, barely perceptible stimulation was applied at the acupoint known as Neiguan on the wrist. "This reduced TLESRs by a very significant 40% -- from six an hour to 3.5 an hour," Holloway said. The paper added: that the rate of TLESRs during the Neiguan acupoint stimulation "was significantly lower than that during both the baseline period without any stimulation (six per hour, with a range of five to eight), and the period of sham stimulation at the hip (six per hour; range: four to eight) with a probability value of less than 0.02."
The paper noted that "because gastric distension is the major trigger for TLESRs, Neiguan appeared to be a more relevant site for affecting triggering of TLESRs than did Hukoau," another gastrointestinal-related acupuncture site. Patients are interested in understand the mechanisms of how acupuncture might bring relief from acid reflux symptoms for some people.
Mechanisms of action elusive; role of opioids discounted
Addressing the mechanisms of action, the paper said: "Whether gastric distension triggers TLESRs through tension or stretch receptors remains controversial. Nevertheless, because the distension volume [in the experiments] was kept constant and because acupoint stimulation did not affect gastric pressure, it seems unlikely that it was acting through alterations in gastric motility. The mechanism of inhibitory effect of electric acupoint stimulation on triggering of TLESRs thus remains to be elucidated."
Indeed, from a scientific viewpoint, the entire question of how acupuncture works is still a matter of much conjecture, though some studies have suggested that opioid receptors may be involved. So after the initial findings, the Holloway team essentially repeated the experiment to test this hypothesis by seeing if the receptor antagonist naloxone would block the acupoint effect. The results were negative, "but due to the peculiarity of results in a four-way study, we can't be sure that opioids aren't involved," Holloway said, according to the "August 30, 2005 news release, "Acupuncture versus acid reflux: 40% cut in sphincter relaxations brings hope for relief."
Holloway added, according to the news release, "What we've shown here is a rather interesting proof of concept, which tackles one of the approaches to acid reflux by controlling the valve that controls acid leak. If we can stop the TSLERs events, that would be a major therapeutic gain. But it's a major leap from where we are to a real cure," he said.
· Holloway said that studying the effect of acupoint on healthy subjects in the context of eating a meal, rather than mechanically distending the stomach, would be useful.
· The paper concludes: "The efficacy of electric acupuncture in reducing the frequency of TLESRs and reflux in patients with GERD…awaits further study.
· "In addition, knowledge of the underlying mechanisms of the effect of electric acupuncture may help to identify target sites for therapeutic intervention on TLESRs."
The GERD-HH connection, and the question of a possible protective role of H. pylori
Two areas of additional interest in this area concern the GERD-HH connection and H. Pylori. "The possible role of a hiatal hernia in GERD has literally gone full circle," Holloway noted, according to the "August 30, 2005 news release, "Acupuncture versus acid reflux: 40% cut in sphincter relaxations brings hope for relief."
Initially the hiatus hernia was thought to be the major, perhaps only pathogenetic factor for reflux as it was the only abnormality that could be detected in patients with reflux symptoms; endoscopy and esophageal manometry had yet to be invented. With the development of esophageal manometry, the presence and importance of the LES was recognized, and abnormal LES function in reflux disease was identified. Consequently, the importance of hiatus hernia was virtually dismissed.
"Subsequent research, however, has clearly shown that the development of a hiatus hernia has a detrimental effect on LES function. Thus reflux disease occurs because of LES dysfunction and, in many patients, the additional effects of a hiatus hernia," Holloway said, according to the "August 30, 2005 news release, "Acupuncture versus acid reflux: 40% cut in sphincter relaxations brings hope for relief."
What about H. pylori?
As for H. pylori, in a fact sheet on heartburn, HH and GERD, NIDDK includes these poignant observations: "Much research is needed into the role of the bacterium Helicobacter pylori. Our ability to eliminate H. pylori has been responsible for reduced rates of peptic ulcer disease and some gastric cancers.
At the same time, GERD, Barrett's esophagus, and cancers of the esophagus have increased. Researchers wonder whether having H. pylori helps prevent GERD and other diseases. Future treatment will be greatly affected by the results of this research," the NIDDK paper concludes.
Heartburn – generally caused by naturally occurring acids splashing back up from the stomach – is often marked by a characteristic burning sensation that sufferers describe as rolling up into their chest
Fatty foods play a starring role in this process, You may wish to check out the November 22, 2011 news release, Holiday season could ring in 'heartburn season'.
"Most of the time heartburn is a nuisance, not a tremendous threat to your health," said Dr. Stuart Spechler, professor of internal medicine in digestive and liver diseases at UT Southwestern Medical Center, according to the news release. "I tell most of my patients that it's going to be a tradeoff – is the food going to taste good enough to suffer through the heartburn?
"If you know you're going to eat something that ordinarily gives you heartburn, there are medications that you can take before eating that food that might help."
Prevention now emphasized
For decades, the plop-plop-fizz-fizz approach of antacids taken after people already were experiencing heartburn was the only therapy available. Emphasis has since shifted to prevention.
Those who are planning to indulge in foods likely to cause them heartburn can now take a histamine receptor blocker (H2 blockers), which slow the production of stomach acid and are generally available over the counter.
"Most people suffering from heartburn get it every now and then. Those are the people who really benefit from this on-demand therapy," says Dr. Spechler, according to the news release. "If you're going to eat something you know is going to give you heartburn, you can take one of those pills a half hour before your meal, and you may be able to prevent the heartburn."
The most powerful type of medicines, and the ones more suited for people who have ongoing heartburn, are called proton-pump inhibitors. There is only one brand of proton pump inhibitor, Prilosec, available over-the-counter.
"They're very powerful at stopping the stomach from making acid, but it takes a number of hours or even days for them to reach their full effect. So if you want to eat a pizza in the next half hour, it's not going to stop the acid that you're going to make in that time," Dr. Spechler explains in the news release.
Antacids can help if foods consumed generate heartburn. Antacids act like a sponge to soak up the excess stomach acid, but they do nothing to prevent the stomach from creating more acid. So it may help to take some antacid tablets to soak up acid currently being produced and take an H2 receptor blocker to slow the stomach from producing further acid.
What is heartburn?
Heartburn is caused most often by the reflux or backwash of acid from the stomach up into the esophagus, which is the long tube that carries food from the throat to the stomach. A valve at the end of the esophagus is supposed to function as a one-way release, relaxing to allow food into the stomach and closing back up so food and acid in the stomach stay there while the food is digested. If there is a leaky valve, gastroesophageal reflux disease, or GERD, may result. The primary symptom is heartburn.
"As a general rule of thumb anything that tastes really good is likely to give you heartburn," Dr. Spechler says in the news release. "And the reason is the fat content. Fat does a lot of things that promote heartburn. It stops the stomach from emptying well, so now you have more material in the stomach that's ready to reflux. It also further weakens that leaky valve."
Eating or drinking certain types of foods, such as milk, in an attempt to reduce stomach acid generally doesn't work, says Dr. Spechler, in the news release. Dr. Spechler is a member of the American Gastroenterological Association's Committee on GI Research.
"We used to use milk as an antacid, but it's really a very poor antacid," he said in the news release. "Most of the foods that we eat buffer acid, but they also stimulate the stomach to produce acid later. That's why we don't recommend them as a specific treatment."
Avoiding foods that historically cause heartburn is the better strategy
"As a group, anything fatty and anything chocolate is likely to be causing a problem," he states in the news release.
When to see a doctor
Unfortunately, there's no simple answer to when heartburn sensations should prompt a visit to the doctor.
Occasional heartburn usually doesn't signal a more complex problem, such as Barrett's esophagus or esophageal cancer. "But if you're taking medications daily, I think you should be concerned about it," Dr. Spechler says in the news release.
There are some warning symptoms that, if associated with chronic heartburn, may be signs of more serious problems. Questions to ask yourself:
- Are you having difficulty swallowing?
- Are you losing weight?
- Does it hurt when you swallow?
- Do you have fevers?
- Do you have signs of bleeding? (Passing black stools is a sign there might be bleeding from the esophagus into the stomach.)
"If you have heartburn associated with those warning symptoms you really should get in to see your doctor as soon as you can," he says, according to the news release.