Gastro-oesophageal Reflux Disease is a VERY common problem. Simply speaking, it is caused by a weakening of the Lower Eosophageal Sphincter (LES) which allows stomach contents including stomach acid to ‘reflux’ up into the oesophagus and higher. This creates the feeling of the heart burn and chest discomfort which can mimic cardiac chest pains.
Sometimes people become numb the heart burn and they no longer experience the pain but they still have ongoing gastric acid reflux into the oesophagus. However doesn’t just stop at the oesophagus. It reaches up into the pharynx (throat), the nasal and sinus passages and can travel back down via gravity into the respiratory tract. These particular patients have ‘silent’ reflux, and can experience chronic symptoms of throat clearing, post nasal drips, runny nose, sinusitis, even chronic cough and secondary asthma (based on where the stomach acid reaches).
Generally speaking, both silent and normal GORD are treated the same way. Oral medications called Proton Pump Inhibitors (PPI) are highly effective for decreasing the acidity of the stomach thereby reducing irritation to the oesophagus and upper respiratory tract. As effective as it is, it doesn’t change the fact that the lower oesophageal sphincter has loosened. Some patients will be refractory (unresponsive) to PPIs and continue to have GORD symptoms despite medications and avoiding acidic foods. At that point, the next step is to consider surgery to tighten the lower oesophageal sphincter (fundoplication). However, this surgery does not guarantee an improvement either.
Recently I have been having success in treating refractory (non-treatment responsive) GORD. The aim of the treatment is to stimulate the Lower Oesophageal Sphincter in order to increase it’s resting tone with the end result being a more tight LES. With this approach, I have been able to significantly improve refractory GORD for my patients.
I have a particular case of an 83 year old gentlemen with refractory GORD symptoms despite daily PPIs and 2x previous GORD surgery (fundoplication). It took 3 sessions (2 weeks apart), but now he has significantly reduced heart burn and nasal/sinus congestion. His symptoms are not zero, since he is a particularly severe case. I doubt that his LES tone will increase enough that he will have zero symptoms but he most certainly is very happy with the result.
Usually there’s a reason that the LES is weak. Often, it is because people eat oo much at a time and their stomachs get too distended which also loosens their LES. I often advise my GORD patients to eat smaller amounts at time to avoid over distending the stomach. They may have to break up their meals into several small meals throughout the day.
With the above advice, I see him every few weeks to months when he starts feeling his GORD symptoms come back (LES starting to loosen). Unfortunately, due to old age and probably genetic predisposition, I do not think there is a cure for his GORD but he definitely has a much improved quality of life without that constant nagging heartburn. He continues with his PPI medications daily as well. He will be unable to go off them. For other younger patients, they have managed to reduce their PPI requirements from daily to every few days or only as required.
This is not only my experience, there are studies that indeed show that acupuncture can indeed strengthen the LES.
Given my above experience and the evidence base, I would strongly consider acupuncture as an adjunctive treatment to help with GORD symptoms as well as to reduce reliance on PPI medications.