Gastro-oesophageal reflux.

Diagnosis of Gastro-oesophageal reflux is often made without investigation simply by diagnosis of symptoms. These include heartburn, especially when bending over or lying down, or when drinking alcohol or hot liquids. Investigations, if necessary, may include barium swallow, intraluminal pH monitoring, and radiolabelled technetium. (Kumar & Clark, 2002, p. 264)

Short-term aims are to alleviate the symptoms and aggravating factors, such as reducing high stomach acidity, and lowering stress. (Mills & Bone, 2000, p. 174)

Longer-term aims are to improve the tone of the oesophageal sphincter.

Phytotherapeutics, their Actions and Therapeutic Ranges:

• Licorice - Anti-inflammatory, anti-ulcer, anti-spasmodic, demulcent, expectorant, laxative. (Newall, et al., 1996. p. 183) (Mills & Bone, 2000, p. 465). (Bone, 2003, p. 65)

Range: 15-40 ml/wk of a 1:1 tincture in 20% ethanol. (Bone, 2003, p. 479)

• Marshmallow - Antilithic, demulcent, diuretic, emollient, expectorant, vulnerary. (Hoffmann, 2002. p. 59) (Newall, et al., 1996. p. 188)

Range: 20-40 ml/wk of a 1:2 tincture in 25% ethanol (leaf). (Bone, 2003, p. 479)

 

As marshmallow root or leaf can be prescribed, in this case I am using the leaf, as it is indicated for irritation of the gastric mucosa. (Bone, 2003, p. 321)

• Golden seal - Anticatarrhal, antihaemorrhagic, anti-inflammatory, antimicrobial, bitter, choleretic, depurative, mucous membrane trophorestorative, reputed oxytocic, stomachic, vulnerary. (Mills & Bone, 2000. p.286)

Range: 15-30 ml/wk of a 1:3 tincture in 45% ethanol. (Bone, 2003, p. 478)

• Meadowsweet - Antacid, anti-inflammatory, astringent, diaphoretic, diuretic, urinary antiseptic (mild). (Bone, 2003, p. 324) (Mills, 1994. p. 147)

Range: 20-40 ml/wk of a 1:2 tincture in 60% ethanol. (Bone, 2003, p. 479)

Synergistic compounding:

Both Licorice and Marshmallow have demulcent properties, so both will assist in soothing the mucus membrane lining of the stomach and esophagus. (Bone, 2003, p. 65 & 321)

Dosage: In this case the administration dosage will be 100 ml for one week, and will comprise the following:

• Licorice - 25 ml
• Marshmallow -  30 ml
• Golden seal - 15 ml
• Meadowsweet - 30 ml

Suggested daily dosage is 5 ml 3 times per day.

I have chosen 25 ml and 30 ml of Licorice and Marshmallow respectively as that is within the mid-range of their therapeutic doses, and as they work synergistically high doses of each should not be required.

I have chosen the minimum therapeutic dosage of Golden seal as it is a bitter herb and as such may increase gastric acidity if used in large quantities. At low doses, however, it can improve the tone of the lower oesophageal sphincter and also increase gastric emptying. Furthermore, Golden seal is a mucous membrane trophorestorative so may assist in healing the oesophageal membrane. (Mills & Bone, 2000, p. 174) (Bone, 2003, p. 250)

I have chosen a mid-range dosage of Meadowsweet for its anti-inflammatory and antacid actions. This will help reduce acidic irritation of the oesophagus and also counteract some of the effects of Golden seal stimulation of gastric acid. (Bone, 2003, p. 324)