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344 DOI: 10.1089/act.2010.16611 • MARY ANN LIEBERT, INC. • VOL. 16 NO. 6 ALTERNATIVE AND COMPLEMENTARY THERAPIES
DECEMBER 2010
Abstract
Herbal medicines offer many potential ways to help people with
gastroesophageal reflux disease (GERD), including by treating
the underlying transient lower esophageal sphincter relaxations
(TLESR), helping relieve symptoms, and reducing inflammation.
Fumaria officinalis (fumitory-of-the-wall) and Chelidonium ma-
jus (celandine) are two among many cholagogues that empirically
seem to be helpful. Another cholagogue, Artemisia asiatica (Asian
wormwood), has been shown experimentally to reduce GERD-
related symptoms.
Atropa belladonna (belladonna, deadly nightshade) and other
anticholinergics may also correct TLESR. Demulcents, such as
alginic acid, Ceratonia siliqua (carob), Ulmus rubra (slippery elm),
Althaea officinalis (marshmallow), and Aloe vera (aloe) leaf gel
can reduce acute symptoms and heal acid-damaged tissues.
Inflammation modulators, such as deglycyrrhizinated lic-
orice, Calendula officinalis (calendula), Curcuma longa (tur-
meric), Zingiber officinale (ginger), Rosmarinus officinalis
(rosemary), and Symphytum officinale (comfrey) may also help
with tissue repair and symptom control. Herbal medicine has
much to offer patients with GERD but more clinical research
is needed.
Introduction
Gastroesophageal reflux disease (GERD) encompasses two
conditions, nonerosive reflux and erosive esophagitis. Although,
historically, erosive esophagitis was considered an inevitable
consequence of nonerosive reflux, there is now fairly substantial
evidence that the two are distinct conditions and progression
from nonerosive reflux to erosive reflux to Barrett’s esophagus is
uncommon even without treatment.1 It was also once thought
that Barrett’s esophagus (or metaplastic transformation of the
esophageal lining into a type more similar to gastric epithelium)
ultimately transmuted into esophageal cancer. This outcome of
GERD in fact seems to be quite rare or represents a complete-
ly different disease that just happens to occur simultaneously
with GERD.2
Because the consequences of GERD are not as dire as once
thought, there is simply much less need to suppress gastric
acid completely. This, however, is the conventional treatment
for GERD, questionable though it is. Presently, proton-pump
inhibitors are the third most prescribed drugs in the United States,
generating more than $13 billion in sales each year.3
The negative effects of long-term acid suppression as a
treatment for GERD include increased risk of pneumonia, os-
teoporotic bone fracture, micronutrient malabsorption, gastric
and small-intestinal bacterial overgrowth, esophageal candidi-
asis, and food allergy.4–7 Moreover, it is well-documented that
acid-suppressing drugs do not fix the underlying problems in
GERD. When these drugs are withdrawn, symptoms almost
always return.8 This is an area where alternative, natural ap-
proaches can produce superior results if the focus is on ad-
dressing the causes of GERD and managing the symptoms
with more benign botanical agents. This article reviews the use
of those botanicals.
Cholagogues
The major pathophysiologic defect underlying GERD is
known as transient lower esophageal sphincter relaxations
(TLESR).9 Normally the lower esophageal sphincter (LES)
relaxes only during swallowing, but, in GERD, the LES re-
laxes inappropriately, albeit temporarily, at other times of the
day and night. Many factors are believed to contribute to
TLESR, including obesity, hiatal hernia, overeating, lying
down after eating, wearing tight clothing around the mid-
section, and smoking.4 Increasingly, medications that relax
or otherwise affect the LES also play a role, including an-
tihistamines, narcotic analgesics, calcium-channel blockers,
and bronchodilators.10
Often, patients who make dietary and lifestyle changes, in-
cluding elimination of likely causative agents, can eliminate
GERD symptoms. However, from a practical point of view,
many patients will not be able to make or sustain those changes
and will continue to experience symptoms. Herbal medicines
should then be added to help correct TLESR.
Herbs for Gastroesophageal
Reux Disease
Eric Yarnell, ND
and Kathy Abascal BS, JD, RH (AHG)
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While treating 2 patients for gallbladder symptoms, one of
the authors (Dr. Yarnell) observed that cholagogue botanicals
also reduced and seemed to resolve these patients’ GERD
symptoms.* Cholagogues are herbs traditionally used to regu-
late gallbladder tone and activity; most notable for this activity
are Fumaria officinalis (fumitory-of-the-wall, fumitory) herb
and Chelidonium majus (celandine) herb.
No clinical work appears to have been published on the use
of these herbs for addressing GERD, but, logically, as these
herbs relax smooth muscle in the gallbladder, they might well
have a similar effect on smooth muscle in the LES. At least one
study has shown that the cholagogue herb Artemisia asiatica
(Asian wormwood), combined with the antiacid drug omepra-
zole, offset symptoms of reflux esophagitis and prevented its
occurrence in rats.11
Celandine is a potent herb that should only be used un-
der the care of a practitioner skilled in its use. There are
isolated reports of hepatotoxicity associated with celandine
use, but this problem has not yet definitively proven to be
caused by the herb.12,13 Because there are so few reports,
it is possible that the reported reactions were idiosyncratic
(meaning that this effect only occurs in a small fraction of
the population who are somehow susceptible and that there
is no inherent propensity of the herb to damage the liver).
Some preclinical work suggests that celandine can actually
be hepatoprotective.14,15
Anticholinergic Herbs
Atropa belladonna (belladonna, deadly nightshade) leaf and
root contain alkaloids that act as muscarinic receptor antago-
nists. This anticholinergic herb, and in particular atropine, has
been shown to decrease TLESR despite overall relaxation of
the LES, with a net reduction in reflux episodes in human tri-
als.16,17 The action of atropine is apparently in the brainstem
as opposed to a local action in the LES.18
Purified atropine tends to cause more adverse effects than
the whole herb, and, as a result, only whole-plant extracts are
recommended for people with GERD. A typical dose of a 1:5
tincture of belladonna leaf is 8–10 drops with each meal. Mild
dry mouth may occur but is not a reason to modify dosing. In
contrast, blurred vision or confusion that develops after taking
the herb can be signs of overdose. If these symptoms occur, the
herb should be withdrawn until the symptoms resolve. It can
then be readministered at half the prior dose.
Demulcents
Demulcent herbs and herbal compounds are frequently
used to offset symptoms in patients with reflux. These rem-
edies are particularly attractive because of their extremely low
toxicity. They are also safe and fairly well-studied, even in in-
fants with reflux. Demulcents are believed to help because they
reduce inflammation and form a temporary protective barrier
against inflammation.
The algal polysaccharide known as alginic acid, combined
with antacids, has been confirmed to relieve reflux symptoms
and esophagitis in infants and children. The dose used was 1–2
mL/kg per day.19
Ceratonia siliqua (carob) pod powder is a flavorful demul-
cent with a taste reminiscent of chocolate. Its pods grow on a
tree in the Fabaceae family. Carob is frequently administered
mixed with applesauce. One study found a combination of
carob, alginic acid, and antacids helpful and completely safe
for relieving GERD symptoms in adults.20 Carob (350 mg)
mixed with cow’s milk has repeatedly helped reduce reflux in
infants.21,22 However, in the authors’ opinion, cow’s milk is
not optimal for most infants, and a better practice would be
to add carob to other bases such as applesauce, breast milk,
or rice gruel.
*is information was derived from notes used in Dr. Yarnell’s medi-
cal practice.
Atropa belladonna (belladonna, deadly nightshade). Drawing © 2010 by
Kathy Abascal, BS, JD, RH (AHG).
Calendula officinalis (calendula).
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Other common demulcents used to treat GERD are Ul-
mus rubra (slippery elm) bark, Althaea officinalis (marshmal-
low) leaf and root, and Aloe vera (aloe) leaf gel. Slippery elm
and marshmallow are generally made into cold infusions, or
powder is added to water to make a gruel. The usual adult
dose is 5–10 g with each meal. Because of the progressive
destruction of slippery elm by Dutch elm disease, marsh-
mallow or aloe gel may be the best choices from an eco-
logic perspective. The usual dose of aloe gel is 1–3 oz with
each meal.
Inammation Modulators
Patients with erosive esophagitis also frequently benefit
from the addition of herbs that decrease inflammation and
promote healing. All the demulcents mentioned above fit
this bill, as do a host of other herbs. There is surprisingly
little research on these herbs, despite the fact that they are
such obvious choices. Only Glycyrrhiza glabra (licorice) root
has been established to be helpful, in its deglycyrrhizinated
form.23 However, Calendula officinalis (calendula) flower,
Curcuma longa (turmeric) rhizome, Zingiber officinale (gin-
ger) rhizome, Rosmarinus officinalis (rosemary) leaf, Symphy-
tum officinale (comfrey) leaf, and many other herbs will prob-
ably prove to be equally efficacious.
Conclusion
A multifaceted herbal approach can help both treat un-
derlying causes of GERD as well as managing symptoms,
helping many patients reduce or avoid long-term use of an-
tiacid drugs. Cholagogues and anticholinergics may help re-
duce or eliminate TLESR, the base abnormalities in GERD
patients, especially if these herbs combined with lifestyle
changes. Demulcents and inflammation-modulators can
help relieve acute symptoms and heal damaged tissues.
These approaches need to be studied better to determine
optimal doses and specific herbs, and to clarify when and if
antiacid drugs are needed in conjunction with herbs. In the
meantime, there is a significant ability—and opportunity—
to improve the status of patients with GERD through the
use of botanical medicines. n
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Eric Yarnell, ND, is chief medical officer of Northwest Naturopathic Urology,
in Seattle, Washington, and is a faculty member at Bastyr University in Ken-
more, Washington. Kathy Abascal, BS, JD, RH (AHG), is executive director
of the Botanical Medicine Academy in Vashon, Washington.
To order reprints of this article, e-mail Karen Ballen at: Kballen@liebertpub.com
or call (914) 740-2100.
16.6ACT_pages.indd 346 12/15/10 3:20:31 PM
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