Gastro-oesophageal reflux: classic approaches and new developments in pharmacies

Gastro-oesophageal reflux is a very widespread phenomenon that consists in acid and/or bile rising from the stomach into the oesophagus. It can occur occasionally or become chronic.

When it also causes a number of troublesome symptoms and complications, it is identified by the name Gastro-Oesophageal Reflux Disease, or GORD. Gastro-oesophageal reflux disease (GORD) is very common and affects around 20% of the adult population in high-income countries^1-2.

In this article we will look at the main risk factors, the symptoms, and both the classic and the innovative approaches.

• Gastro-oesophageal reflux: risk factors and typical symptoms
• Classic approaches: medicines and food supplements
• Gastro-oesophageal reflux: an innovative approach in the pharmacy

Gastro-oesophageal reflux: risk factors and typical symptoms

The main risk factors³ for reflux are:

• stress, nervous tension
• obesity,
• tobacco smoke,
• genetic predisposition,
• fatty foods,
• fizzy and caffeine-containing drinks,
• alcohol,
• medicines that interfere with the lower oesophageal sphincter,
• delayed gastric emptying,
• mechanical defects of the sphincters (cardia and pylorus).

So, first of all, it is very important to correct bad habits and adopt a more balanced lifestyle.

Gastro-oesophageal reflux disease is generally identified through the typical symptoms³ that characterise it:

• heartburn,
• retrosternal pain,
• acid rising into the oesophagus,
• dysphagia,
• chronic (dry, hacking) cough.

When these complaints are very pronounced and occur more than once a week they are considered chronic, and they also cause a decline in perceived quality of life.

Beyond how the person perceives their own condition, a problematic organic situation also develops: a chronic inflammatory state and localised pain in the lower part of the chest.

Many patients, after years spent without finding definitive solutions, resign themselves to the condition, living in a state that nevertheless limits them in their normal activities and social life.

Classic approaches: medicines and food supplements

The factor that leads people with this problem to lose confidence is the continual search for treatments without finding a real solution. This happens because very often this gastric discomfort is underestimated and treated only at the symptomatic level.

The main approaches involve medicines that are often used for long periods of a person’s life (even though they should be limited) and act mainly on the symptoms in order to:

• reduce the amount of acid produced by the stomach;
• prevent acid from rising towards the oesophagus and protect its mucosa;
• improve gastric emptying.

These include, for example, antacid buffers, alginates, proton pump inhibitors⁴, histamine H2 receptor antagonists, prokinetics, etc.

It is important however to bear in mind that these medicines⁵ may:

• cause allergic reactions in those who do not tolerate their components;
• sometimes prove ineffective or lose efficacy in the long run;
• have to be taken at high dosages in order to manage the symptoms;
• in the long term, lead to potential deficiencies, for example of Iron and vitamin B12
• early osteoporosis, if used continuously and at high doses;
• not be suitable for really resolving the problem.

In recent years approaches based on food supplements have also increased, precisely in order to avoid the prolonged use of medicines and limit possible side effects.

Here too, however, it is important to pay attention to the products you choose. In fact:

• some act only as a buffer without actually regulating acid production
• most do not take the emotional-nervous dimension into account
• many are based on simple plant extracts
• others are based on a single ingredient

Furthermore, public demand for natural products to tackle this type of problem is increasingly widespread, probably because of a perception of fewer possible unwanted effects during long-term treatments.

Gastro-oesophageal reflux: an innovative approach in the pharmacy

As knowledge in the field of supplements and herbal medicine has expanded, new approaches have been developed to act directly and comprehensively on the wellbeing of the stomach and the oesophagus.

It is essential that an approach to this issue takes into account:

1. The regulation of gastric acidity

Keeping the acid secretion of the stomach under control is one of the main focuses in order to prevent excessive production from causing erosion of the mucous membranes.

Acting in this direction alone, however, is often not decisive. As reported in a broad review of studies, approaches with proton pump inhibitors and/or histamine receptor regulators can only partially resolve the symptoms of GORD⁶.

2. The emollient and soothing action on the gastrointestinal mucous membranes

A soothing action is very important, since the acids that rise along the oesophagus typically attack its mucous membranes, establishing a state of chronic inflammation.

For example, a very interesting scientific paper⁷ showed that Olive leaf extract is able to attenuate the inflammation and the oxidative imbalance of those areas, preventing episodes of gastritis.

3. The mechanical protection of the mucosa: barrier effect

In addition to the aspects above, in the case of reflux it is also important to provide elements that can coat the mucosa so as to protect its cells and offer them the right conditions for proper regeneration. Essentially, a typical mechanical barrier effect. This concept was also reported in a recent review⁸ which highlights the importance of combining a mechanical protective effect with the typical treatments for the regulation of acidity.

4. The psychosomatic component

What is all too often not taken into account for complete gastric wellbeing is precisely the emotional and psychosomatic side.

This is essential, however: just consider that gastric secretion is strongly influenced by the body’s autonomic nervous systems (sympathetic and parasympathetic), since their neurotransmitters have a direct and powerful impact on the production of hydrochloric acid and of protective mucus, and can therefore alter their balance.

Moreover, the stomach has as many as 3 layers of smooth muscle which, under the influence of stress and nervous tension, can generate spasms and alterations in the motility of the organ, thus affecting its regular function.

Numerous studies have linked states of anxiety and depression to the development of reflux disease and in recent years this aspect is increasingly becoming a problem among young people, who are indeed subject to intense social stress.

A very interesting cross-sectional study⁹ was carried out on as many as 2,500 participants aged between 18 and 40. In this sample, GORD was diagnosed in 401 participants, 16%. The prevalence was higher in men.

People with reflux disease, however, had a higher prevalence of anxiety and depression than patients without the disease.

It is therefore important for the Pharmacist and the Doctor to give due consideration to all these physiological aspects together, in order to be able to make a significant difference to the effective response that can be offered to the patient with GORD.

Food supplement: something new in the Pharmacy

Today there is something new in the pharmacy that brings together all these aspects in a single, complete and natural approach: Reflugea Forte.

The formulation of this alcohol-free liquid food supplement includes:

• extract of Amla (Phyllanthus emblica L.) — regulation of acidity
• leaf extract of Mallow (Malva sylvestris L.) which provides mucilages — emollient action and barrier effect
• patented extract of Prickly Pear and Olive (Mucosave®FG) — soothing and antioxidant action
• extract of Mastiha Resin (Pistacia lentiscus L.) — support for gastric function
• extract of Fig (Ficus carica L.) and Lime Blossom (Tilia tomentosa Moench) — support for the emotional-nervous component

The new awareness surrounding gastro-oesophageal reflux will increasingly lead to the use of complementary and synergistic approaches, natural ones in particular, that consider the physiopathological issue in all its various aetiological aspects.