A case of Duodenitis, Gastritits, Reflux Oesophagitis and Hiatus Hernia

© Dr.R.S.Mann & Dr. Vandana Patni 2011

Presented by 

Dr. R S Mann & Dr. Vandana Patni.

Mr G. Singh, 33 yrs, Male patient presented the following complaints

March 25, 2011.

Pain abdomen, cramping, eating after, stool before which ameliorates after stool. Flatulence, distension of abdomen with rumbling. Stool mucous on and off. Flatulence very offensive, alternate constipation and diarrhea. Constipation on eating meat.

All the problem for many years, diagnosed for Reflux Oesophagitis, Hiatus hernia, Gastritis and duodenitis on Endoscopy. Using antacids and many other medicines for years. 

Repertorizations  in Radar 9:-

ABDOMEN - DISTENSION - flatulence - from
ABDOMEN - DISTENSION - painful
ABDOMEN - FLATULENCE
ABDOMEN - PAIN - cramping - eating - after
ABDOMEN - PAIN - cramping - stool - after - amel.
ABDOMEN - PAIN - cramping - stool - before
RECTUM - CONSTIPATION
RECTUM - DIARRHEA - alternating with - constipation
RECTUM - FLATUS - offensive
STOOL - MUCOUS
GENERALS - FOOD and DRINKS - meat - agg.

Prescription :-

Sulph 200 CH  2 dose on 2 hours gap.

China 30 CH  One dose daily.

Pulsatilla 30 CH One dose daily.

For a week.

April 2, 2011.

A little better but have few another complaints not described earlier and was not present on first visit because he was continuously using Antacids, now because antacids are stopped after first prescription, some more symptoms are here.

Stomach burning pain which aggravates after eating. Flatulence offensive, rumbling in abdomen here and there. All the complaints aggravates after eating. Heaviness stomach after eating.

Prescription :-

Lycopodium 30 CH One dose daily.

Robinia 30 CH One dose daily.

For two weeks.

April 19, 2011

Flatulence, Burning in stomach, rumbling improved.

Pain Hypogastrium ameliorate by pressure.

Burning  pain in all over the abdomen, better by drinking water.

Repertorizations  in Radar 9:-

STOMACH - HEAVINESS - eating - after

ABDOMEN - PAIN - burning

ABDOMEN - PAIN - Hypogastrium - pressure - amel.
GENERALS - FOOD and DRINKS - water - amel.

Prescription :-

Iodum 30 CH  Two doses two hourly.

Sang Can 30 CH  One dose daily

Robinia 30 CH One dose daily

For one week.

April 27, 2011

All complaints better with very mild distress.

Prescription –

Lycopodium 30 CH  One dose daily.

Robinia 30 CH One dose daily.

For one week.

May 7, 2011

Burning abdomen.

Rumbling, flatulence.

Mucous stool.

Abdomen pain cramping.

Earlier symptoms returned back.

Prescription:-

Sulhpur 200 CH  Two doses on 2 hours gap.

Nux Vomica 30 CH One dose daily on bed time.

For one week.

May 13, 2011

All complaints relieved again.

Prescription:-

Sac. Lac. Only

For a week.

May 24, 2011

Stool thin, not formed properly.

Mucous with stool only one day.

Pain burning abdomen which aggravates after eating.

Flatulence, distension.

Prescription –

Sac. Lac. Only

For a week.

June 2, 2011

Has good appetite, but easy satiety.

Stool fatty, greasy, stick to pot.

Repertorizations  in Radar 9:-

STOMACH - APPETITE - easy satiety

STOOL - FATTY, greasy

Prescription:-

Platina 200 CH 2 doses with an interval of two hours.

Sac. Lac.

For One week.

June 14, 2011

Get Coryza.

Sneezing.

Raw, sore throat.

Prescription –

Ars. Alb. 30 CH One dose Daily

For 3 days only.

June 30, 2011

Flatulence.

Stool Black.

Pain Epigastrium.

Repertorizations  in Radar 9:-

STOMACH - PAIN - Epigastrium

ABDOMEN – FLATULENCE

STOOL - BLACK

Prescription –

Vertarum Album 30 CH One dose daily.

Cuprum Met 30 CH One dose daily.

For one week.

July 9, 2011

Heaviness in stomach which aggravates on eating.

Burning in stomach ameliorates by drinking plain water.

Burning and acrid eructation.

Sluggishness.

Repertorizations  in Radar 9:-

STOMACH - ERUCTATIONS; TYPE OF - burning

STOMACH - ERUCTATIONS; TYPE OF – acrid

STOMACH - HEAVINESS - eating - after

STOMACH - PAIN - burning

GENERALS - SLUGGISHNESS of the body

GENERALS - FOOD and DRINKS - water - amel

Prescription –

Phosphorus 200 CH  2 doses with gap of two hours.

Lycopodium 30 CH One dose daily.

July 18, 2011

Pain epigastrium.

Pain gnawing.

Pain eating after.

Stool thin, mucous.

Symptoms  on July 9, 2011  are also included in repertorization.

Repertorizations  in Radar 9:-

STOMACH - ERUCTATIONS; TYPE OF - acrid
STOMACH - ERUCTATIONS; TYPE OF - burning
STOMACH - HEAVINESS - eating - after
STOMACH - HERNIA; HIATUS

STOMACH - PAIN - burning
STOMACH - PAIN - eating – after

STOMACH - PAIN - Epigastrium

STOMACH - PAIN - gnawing

ABDOMEN - PAIN - gnawing
STOOL - MUCOUS

STOOL - THIN

GENERALS - FOOD and DRINKS - water - amel.

GENERALS - SLUGGISHNESS of the body

Prescription –

Last prescription was right.

Sac. Lac.

For one week.

July 25, 2011

Stool mucous for 2 days.

Pain and Burning improved.

General weakness, desire to lie down.

Meat causes constipation.

In summers patient feel much aggravations.

Always remain cheerful and happy. (Enters consulting room smiling)

Pain lower limbs.

Appetite with easy satiety.

Repertorizations  in Radar 9:-

MIND - CHEERFUL
STOMACH - APPETITE - easy satiety
STOOL - MUCOUS
EXTREMITIES - PAIN - Lower limbs
GENERALS - LIE DOWN - desire to
GENERALS - SEASONS - summer; in - agg.
GENERALS - WEAKNESS

RECTUM - CONSTIPATION
GENERALS - FOOD and DRINKS - meat - agg.

Prescription –

Lycopodium 200 CH 2 doses with two hours gap.

Sac. Lac

For one week.

August 5, 2011

All symptoms improved.

On August 4, eaten meat but no constipation today.

Prescription –

Sac. Lac.

For one week.

August 25, 2011

On August 11 mucus stool, pain stomach, rumbling, cramping pain and urging for stool eating after, all these complaints subsided next day.

On August 24, waken in morning with uneasiness in stomach, drink some water which vomited out after sometime, very sour, then ameliorated immediately after vomiting.But stil have desire to drink chilled water.

Pain epigastrium as well as he started breakfast.

Feeling lot much appetite but could only eat one chapatti (Bread).

Bloated feeling, eating after.

Weakness, wants to lie down.

Heaviness of head.

Sneezing paroxysmal with post nasal discharge.

Repertorizations  in Radar 9:-

HEAD - HEAVINESS
NOSE - DISCHARGE - Posterior nares
NOSE - SNEEZING - paroxysmal
STOMACH - APPETITE - easy satiety
STOMACH - PAIN - eating - after
STOMACH - VOMITING - drinking - after
STOMACH - VOMITING; TYPE OF - sour
GENERALS - FOOD and DRINKS - cold drink, cold water - amel.
GENERALS - FOOD and DRINKS - cold drink, cold water - desire
GENERALS - LIE DOWN - desire to
GENERALS - WEAKNESS

Prescription –

Phosphorus 200 CH 2 doses with gap pf two hours.

Sac. Lac.

For one week.

September 10, 2011

All complaints better.

Patients says he never felt so much easy and light in his stomach.

No Prescription.

November 1, 2011

No complaints.

Inferences –

1. Earlier, case started with few symptoms, and wrong prescriptions were given.
2. The cases which are under allopathic treatment does not disclose all the symptoms on first visit, because they are hidden, after discontinuing those medicines we get more symptoms on later visits.
3. Phosphorus and Lycopodium cured the case finally.
4. Prescribing more then one medicine at a time, only complicated the case.
5. Earlier prescriptions just push the case towards more clear features.
6. Many similar medicines can give relief to patient but they does not cure. And their effect does not continue for a long time. 
7. Daily prescriptions in chronic cases, like this, only prolong the case unnecessarily.  

Copyright under International Copyright Act

© Dr.R.S.Mann & Dr. Vandana Patni 2011

Heartburn Or Hyperacidity

Esophagus is a tube like structure which passes food from mouth to stomach. At lower end of esophagus a valve like structure called Lower Esophageal sphincter (LES) act as one way valve which let pass food from esophagus to stomach but stop its regurgitation.
Secretion of acid in stomach is normal process to digest the food. Inner most lining of stomach wall is acid resistant, so stomach itself does not get any harm from acid secreted in stomach but esophagus has not such kind of protective lining. In normal conditions acid mixed food does not regurgitate up in esophagus. But when food and acid refluxes back into esophagus it produces symptoms from mild discomfort to severe burning. This is known as Gastro-Esophageal Reflux( GER).
Acid Reflux is a very common symptom but if it is felt more than twice a week in long term it can produce Gastro- Esophageal Reflux Disease ( GERD).
Symptoms of Gastro- Esophageal Reflux Disease ( GERD) :-
1. Frequent Heartburn- although it is a burning sensation in mid chest or lower part of esophagus but it has no relation with heart.Burning mostly increases with eating and may last for hours after eating. Burning may increase with stooping, lying down.
2. Acid Belching- Eructation of acid or acrid water in mouth with eructation.
3. Symptomless- Less incidentally GERD may occur without usual symptoms of burning or heartburn. Instead in children there may be Dry cough, Asthma like symptoms or difficult swallowing indicating to GERD.
Factors or Causes Responsible for GERD:-
In many cases exact cause remains unclear but some important factors are underlined.
A. Acid reflux caused by Hiatus Hernia, a structural abnormality in which stomach and LES ( Lower Esophageal Stricture) junction moves above the diaphragm.
B. Pregnancy- Many women feel heartburn first time in pregnancy, it occurs due to increasing level of hormones and growing size of fetus which increases intra-abdominal pressure which reflux acid into esophagus. Most women feel worst symptoms in third trimester and after delivery symptoms go away completely.
C. Smoking- Smoking increases heartburn episodes by increasing acid secretions, reducing salivation in mouth which neutralize acid effects in esophagus, reducing lower esophageal sphincter muscle’s function which increases acid reflux into esophagus.
D. Obesity- Obesity increases intra abdominal pressure which increase acid leakage into esophagus.
E. Foods and Food Habits– Eating large meals and eating just before bedtime can increase heartburn.Some foods increases events of heartburn as :- Alcohol, Carbonated beverages , chocolate, tomato and tomato products like sauce, citrus food , coffee and tea, spicy food, garlic and onions. All these foods can trigger heartburn.
F. Mental stress related to shift working, emotional and economical issues may increase Heartburn symptoms.
Diagnosis :-
Frequent heartburn, sour and acrid eructation is sufficient to diagnose this condition. But sometimes to know extent of disease further examination is needed-
A. Barium Swallow.
B. Endoscopy.
C. pH Monitoring.
D. Biopsy in cases of suspicion of cancer.
Management and Treatment :-
Lifestyle and dietary changes can improve episodes of Heartburns and prevent Gastro-Esophageal Reflux Disease.
A. Avoid food and beverages which trigger heartburn as alcohol, soda, carbonated drinks, chocolates, tomato based foods, garlic etc.
B. Quit Smoking.
C. Food Habits- Eat small meals at a time.Finish your food 2-3 hours before going to bed.
D. Weight Reduction and manage obesity- Weight reduction and managing obesity can improve recurrent episodes of heartburn.
E. Improve your sleep- Quit night watching and improving sleep quality can reduce heartburns.
F. Raise 6 inches of your head side of bed- Raising head side 6 inches improve the flow of acid in stomach away from esophagus which reduce the heartburns.
G. Stop wearing tight clothes.
If using these tips is not sufficient to stop episodes of heartburn then further treatment is necessary because frequent acid spilling in esophagus can produce ulcers, bleeding and can develop cancer of esophagus.
Allopathic Treatment-
Antacids are used to reduce heartburns and acrid eructation. Foaming agents, H2 blockers, Proton pump inhibitors and Prokinetics are most common type of drugs used for antacid effects.
Long term effect of antacids can result in side effects as diarrhea, altered calcium metabolism and extra build up of magnesium in body. Too much magnesium can effect patient of kidney disease.
So continuous use of antacids without consultation may endanger health.
Homeopathic Treatment-
Homeopathy has very effective medication for acute and chronic cases of Hyperacidity and heartburn. Regular use of homeopathy on one hand can prevent from GERD and on another hand homeopathic medicines prevents from side effects as in case of regular use of allopathic antacid drugs.
Homeopathy has 274 medicines for Heartburn, Acrid Eructation and burning esophagus. Long term use of these medicines never impose any side effect on health. Some very common medicines are-
Lycopodium, Nux Vomica, Acid Sulf, Robinia, Sang. Can., Arsenic Alb, Nitric Acid, Phosphorus etc.
When to Consult a Physician:-
1. If heartburn occurs more then two times a week.
2. If You wake up in night due to heartburn.
3. If routine medicines which you are using is not working now.
4. If heartburn associated with difficulty in swallowing.
5. If there is hoarseness, difficulty in respiration after eating or lying down after eating.
6. If there is unexplained weight gain or weight loss.
7. If heartburn is started to disturb your routine life.