Dyspepsia and Gastric Dysfunction

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Dyspepsia is a very common medical problem in the United States. The term refers to impaired gastric function, and hence is related to other increasingly common functional diseases, such as gastric esophageal reflux (GER) and irritable bowel syndrome (IBS). Symptom characterization includes any of the following: epigastric pain, 'heartburn', nausea, and gas production. It has been dismissed with the term upset stomach in the past, and left untreated. Often, little diagnostic attention is paid, or objective testing, and the patient is routinely prescribed medications to further block stomach function in the form of pharmaceutical agents that block production of gastric acids. These medications, proton pump inhibitors and histamine H2 receptor blockers, such as Nexium, Zantac (Ranitidine), Protonix, Prevacid, Aciphex, Prilosec, Tagamet (Cimetedine), Pepcid, Axid, Mylanta, now come with multiple serious box warnings from the U.S. FDA now that the drugs have gone generic, and many Medical Doctors are advising patients that long-term use, especially with aging, perimenopause, pregnancy, parathyroid or thyroid disorders, or with risk for osteoporosis, as well as with various medications that increase risk of osteoporosis, anemia, and/or cardiovascular disease. In addition, a number of large studies have shown a dramatically increased risk of intestinal infections in time of stress with long-term use, especially with Clostridium difficile enteritis in antibiotic resistant nocosomial (hospital-acquired) infections, and in 2016 a large cohort study of 249,751 patients taking proton pump inhibitors in a 2015 Risk in Communities study conducted by The Johns Hopkins University School of Medicine found that the chronic use of these drugs significantly increased the risk acquiring chronic kidney disease. There is no longer any doubt whatsoever that we need to find other ways to treat gastric dysfunction.

There are a number of classifications of dyspepsia, including acid dyspepsia, adhesion dyspepsia (inflamed tissue adhesions), atonic dyspepsia (lacking muscle tone), fermentative dyspepsia (slowness in stomach emptying causing a fermentation of contents, and stomach fullness), flatulent dyspepsia (where intestinal gas is allowed up into the stomach, producing foul burping), nervous dyspepsia (associated with autonomic nervous dysfunction or anxiety), and reflex dyspepsia (excited by reflex irritation due to disease elsewhere in the stomach or intestines). Many patients are finding that one of these, or a combination of these types, are presenting serious problems with their health and daily healthy function. In addition, recent large studies have shown that GERD (gastroesophageal reflux disease), a manifestation of chronic dyspepsia, is highly associated with Metabolic Syndrome, and involves dysfunction in the upper small intestine and gallbladder as well as the stomach. The comorbidity of gastric dyspepsia and Irritable Bowel Syndrome (IBS) has become clear as well, and scientific study has shown us why these dysfunctional syndromes are linked. A number of syndromes of gastric dysfunction are rising dramatically in incidence, grouped under the title of gastrointestinal motility disorders, such as gastroparesis, which increased as a primary diagnosis by 158 percent between 1995 and 2004, and similarly as a diagnosis secondary to other causes, especially diabetic neuropathy, Metabolic Syndrome, and medication induced gastroparesis (narcotic pain medication, antidepressants, calcium channel blockers for hypertension and tachycardia, anticholinergic and antimuscarinic drugs to treat Irritable Bowel Syndrome (IBS) and urinary frequency, such as Bentyl and Levsin, diabetic medications such as Victoza, Byetta and Symlin, Interferon to treat Hepatitis C, Levodopa to treat Parkinsonism, and yes, proton pump inhibitors and H2 receptor antagonists that treat acid reflux and heartburn). Some of these cases have been described as delayed gastric emptying, and a 1981 study (McCallum, Berkowitz, Lerner) showed that in a group of 100 patients with gastric reflux disease (GERD) that 41 percent had delayed gastric emptying, and some more recent studies have shown an incidence of 57 percent in GERD patients. Most of these cases are described as idiopathic, or without a clear objective cause, and the array of potential causes or contributors is large. Clearly, a more holistic and thorough individualized treatment approach is needed to correct these problems. By prescribing a one-size-fits-all therapy that does not address the whole health problem and comes with serious long-term adverse health consequences, standard medicine has failed the patient population. Integration of Complementary Medicine solves this dilemma, and is proven to work.

If you suffer from dyspepsia, or functional gastric disorder, the right course of therapy involves utilizing Complementary and Integrative Medicine (CIM/TCM) to help restore gastric function with a more holistic and individualized protocol. A comprehensive therapeutic protocol from a Licensed Acupuncturist and herbalist involves guidance with diet and lifestyle, herbal and nutrient medicine, as well as acupuncture, and is specific to individual needs, providing an array of treatments that address this health problem that is more complex than most patients realize. Each case may require a different overall treatment approach and time frame for resolution of the problem.

Treatment of underlying causes and restoration of gastric and gastrointestinal function will not only relieve what is euphemistically called "heartburn", but will result in improved quality of life, and better health. Understanding of this problem and a proactive approach to resolution is the choice of more and more intelligent patients, as FDA warnings accumulate concerning the pharmacological inhibitors of gastric secretions such as proton pump inhibitors and histamine H2 receptor blockers. By 2014, widespread warnings of malabsorption of essential minerals, such as calcium and magnesium, Vitamin B12, and other important nutrients, increased risk of gastrointestinal infections, such as antibiotic-resistant Clostridium difficile enteritis, and increased risk of osteoporosis and bone fractures with chronic use of gastric inhibiting drugs, are making many patients and prescribing doctors rethink the too easy long-term prescription of these medications. Integration of Complementary Medicine may improve gastrointestinal health and function and allow patients to decrease dependency, and perhaps resolve the need for gastric acid inhibitors.

One of the well-known causes of dyspepsia in the United States is the chronic use of nonsteroidal anti-inflammatories (NSAIDS) such as ibuprofen, aspirin, naproxen, etc. Vioxx and celebrex, or rofecoxib, a Cox2 inhibitor, was created to reduce the high incidence of dyspepsia with NSAIDS, although this drug was recalled due to a high incidence of cardiovascular pathology and many lawsuits against the company. Studies generally show that 2-3% of patients taking NSAIDS regularly experience upper GI gastric bleeding, and a larger percentage experience less dangerous dyspepsia. In Europe, a 2007 Oxford University study found that the incidence of dyspepsia reported to medical doctors was greater than 15 per 1000 persons seen per year. This reflected a low reporting of incidence to the medical doctors, and the researchers found that a much greater percentage of people suffer from dyspepsia but do not consult with a medical doctor. The most common diagnosis on follow-up was irritable bowel syndrome (IBS), and the risk of developing gastroespophageal reflux (GERD) in the following year increased 60 percent. There was little association with alcohol use, smoking or obesity, and both sexes were affected fairly equally. There was also increased risk with current users of biphosphonates, the medications used to treat or control osteoporosis. In the United States, recent studies found that over 2% of the population consult with medical doctors for dyspepsia, and the prevalence of IBS has reached 10-20%. Population studies have found that nearly 25% of adults suffer from dyspeptic symptoms.

There was a belief in the past that overgrowth of heliobacter pylori was a significant cause of dyspepsia. This has been discounted in a number of large studies. H. pylori is a symbiotic bacteria found in the gut of over 60 percent of the world population. It's association with a wide variety of stomach pathologies, as well as migraines, it's ability to thrive in an acidic environment, and the fact that it produces an enzyme called urease that aids deficient protein digestion when the usual protein acid pepsin is slow to excrete, suggests to many researchers that this bacteria is the result of, and not the cause of, dysfunctional stomach pathology. Also, H. Pylori has a corkscrew shape that allows it to overgrow in the unhealthy stomach lining, and it thrives in an acid state, suggesting that the tissue is unhealthy prior to H. Pylori overgrowth and not as a result of Heliobacter Pylori. Long term studies show that the harsh antibiotic regimen used to decrease the bacterial overgrowth has a large noncompliance due to side effects and poor long term outcomes, often with an increase in GERD and dyspepsia as a consequence. A large cohort study by Vanderbilt Medical Center, in Nashville, Tennessee, in 2013, found that a study of 1463 patients in 7 Latin American countries, randomized to 3 types of antibiotic regimens, also found an 11.5 percent recurrence of significant H. Pylori overgrowth one year after complete eradication with the pharmaceutical regimen. Clearly, the underlying causes of Helicobacter pylori overgrowth need to be addressed, as well as restoration of gastointestinal function.

We see that standard treatment of H. pylori overgrowth is problematic. On the other hand, a number of benign herbal therapies have proven effective in studies, including Dragonsblood resin, Abrus cantoniensis (Ji gu cao), Saussurea lappa (mu xiang), Rabdosia trichocarpa, Plumbago zelanica (Bai hua teng), and other Chinese herbs that have moderate inhibitory effect. A 2005 study of herbal H. Pylori inhibition by the University of Illinois at Chicago (cited below) found that a number of herbal extracts showed in vitro inhibition of multiple strains of H. Pylori, including Curcuma longa (Jiang huang) and ginger, Gentiana lutea (Long dan cao), Mentha piper (Kava), Myristica fragrans seed (Rou dou kou), Achillea millefolium, Juniper berry, and Melissa officianalis (lemongrass). Alcohol extracts of these herbs were used. A 2005 study of herbal anti-H. Pylori effects was also conducted at National Chung Hsing University, Taiwan, and showed significant inhibition with Alpinia speciosa (Cao dou kou and Gao liang jiang), Artemesia argvi (Ai ye), and other common herbs in alcohol extract. Helicobacter Pylori (H. Pylori) overgrowth is thus shown to be a consequence and not a cause, of gastrointestinal dysfunction, and overgrowth is easily inhibited with herbal therapy combined with restoration of healthy gastric function and membrane integrity. These herbs proven to inhibit H. Pylori are commonly used in Chinese Herbal Formulas to treat gastrointestinal dysfunction. This course of therapy avoids the harsh adverse effects of antibiotic regimens, does not promote the increasing antibiotic-resistant strains of H. Pylori, and results in overall gastrointestinal health for the future. Of course, if this conservative course of therapy is tried and fails to curb a more serious case of H. Pylori overgrowth, then harsh antibiotic therapy may be warranted. Even with this pharmacological treatment, though, restoration of gastrointestinal function and health is necessary, and Complementary and Integrative Medicine (CIM/TCM) may provide this care. Acupuncture stimulation provides a symbiotic effect to enhance this herbal therapy.

Other health problems are also associated with dyspepsia and gastrointestinal dysfunction. There is a high incidence of functional gastric disorder and irritable bowel syndrome (IBS) with patients experiencing a history of depression, anxiety, abuse and other psychosocial stress. Acupuncture and herbal medicine is also able to treat these stress disorders, anxiety, depression etc. effectively. Some recent studies have linked food allergies to these functional disorders, especially when IgG were elevated, suggesting celiac disease. Autonomic nervous disorders are increasingly common and are also linked to functional GI disease. These disorders commonly occur with chronic myofascial pain syndromes. Hormonal imbalance is also often linked to functional GI disorders and autonomic disorder. Parathyroid hormone increases gastric acid and pepsin secretion, and a subclinical hyperparathyroidism and hypoparathyroidism is increasingly seen in the population, with Vitamin D3 deficiency, excess phosphates in the diet, subclinical hypothyroidism, and other neurohormonal imbalances associated with parathyroid dysfunction. The Licensed Acupuncturist is able to correct myofascial pain syndromes, treat anxiety and stress disorders, aid neurohormonal balance, and improve stomach function with the same course of therapy. This holistic and comprehensive approach is well suited to dyspepsia.

Gastric dysfunction, dyspepsia, and GERD may eventually extend to the throat, and laryngopharyngeal reflux, or reflux of gastric contents to the larynx and phyarynx are not uncommon. Symptoms of this expanding pathology include the feeling of an obstruction in the throat (globus pharyngeus), frequent throat clearing, post-nasal drip, dysphagia (trouble swallowing), a persistent dry cough, and even dysphonia (trouble speaking clearly, or alteration of the sound of the voice).

Testing for this problem relies on a visit to the hospital or clinic that utilizes a 24 hour test examining the acidity relationship between the upper and lower esophageal sphincters, which is accomplished by inserting a small tube via the throat into the esophagus and using a small computerized monitor that the patient may place in a shirt pocket. The patient may leave the clinic with this device. Standard medicine still relies on gastric acid inhibition for this problem exclusively, despite the widespread tissue problems that are apparent. Many patients realize that a more holistic and thorough approach to treatment is needed in these cases. There is a high association of laryngopharyngeal reflux with asthma, and in fact, chronic use of steroidal medications to treat asthma and allergies, as well as antihistamines, may have a negative impact on the tissue health of the throat. Steroid inhaler laryngitis is not uncommon, with chronic use and overuse resulting in negative tissue health, resulting in mucosal edema (swelling), tissue granularity (roughness), hyperemia (excess blood flow / congestion), hypervascularity and leukoplakia (white patches/candida), often observed in laryngoscopy. Overgrowths of candida and other common GI flora and fauna may also be encouraged by chronic use of steroid inhalers. The patient may need help with Complementary Medicine to control asthma when going off of these drugs, as well as help with tissue repair. A number of therapeutic goals may need to be addressed with steroid inhaler laryngitis, and while gastric acid inhibitors do nothing to promote tissue healing, control overgrowths of candida, etc., herbs, nutrient medicine and acupuncture can help achieve all of these goals.

Physiological Facts About Stomach Function

The acidity in the stomach and small intestine is a variable system that should react to food to insure proper digestion, assimilation of nutrients, and stomach emptying, as well as the proper secretion of digestive enzymes from the pancreas in the small intestine. The relief of symptoms often involves use of chemical medications that block parts of this complex system of feedback regulation, either histamine formation or acid formation with proton pump inhibitors. This is not a cure. Symptom relief may occur with this drug protocol, but this does not always signify a cure of the medical condition. Use of Complementary Medicine in the form of acupuncture combined with herbal and nutrient medicine to restore stomach and small intestine function is needed to achieve an end to acid reflux and the side effects of long term use of medications, which include calcium imbalance with increased risk of joint problems & osteoporotic stress fracture, magnesium deficiency with many adverse effects, pernicious anemia and cardiovascular risk due to malabsorption of Vitamin B12 and high homocysteine levels, increased risk of intestinal infection, especially with antibiotic-resistant Clostridium difficile during hospital stays, and many other side effects with chronic use of these commonly prescribed drugs. Often, the symptoms of reflux are due to more than just stomach acidity, and a majority of cases of heartburn may be due to gastric hypofunction rather than just excess acid production. Read on to learn what you haven't been told about reflux.

The symptoms of reflux in the esophagus may be due to mechanisms other than hyperacidity in the stomach. In this case, standard medication to inhibit production of stomach acids will be ineffective, and in fact may be worsening the pathology, making other approaches necessary. Much scientific study has been conducted concerning the ineffectiveness of standard medication for acid regurgitation and stomach dysfunction with chronic use. The Merck Manual (online: see: Electrical Impedance Testing under Gastroparesis) states: "In electrical impedance testing, an electrical sensor is placed in the distal esophagus to assess nonacid reflux, which is common in patients receiving gastric antisecretory drugs and in infants with reflux disease." This statement shows that it is widely accepted that chronic use of medications that block stomach acid secretion may cause nonacid reflux in the distal esophagus, or gastrointestinal dysfunction.

Esophageal reflux is a common problem that involves poor health of the esophageal tissues as well as a reflux that is often associated with chronic asthmatic and allergic conditions. Studies have shown a strong link between allergic asthmatic triggering and failure of the esophagus to prevent reflux, especially at night. This is because the nerve stimulation is similar in both pathologies. Gastroesophageal reflux is a potent asthma trigger, and corticosteroid asthma medications may contribute to GERD. This creates a vicious cycle with standard medications perpetuating these problems.

A study conducted in 2002 by researchers at the University of Alabama at Birmingham concluded that "Prednisone (a corticosteroid) 60mg/d for 7 days, increased esophageal acid contact times in this small population with stable asthma". The exact mechanism or reason for this increase in esophageal acid reactivity remains unclear, but the researchers concluded that patients with asthma complain of new or worsening esophageal reflux symptoms when treatment with oral corticosteroids is initiated, and this study proved that corticosteroid use worsened acid reactivity in the tissues. Studies also cited below in Additional Information have shown that a high incidence of eosinophilia is seen in cases of childhood GERD, and that most of these children are medicated with steroids, which has a known side effect of eosinophilia. Often, patients are prescribed more than one medication that has the potential to cause functional gastrointestinal disease and poor tissue maintenance, and as an approach of polypharmacy has increased dramatically, so has the incidence of these related problems of dyspepsia, GERD, gastrointestinal motility disorders, and Irritable Bowel Syndrome. It is unlikely that this is just a coincidence.

Transient lower esophageal sphincter relaxations are the primary cause of most gastroesophageal reflux syndromes. Studies have shown that these sphincter relaxations in GERD patients are more prolonged and occur more frequently with poor gastric emptying due to hypofunction of the stomach and small intestine. This creates a situation where the contents of the reflux is more acidic when the homeostatic function of the stomach is impaired, and normal feedback emptying of chyme is not achieved. While these sphincter relaxations are normal for all patients, excess and/or prolonged relaxations of the lower esophogeal sphincter allow gastric secretions to reflux upward and cause mucosal irritation and stimulate increased asthmatic and allergic reactivity, especially when the stomach contents, or chyme, is more acidic with poor gastric emptying. Conversely, syndromes of allergic asthma and hyper-reactivity in the upper airway and esophageal tissues may aggravate GERD. Numerous studies now also show that gastrointestinal dysfunction and food allergies and hyper-reactivity eventually may cause many cases of allergic asthma and rhinitis. While standard medicine has tried to portray this cycle of dysfunction as a simple matter of excess acid, numerous studies show that the feedback cycle in the stomach is complex, involving neurohormonal regulation, tissue health, availability of secretion precursors, bile flow, pancreatic function, and the health of the small intestinal lining. A more holistic treatment protocol is obviously needed. Studies have demonstrated the effectiveness of acupuncture and electroacupuncture to decrease the prolongation and frequency of these transient lower esophageal sphincter relaxations, and such therapy may be combined in a holistic protocol to treat a variety of associated health problems in the same session with Traditional Chinese Medicine.

Gastroparesis is a condition of poor stomach emptying in the absence of a mechanical obstruction, with a widely varied presentation. Usually, both solids and liquids do not digest and empty well, limiting intake. The array of causes include neuropathies of the vagal nerve and/or autonomic nervous regulation, injury to the enteric nerve system, hyperglycemia, and simply dysfunction in the stomach function itself, which is a neurohormonal feedback system. The most common type of gastroparesis is unfortunately idiopathic, meaning we don't know what is causing it, which is frustrating, especially after going through a number of tests that are negative. Association with chronic diabetes, collagen vascular diseases, post-surgical complications, or neurological conditions are seen. While a few studies have shown that chronic Type 1 diabetes now may have an incidence of gastroparesis of about 5 percent, the pathogeneis, or explanation of how diabetes creates this symptom is poorly understood. One population-based study showed an incidence overall in the population of 1.8 percent, and an incidence with patients diagnosed with Type 2 diabetes, who make up about 98 percent of all patients diagnosed with diabetes, at 1 percent (Rey, Choung et al, 2012). This study also showed that the prevalence of a diagnosis of gastroparesis was only 0.02 percent, showing once again that when standard medicine has no effective treatment that there is a reluctance to diagnose something like variable problems in gastric emptying function. There is no doubt that this is a functional problem for most patients, though, and a restoration of gastric function must b achieved. Treating the underlying cause of gastroparesis is the obvious first step, though, and is hampered by a lack of a clear diagnostic explanation. As stated, most cases are 'idiopathic', or without such a diagnostic explanation. The assumed explanation for most cases presented to a Medical Doctor is that gastroparesis is most likely related to a diabetic neuropathy associated with the autonomic nervous system via the vagal nerve system, and involves an imbalance between the sympathetic and parasympathetic responses. More recent explanations focus on the intrinsic nerves and neurohormonal responses of the stomach itself, as we see that a small percentage of patients presenting with gastroparesis are diagnosed with Type 1 diabetes and have no signs of a generalized autonomic dysfunction. The problem here is the reluctance to look 'outside of the box' in standard medicine, even when this is obviously a mistake.

With an emphasis on local intrinsic neurohormonal dysfunction to explain most cases of gastroparesis, we see that a restorative approach and a more holistic perspective is needed. The limited study of this local intrinsic neurohormonal dysfunction has found that there may be a loss of expression of nitric oxide synthase (nNOS) and loss of ICC, or the cells of Cajal in the interstitial tissues of the stomach membrane. These problems are linked, and the deficiency of nNOS alone does not explain the difficulty in triggering gastric emptying, a mechanism involving feedback triggers that are varied, with gastric acids, chyme, pressure, and gastric neurohormones involved in this feedback triggering. Laboratory studies have shown that a loss of these cells of Cajal in the stomach tissues leads to a deficient expression of nNOS, but a loss of nNOS by itself does not cause delayed gastric emptying. Another feedback chemical, heme oxygenase-1, an intrinsic antioxidant, may delay gastric emptying when in excess, and is linked to nNOS deficiency. These studies point to the role of the immune system in gastroparesis, and it appears that this is another problem related to neurohormonal immunology. As this type of study increases, we find in human studies that there are a number of interrelated factors, and a variance in the functional findings of the cells of Cajal (ICC), with a small percentage showing a loss of ICC in the membrane tissues in small studies, but a larger percentage showing a decreased function and distribution of the ICC. An investigation of these issues by the U.S. National Institutes of Health and the Gastroparesis Clinical Research Consortium (GPCRC) found that biopsies show 83 percent of patients with diabetic gastroparesis have membrane tissue abnormalities such as a loss of ICC and increased immunoreactivity of complement cytokines, and a greater incidence of deficient expression of nNOS and and more damage to the ICC and nerves in idiopathic gastroparesis, related to fibrosis around the nerves. Symptoms such as nausea and severity of gastric obstruction related to food intake were related to myenteric immune infiltration in idiopathic gastroparesis, showing that the health of the small intestine and the Biome balance may be involved as well. We see that gastroparesis is probably a slowing developing phenomenon and that gastric obstruction is functional and occurs when a threshold is reached. A study in 2012 at the Children's Hospital of Eastern Ontario noted that the degree of inflammation in appendicitis correlates with impaired ICC function, showing that chronic low-grade infection and inflammatory mechanisms could be responsible for the gastric membrane dysfunctions that lie at the heart of gastroparesis (PMID: 23084203).

Treatment strategies for gastroparesis involve a group of interrelated tactics, including relief of acute symptoms with prokinetic anti-nausea drugs, which the FDA recommends only to be used as needed and short term (4-12 weeks), stimulation of motility, resolution of the low-grade infections or other immune and inflammatory dysfunctions, and restoration of gastric function. Gastric hormones, such as ghrelin, are integral to restoration of function, as this neurohormone stimulates gastric emptying, and has anti-inflammatory and antioxidant effects. Stimulation of the gastric neural reflexes with electrical stimulation is being explored, but requires implantation of electrodes into the abdominal wall, and so far has not proved to be more effective than electroacupuncture stimulation. Acupuncture stimulation has been tested in at least one RCT and shown to be effective for gastroparesis over time, with frequent treatments in short courses. The studied effects of this elecroacupuncture stimulation include improved ghrelin expression as well as improved motility, and results are seen after a short course of frequent treatment, not after just one treatment. All of these goals of therapy, which need to be combined into a more holistic protocol, can be achieve with CIM/TCM, with these short courses of acupuncture and electroacupuncture stimulation, herbal and nutrient medicine eventually correcting this cycle of dysfunction, and such therapy can be integrated with standard care, which clearly has little to offer in the long term. A 2013 review of these findings by experts at the Catholic University of Korea, in Seoul, South Korea (cited and linked in Additional Information) concluded: "The real-world treatment options for gastroparesis are limited; however, it is expected that this situation will be substantially improved as the pathophysiology of gastroparesis comes to be better understood." In the meantime, we see much promise in the integration of CIM/TCM to treat this difficult health problem.

The study of Dyspepsia and other functional gastrointestinal diseases shows that this is a multifaceted health problem that requires a more complex and individualized assessment and treatment protocol than simple blocking of stomach acid production and function. These health problems require a more holistic and restorative treatment protocol. Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) provide this type of care and approach and can be individualized and proceed in a step-by-step manner.

What you can do to restore your health and end these problems

In 2010, the American Gastroenterological Association at their annual conference presented a broad report from experts at a number of the top University Medicine Schools in the nation, and concluded: "These disorders, gastroparesis and FD (functional dyspepsia), are areas of active investigation because they are common, the current therapy is suboptimal, and existing treatments have not been well studied." Clearly, integration of Complementary Medicine is needed, and a more holistic approach.

Is there and easy fix in CIM/TCM to functional dyspepsia and gastroparesis? I'm sorry to say that there is no magic pill. Advertising claims of miraculous herbal cures are false. Instead, there is a treatment plan that combines a step-by-step approach to restore your health, stomach function and gastrointestinal tissues. Your Complementary Medicine physician (Licensed Acupuncturist/Herbalist) can guide your therapy and insure success. You need to commit yourself to the complete regimen, which includes dietary changes, herbal formulas and acupuncture, and integrates these therapies with your standard medical assessment and treatment. A proper assessment will determine whether the problem involves dysfunctional acid production, autonomic nervous disorder, dysfunctional gastric emptying, bile obstruction, celiac disease, non-celiac hypersensitivity, or other contributing factors. If you also suffer from asthma, or have triggers of esophageal hyperreactivity from inflammatory mechanisms, this can also be addressed. There is a proven high association of risk between conditions of asthma, esophageal reflux disease, and obstructive sleep apnea, and a high association of risk for GERD and obstructive sleep apnea with the chronic use and overuse of corticosteroid asthma inhalers (see the article on corticosteroid use on this website). Complementary and Integrative Medicine (CIM/TCM) may offer you the chance to reduce dependency on these medications and restore health in these interconnected health problems. The good news is that when all the health factors are addressed properly, your dyspepsia problem may resolve and healthy function restored without chemical dependency.

In the last few years, research has led to a number of effective herbal and nutrient medicines that help restore gastric function, decrease hypersensitivity to food chemicals, and improve complete protein digestion, resolving problems with difficult proteins such as gluten and dairy. The formula Digestive Aid, by Vitamin Research Products (VRP), for example, combines Pepsin, Gamma Oryzanol, betaine and thiamin hydrochloride with zinc glycinate, fucoidan, sodium copper chlorophyllins, and active Vitamin B6 (P5P) to support the stomach's production of hydrochloric acid naturally, as needed, as well as to heal and strengthen the mucosal lining of the stomach. Lectin Lock, produced by VRP as well, utilizes nutrient chemicals that are proven to lock onto excess lectins, difficult to digest proteins that create hypersensitivity to a variety of foods, and may decrease unwanted immune responses as well. One of the ingredients in Lectin Lock, N-acetyl glucosamine (derived from crab shell) has been the subject of much research into autoimmune and hypersensitivity reactions, and chemicals from okra, bladderwrack, D-mannose, mucin, and sodium alginate, are combined again with pepsin to both decrease food sensitivity and restore pepsin dysfunction, or dyspepsia. Enteromend, from Health Concerns, combines a number of researched enzymes to restore dipeptyl peptidase 4 (DPP-IV), which aids complete breakdown of difficult protein peptides, such as gluten, and this array of enzymes also aids complete digestion of difficult carbohydrates, fats, and sugars. Incorporating these researched products into an individualized treatment protocol allows the Complementary Medicine Physician to achieve much faster restoration of gastrointestinal homeostasis.

The study of specific herbs and herbal formulas to treat functional gastric and intestinal problems is extensive, with many positive findings, but the protocol in holistic medicine is not a one-size-fits-all treatment, as is tried in allopathic medicine, and randomized controlled trials of herbal medicines used alone without differentiation of the appropriate subsets of patients is problematic. The professional TCM physician is trained to both individualize the therapy, combine synergistic treatments in the same course of treatment, and take a step-by-step approach to resolve more complex health problems. To continue to judge the efficacy by these underfunded RCTs (randomized controlled human clinical trials) and evaluation by standard allopathic medicine, which has been very antagonistic to holistic integrative medicine, is not a logical system to evaluate and utilize CIM/TCM. Reviews of single types of common herbal of treatments have shown proven efficacy with RCTs, but the results need to be applied to a more realistic clinical treatment protocol. For instance, in 2013, a common TCM herbal formula for gastric dysfunction, Ban Xia Xie Xin Tang, was evaluated in a meta-review of all published studies by the China Academy of Chinese Medical Sciences, in Beijing, China, and the Beijing University of TCM. This meta-review found 16 RCTs involving 1302 patients, and found that all of them showed that the herbal formula significantly outperformed the placebo or control groups. The conclusion, like almost all such reviews published in standard medical journals, though, stated that these 16 RCTs were of low quality, and that we needed heavily funded large scale RCTs to fully confirm the efficacy. None of these studies found any obvious adverse side effects. To see this one example of such study, just click here: http://www.ncbi.nlm.nih.gov/pubmed/23935681 . Patients and physicians need to view such scientific proof with perspective and logical analysis, rather than just the biased headlines in the media, and see that if such proof exists, and no adverse health effects are expected, that including such protocols within a broader and more individualized set of treatments and health advice is a sure to achieve reliable success. There is no single herbal magic one-size-fits-all cure for the broad array of health problems associated with dyspepsia and gastric dysfunction, but there is proof of great effectiveness with a sensible holistic protocol, and any trained TCM physician can easily provide this care.

In addition to therapy, as always, there are therapeutic activities that you, the patient, must also try and take responsibility for. Causes and aggravating factors need to be eliminated. If certain foods, excess alcohol, caffeine or smoking aggravates the acid reflux or heartburn, these obviously need to be curtailed, at least until you are healthy. Mechanical aspects may also be aggravating your condition. Try avoiding lying flat after eating, and avoid eating anything substantial for 2 hours before bedtime. Elevating the head of the bed helps many patients with acid stomach at night. Even a small riser under the head posts, or a few small boards, may help greatly without creating too much of a slant to the bed. Sometimes, losing a little weight and exercising the abdominals will help to take pressure off of the stomach and esophagus, as will myofascial release of the diaphragm. Avoiding stress with meals is essential, and taking a little walk after eating often helps digestive function. Decreasing simple carbohydrates in the diet has also proven helpful, and a diet with whole grains and fresh vegetables predominant is recommended.

Many medications may slow stomach function and emptying and thus contribute to this problem, including antacids containing aluminum hydroxide, antidepressants, Lithium, narcotic pain meds and calcium channel blockers prescribed to relieve reflux and other problems. Stomach emptying may also be inhibited by poor response of the pancreas in excreting digestive enzymes into the upper small intestine, or duodenum. You might want to discuss whether any medications may be contributing to your dyspepsia, and try taking supplements of digestive enzymes and herbs to trigger an improved gastric emptying.

Improper levels of bile salts may also lead to a slow response of stomach emptying. Bile stones or other obstructions related to ductal inflammatory scarring, or poor function of the liver and bile formation may contribute to this problem. If the gallbladder has been removed, bile salt deficiency may be significant and the patient may consider supplementation with oral bile salts. Studies have shown that patients with deficient bile excretion and poor intestinal function have a higher incidence of tissue irritations in the body from poor breakdown of toxins, malabsorption of fatty acids etc. This often leads to increased psoriasis, muscle inflammation and arthritis, as well as gastroesopohageal reflux. Bile salt supplementation, when prescribed properly, has been shown to help with these problems. If the problem lies with bile obstruction due to formation of sludge in the bile ducts or poor liver function, increased bile flow and improved biliary formation may be achieved with a combination of nutritional supplements and herbs, as well as with acupuncture.

Excess bile salts, as well as deficient bile, may also cause problems with stomach function and GERD. Excess bile salts, caused by a high fat consumption, poor stomach and small intestine function, or poor colon health, along with aspirin, alcohol and other irritants, are directly injurious to the mucosal linings and may alter the permeability. This allows back diffusion of stomach acids, or hydrochloric acid, injuring tissues, especially blood vessels, and liberating excess histamine, which is a stimulant of increased acid and pepsin secretions. This vicious cycle needs to be corrected, not just subdued. Health of biliary system and restoration of healthy mucosa needs to be achieved with a holistic approach. The Complementary and Integrative Care Physician may help you to properly assess your problem and take the right approach to treatment.

Overuse or chronic use of aspirin and other NSAIDS (non-steroidal anti-inflammatories) may also damage gastroesophageal linings and cause reflux. This problem is very serious, and each year thousands of people die of GI bleeding when taking these common pain relievers. Why does this happen? Study shows that these drugs, which work by blocking inflammatory regulating chemicals called prostaglandins, inhibit the protective role of these prostaglandins in the mucosal linings of your stomach, esophagus and the sphincter between your stomach and esophagus. Prostaglandins are abundant in this mucosa and play an important role in gastric mucosal defense. When this defense is compromised, normal stomach acids, or pepsin, is allowed to autodigest these mucosal linings. This mucosal lining also prevents backflow of hydrogen ions from the lumen to the blood even with periods of high acidity. When the mucosa is compromised, blood acidity may increase, causing total body acidity that disrupts normal metabolism, and threatening cardiovascular irritation that eventually may lead to areas of atherosclerotic plaque accumulation. Compromise of mucosal integrity may also lead to unwanted toxins and larger molecules getting through your body's defenses into the blood stream. This is called 'Leaky Gut Syndrome' and may cause muscle inflammation and pain as well as increased stress for the liver detoxification process. Poor gastrointestinal membrane health allows entry of bacteria, Pleomorphic bacteria (adaptive responses that decreases the size of bacteria to penetrate membrane protection), bacterial endotoxins, and lectins that may cause of contribute to a wide variety of systemic health problems, especially allergic hypersensitivity and autoimmune responses.

This mucosal breakdown also allows permeability of large proteins, both into the blood, and out of damaged blood vessels, sometimes causing significant loss of plasma proteins which carry many essential chemicals in to body, including steroid hormones. This permeability may also allow antigen proteins to enter the blood, stimulating allergic hyperreactions. When the issue of mucosal health is not addressed, health problems arise that the patient did not realized were connected to poor stomach and intestinal health. When symptoms were controlled by anti-secretory drugs, the patient felt that all was well, but this may be a serious mistake. Although symptoms were controlled by drugs, the underlying dysfunctions were not addressed, and contributing to a host of other health problems.

How does acupuncture stimulation help to correct dyspepsia and GERD?

An article from Duke University Medical Center, published in the Journal of Gastroenterology, May, 2006, stated that acupuncture has been shown to alter acid secretion, GI motility and visceral pain, and that it is expected that acupuncture will be used in the standard treatment of patients with functional GI disorders in the future. A study headed by Dr. Richard Holloway of the University of Adelaide, South Australia, found that one of the known causes of GERD, transient lower esophageal sphincter relaxations, were inhibited 40 percent by electrical stimulation at the P6 point on the wrist. The study was published in the August, 2005 issue of the American Journal of Physiology-Gastrointestinal and liver Physiology. Further study by the NIH is underway to confirm these studies and provide well-funded research evidence to duplicate evidence from Chinese studies. Of course, none of these studies will incorporate the entire protocol routinely used by the competent Licensed Acupuncturist and Herbalist. Continued research is creating new and effective treatment options for the Licensed Acupuncturist and herbalist. This evidence-based medicine is transforming the practice of TCM, and providing the patient with more effective treatment options. Unfortunately, as evidence and protocols are developed, the number of products that patient may take increases dramatically. To insure that you are taking the most effective course of these treatment products in the correct sequence, and for the shortest durationg of time, you need a physician that is knowledgeable and able to spend the time with you to properly assess and persistently treat the dysfunctions of the individual patient.

Acupuncture stimulation not only helps to decrease lower esophageal sphincter relaxations, but studies (cited below) show that specific acupuncture stimulations improve gastrin secretion, mucosal health in the stomach, serotonin metabolism and production of calcitonin gene-related peptide. Numerous studies have also demonstrated significant effects on pancreatic peptide and insulin modulation, intestinal motility, sympathetic nerve responses, vagal nerve modulation, and had central nervous system effects, modulating the control centers in the cerebral cortex, such as the thalamus, hypothalamus, anterior cingulate, and insula. The overall effects of the complete prescription of points used may serve to normalize function holistically, leading to a restorative effect, and no dependency on future therapy or medicines. Of course, the combination of acupuncture, electroacupuncture, herbal and nutrient therapy, along with sound advice on diet and lifestyle changes, will have an even more profound effect. This is the type of therapy offered by the Complementary Medicine physician in Traditional Chinese Medicine.

To end the problem of dyspepsia and gastrointestinal dysfunction, and to avoid the health problems that may arise when these become chronic, try utilizing a Complementary Care physician, such as a Licensed Acupuncturist, to guide a complete and comprehensive course of therapy that will lead to restoration of healthy stomach function and an end to these problems.

Some novel and traditional remedies used by physicians to treat dyspepsia

Dyspepsia is a growing and serious health problem in the current United States population, yet it has been treated successfully throughout time. Often, we are given the impression that old remedies were based on nothing but superstition and folklore, and that you must depend on modern pharmaceuticals to correct your problems. This is patently untrue. Botanical remedies, as well as diet and lifestyle changes, were used very effectively in the past, and the subject of past scientific study, as well as current research. Here are a few examples, not to suggest a one-size-fits-all approach to your dyspepsia, but as an informative and historical resource. Your therapy, with the vast array of treatment options available in Complementary Medicine, should be guided by a professional, and should be integrated with proper diagnostic assessment from a Medical Doctor and their facilities.

One of the basic treatment protocols to restore stomach function is to first neutralize acids, and then stimulate stomach secretions before eating, especially with meals that may cause stomach dysfunction, or with the first meal of the day, in order to get your stomach behaving properly for the rest of the day. This would be accomplished by first using a small amount, one teaspoon to one tablespoon, of natural vinegar, such as Bragg's apple cider vinegar, dissolved in a small cup of hot water with a teaspoon of honey. Do this about a half hour before the meal. Then follow this after at least a few minutes, with herbs to stimulate increased stomach function. Some of these are listed below. A strong chamomile tea is also useful to stimulate stomach secretions right before eating. A shot of bitters may be used. This prevents food from encountering a chronic acid or alkaline condition that slows stomach gastric juice formation. When this occurs, the stomach functions slowly, and then hyperreacts after the meal with excess of acid and poor stomach emptying. Hence, heartburn after eating or between meals, or at night. A nutrient supplement combination containing gastric acid precursors and cofactors, such as the product GastricAid (Digestive Aid) from Vitamin Research Products, can be very helpful for patients with gastric hypofunction. Other herbs and digestive enzymes may be taken after the meal to aid efficient stomach emptying and digestive function.

Clearing of problems with hypersensitivity reactions in the intestinal lining, or food malabsorption, as well as imbalance of natural flora and fauna further down in the gut, is also recommended. An herbal formula to clear overgrowths of common bacteria, fungi, or helminths is taken first, and then protease enzymes and probiotics. If you follow this course, and do not see improvement, I would be surprised. As always, it is best to consult a professional, get an accurate diagnosis, and proceed with these herbal and nutrient therapies in a step-by-step process. Utilizing herbal and nutrient therapy without sufficient expertise can produce poor or negative results. In addition, research in recent years has discovered key food chemicals that act to clear excess lectins, the molecules used by all organisms, animal, plant and even some microbes, as immune protection. Some of our foods have learned to produce lectins that are difficult to clear to discourage their being eaten by animals, including humans, and many humans with diminished health of the gut membranes and immune functions experience accumulation and hyper-reactivity to lectins in their food. Using a formula of molecules that lock onto lectins to help clear them often resolves food hyper-reactivity that we mistake for full allergic reactions. In addition, improving the gut membranes with N-acetyl cysteine, and encouraging increased production of the proteolytic digestive enzyme dipeptyl peptidase 4 (DPP4) when problems digesting difficult proteins in wheat or dairy occur may help subsets of patients. Improving overall gastrointestinal health and function is the key to maintaining a proper homeostatic feedback regulation and gastric function and health. In addition, patients often have a problem with bile flow regulation, bile sludge, and liver and gallbladder health and function that may impede the complex homeostatic feedback regulation of the stomach secretions, and cause reactivity to fatty foods. A holistic protocol with acupuncture, herbal formulas and nutrient medicine is individually combined and tailored to achieve all of these goals in the same treatment session, and can be altered as the health changes or improves. Traditional Chinese Medicine is ideal for addressing these many goals in therapy simply and effectively.

A number of herbal extracts and formulas have been shown to be effective in scientific study to treat gastric dysfunction and hypofunction, and are usually prescribed in a step-by-step manner, utilizing short courses, not chronic dependency. Acupuncture stimulation works symbiotically to enhance the effects of a comprehensive treatment protocol. Usually, gastric function is aided by formulas with gentle herbs to help digestion in Chinese herbal medicine, interspersed with short courses of appropriate herbs to clear overgrowths and imbalance of bacteria, and help heal the stomach lining. Often, the small intestine health and function, as well as healthy secretion of pancreatic enzymes and bile, need to be restored to allow timely emptying of the gastric contents, or chyme. This type of therapeutic protocol is different than the taking of a single pill forever in standard medicine, and different expectations must be acknowledged by the patient. The goal of therapy in Traditional Chinese Medicine and Complementary Medicine is not to just inhibit stomach secretions to obtain immediate and temporary relief, but to restore normal homeostatic mechanisms over time. Professional diagnosis and guidance is important to achieve effective results. Some examples of classic herbal medicines for dyspepsia are listed below, although this list is just a sample of what is available to the professional herbalist or naturopathic doctor.

  • Artemisia absinthia and southernwood: small doses of artemisia absinthium give tone to the stomach membranes, and are useful in atonic dyspepsia. Large doses irritate the stomach and increase the heart rate, may produce headache and chronic intoxication. Hence, the use of absinthe, an alcoholic beverage popular in Europe, was made illegal in the last century due to persons abusing this alcoholic beverage. Absinthe is making a return to popularity again these days. The taking of small dosages of absinthe, or a medicinal artemesia absinthium, has been a popular remedy for dyspepsia and other health problems in the areas of Europe where this bush grows naturally, and production of absinthe and use among the conservative peoples of these rural areas has continued through time, despite illegality. Absinthe was given as a small dose ration to members of the Foreign Legion in Europe until it was officially made illegal. This ration of the herb reportedly prevented malaria among the troops in Northern Africa, and the month after the discontinuing of ration resulted in a large percentage of troops dying from malaria during a long forced march. The herb can be taken as a water infusion, like tea, which is very bitter. It may also be taken as an essential oil, or volatile oil, 1-5 drops in hot water, or added to tea. A more benign form that may be effective is an alcohol extract, which doesn't produce some of the more bitter and stimulant chemicals, but does extract key volatile oils and chemicals. Other artemesia species are also frequently used through history and today. These include Artemesia southernwood, Artemisia annua (qing hao), Artemesia argyi (ai ye), Artemesia yinchenhao, and Artemesia anomalae (liu ji nu). Artemisia annua is the source for artemisin, a chemical that is now the number one cure for malaria in the world. Artemisia argyi is warming, and is used to treat abdominal pain from stomach dysfunction, has an antibiotic effect against shigella, salmonella, staph and strep, stimulates stomach contraction, and also treats malaria. Artemisia annua, or qing hao, on the other hand is cooling, and is not traditionally used to treat dyspepsia, although research has expanded its use into treatment of autonomic dysfunction and neuropathy such as sympathetic reflex dystrophy, because it blocks correlated inflammatory processes and autonomic signals at the spinal cord. It is useful in the treatment of malaria and fever. Artemisia southernwood, or abrotanum, is a remarkable tonic for gastrointestinal function, and an antihelmintic. Artemesia yinchenhao treats both liver infection, such as hepatitis, and nausea with loss of appetite, and mildly increases bile flow. In combination with other herbs it has been shown to increase the rate of liver cell regeneration, reduce blood bilirubin levels, and effectively treat jaundice. Moxibustion, or the treatment using burning herbs to generate heat and chemical stimulation over the acupuncture points, utilizes Artemisia chinensis or indica.
  • Gentian lutea, longdancao or qinjiao: Gentian has long been used in bitters and stomach tonics. It was traditionally the most popular tonic in the United States for atonic dyspepsia, anorexia, and similar complaints, according to the U.S. Dispensary of 1918. It was also useful in treatment of malarial fevers in the form of gentiopicrin, a standardized pharmacological extract that needed 5 pounds of the root to produce a sufficient dose to treat malaria, which was slightly toxic. This illustrates that there are not only various species of Gentian with different chemical content, but large differences in chemical content between the various types of extractions. The public should neither be fooled by commercial products that do not specify species or type of extraction, nor by reports of toxicity that use extremely high dosages and extraction methods to produce botanical extracts and hence falsely alarm the public. These types of studies are probably commercially generated to discourage use of safe and effective botanical cures. Small doses of Gentian were traditionally made into alcohol bitters and taken before meals to stimulate gastric secretions. Gentian sodas, such as Moxie Original Elixir, are reproduced today by realsoda.com, and are essetially the same product popular in 1884. In Chinese herbal medicine, Gentian longdancao has been used in formulas to encourage improved liver function. Taking of the Gentian longdancao in small dose one half hour before meals increases gastric juice secretion in dysfunctional dyspepsia. Scientific study found that the active ingredient gentiopicrin works only by direct effect on stomach tissues, not in active circulation. Other chemicals in the Gentian also slowed transit time in the intestines, treating loose stool, and had an antibiotic effect against a large number of common pathogenic bacteria in vitro. Gentian ginjiao has other active ingredients, but is useful to treat dry constipation, and infant jaundice. To effectively use Gentian to treat dyspepsia, use one of the forms of the herb about a half hour before a meal.
  • Asafoetida: This herb is still used extensively in India for dyspepsia, and was used by U.S. physicians earlier in the century to treat nervous stomach, dyspepsia, gastrointestinal irritation, flatulence, and palpitations. Either an emulsion or tincture was used. It is a carminative, reducing flatus, and antispasmodic, as well as a nervine.
  • Asarum candense, sieboldii, or heteropoides: Wild ginger is a very spicy herb native to California, China, India etc. and had a traditional therapeutic use as a carminative, reducing gas formation, or flatus, especially if this accompanied colic pain, or colon discomfort. Low dosage was used, and since many of the active ingredients are volatile oils, glycosides and carbonic compounds, a tincture is effective and would be less spicy and stimulating.
  • Rheum / Wild rhubarb: various species of this herb have been used around the world to treat dyspepsia and promote gastric health. A favorite medicine of the Eclectic School of Medical Doctors, who specialized in herbal medicine throughout the first half of the twentieth century in the United States, was a combination of rheum, peppermint oil, potassium salts, and goldenseal, and this professional tincture is still available from the Naturopathic medicinal provider, Heron's Botanicals.
  • There are, of course, many herbs to treat the various dysfunctions of the stomach and intestine with dyspepsia. Your professional herbalis has both formulas and specific herbs that work quite well and are extremely safe. The course of therapy in functional GI disorders depends on the degress of dysfunction. Success in therapy should guarantee continued healthy function into the future without dependancy on herbs or drugs.

Additional Information: For more information and links to scientific study on GERD, GER, acid reflux and heartburn, as well as associated health problems:

  1. The National Digestive Diseases Information Clearinghouse, a service of the NIH, gives reliable basic information. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
  2. A comprehensive study of patient population in Europe by the Oxford Medical School showed remarkable information concerning dyspepsia: http://fampra.oxfordjournals.org/cgi/content/full/cmm050v1
  3. A comprehensive United States overview of dyspepsia and functional disorders presented by the National Institute of Health: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1681633/
  4. A 2009 review of scientific study of GERD-related Gastroparesis (delayed stomach emptying and motility), experts at the University of Arizona, in Phoenix, Arizona, U.S.A. provides a thorough analysis of a rising health problem described as a gastrointestinal motility disorder with a multifactorial cause, with the largest set of diagnosis described as idiopathic, or without objective cause. Clearly, this health problem demands a more thorough and holistic treatment protocol that is individualized to really resolve: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886367/
  5. As far back as 1981 we have seen studies that show that between 40-50 percent of patients with acid reflux disease (GERD) have delayed gastric emptying, and a need to address this functional motility problem when prescribing acid-inhibiting drugs. Unfortunately, there are no safe and effective drugs to address gastric motility disorders and the proven aids with CIM/TCM were shunned. The result was a huge rise in prescription of gastric inhibiting drugs and a large rise in gastrointestinal motility disorders: http://www.ncbi.nlm.nih.gov/pubmed/7450419
  6. A 2008 report on gastroparesis by experts at the University of Michigan concluded that this problem affected at least a fourth of the population at that time, was associated or caused by a wide array of health problems and medications, and presented with a wide array of symptoms. The treatment advice was to change the diet, and: "Medications that inhibit gastrointestinal motility should be discontinued if possible." The medications to promote gastric emptying were limited to erythomycin (an antibiotic that would negatively affect the Biome), domperidone (a dopamine receptor antagonist that is not FDA approved, is not legally marketed in the U.S. and comes with signficant FDA warnings), and metoclopramide (common adverse effects of tiredness, diarrhea, restless movement disorders, and an array of less common adverse side effects, warnings and a poor rating of evidence): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258461/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258461/
  7. A report from Family Practice Notebook lists the potential medication causes of gastroparesis, or delayed gastric emptying: http://www.fpnotebook.com/gi/pharm/MdctnsThtDlyGstrcEmptyng.htm
  8. A 2016 report on the standard pharmaceutical protocol to treat gastroparesis, from experts at the Texas Tech University Health Sciences Center, in El Paso, Texas, U.S.A. noted that "none of the medications used for the treatment of gastroparesis are devoid of side effects. Therefore, when prescribing these medications, the risk/benefit ratio should be considered. Since those agents are increasingly administered in combination, awareness of possible drug interactions must be considered in a setting of the Patient' medical history, age, systemic diseases and other medications." Of course, this is a conservative warning of safety concerns and adverse health effects: http://www.ncbi.nlm.nih.gov/pubmed/27031006
  9. A 2015 review of our understanding of gastroparesis by experts at the University of Leuven, in Belgium, states that it is uncertain that gastroparesis can be separated from functional dyspepsia, that glycemic control in diabetic gastroparesis did not provide relief in Type 2 diabetes, and that it was just a risk factor in Type 1 diabetes, not a panacea. Prokinetic therapy was not found to improve gastric emptying or symptoms in meta-review of studies, and tricyclic antidepressants showed no benefit. The response to standard therapy was rated as poor, and the key pathological factors to resolve appeared to involve the health of the stomach membrane and immune dysfunction, with excess expression of macrophages implying that a low-grade interstitial infection was responsible. A wide variety of microbes and parasites could be involved, and current testing and treatment is inadequate: http://www.ncbi.nlm.nih.gov/pubmed/26406565
  10. A 2010 report by Motility Society and the American Gastroenterological Association (AGA) at their annual conference, and prepared by experts at the leading University Medical Schools in the United States, reports that functional dyspepsia and gastroparesis are functional disorders that are increasing in incidence and diagnosis, and that "the distinction between them is blurred by the considerable overlap in symptoms and the recognition that delayed gastric emptying can be seen in FD (functional dyspepsia)." All of these experts agreed that they still did not clearly understand these pathologies and complex dysfunction of mechanisms. The exploration of infection as one of these mechanisms is hampered by the need to use large scale microbial screening, as present testing is limited to just a few potential causes, including Helicobacter pylori, Salmonella bacteria, Rotavirus, and Norwalk virus. Cases related to reactions of vaccination and chronic post-Lyme disease, as well as Epstein-barr virus, have been documented, and a broad spectrum approach to countering low-grade infections and immune dysfunction are needed: http://www.motilitysociety.org/clinician/manuscripts/gastsroparesis_and_functional_dyspepsia.pdf
  11. A 2015 study at the Chongqing Medical University in China showed that such infectious agents as Trichinella spiralis parasites negatively affected the gastric membrane interstitial cells of Cajal (ICC) and changed the motility function in laboratory animals, which could explain some of the mechanisms of functional motility disorders such as gastroparesis: http://www.ncbi.nlm.nih.gov/pubmed/25484117
  12. A 2011 study by experts at the Temple University School of Medicine, in Philadelphia, Pennsylvania, U.S.A. show that a large percentage of patient diagnosed with gastroparesis experience worse symptoms during the premenstrual phase, or luteal phase, when progesterone is deficient relative to estrogens, showing that there is also a hormonal component to functional gastrointestinal motility disorders, which could be corrected safely and easily with CIM/TCM, especially when using bioidentical progesterone cream formulas: http://www.ncbi.nlm.nih.gov/pubmed/21332597
  13. A 2013 report on current scientific understanding of gastroparesis, by experts at The Catholic University of Korea, in Seoul, South Korea, shows that the majority of patients diagnosed are labeled as idiopathic, meaning that we find no clear reason for the diagnosis, and the second most prevalent type is diabetic gastroparesis, related to Type 1 Diabetes, with abnormal tissue growth around gastric nerves and diabetic neuropathy. Both of these types have the same array of dysfunctions related to poor health of the stomach membranes and a neurohormonal immune dysfunction. Standard treatment is described as limited, and the pathology as poorly understood: http://www.jnmjournal.org/journal/view.html?uid=241&vmd=Full#B9
  14. A 2015 study at the Mianyang National University and the Chengdu University School of Medicine, in China, found that the Chinese herb Magnolia officianalis (Hou pou) commonly used to stimulate improve gastrointestinal motility, shows antioxidant and protective effects based on the influence on the interstitial cells of Cajal (ICC), which lie as a focus of pathology of gastroparesis. A randomized controlled trial showed that Hou pou extract prevented dysmotility induced by the drug atropine, showing a potential as part of a broader protocol in herbal medicine: http://www.ncbi.nlm.nih.gov/pubmed/26884941
  15. A 2015 study in China showed that electroacupuncture stimulation at the points ST36, ST21 and SP6 can promote improved gastrointestinal motility, and with diabetic gastroparesis may improve metabolic imbalances of ghrelin, and hormonal imbalances of growth hormones and their receptors, which have been linked to the pathology: http://www.ncbi.nlm.nih.gov/pubmed/26502542
  16. A 2015 multicenter randomized controlled study of acupuncture to treat diabetic gastroparesis, at Jiao Tong University, Tianjin University, and the Beijing University of Chinese Medicine, in China, found that even a short course of frequent treatments could signficantly reduce gastric retention and improve symptoms of gastroparesis. Since standard medicine has little to offer to treat this health problem, integration of acupuncture and herbal/nutrient medicine seems practical: http://www.ncbi.nlm.nih.gov/pubmed/25689986
  17. A 2013 meta-review of all randomized controlled human clinical trials of acupuncture to treat dyspepsia and diabetic or other type of gastroparesis, by experts at the Xiamen Diabetes Institute, in Xiamin, China, found 14 high-quality RCTs and consistent proof that acupuncture significantly outperformed controls or placebos. Of course, the studies were small and we to fully prove efficacy we need larger well-funded studies. There were no adverse side effects, though, and this treatment, short frequent courses of acupuncture stimulation, is clinically combined with other proven treatment modalities: http://www.ncbi.nlm.nih.gov/pubmed/24206922http://www.ncbi.nlm.nih.gov/pubmed/24206922
  18. A 2012 study at Soonchunhyang University College of Medicine, in Bucheon, South Korea, noted that transient lower esophageal relaxations are a major cause of gastroesophageal reflux, and that with GERD patients, this reflux is generally more acidic due to the hypofunction of the stomach and poor emptying of chyme on a timely basis. This is just one of numerous studies around the world that have confirmed that transient lower esophageal relaxations are abnormal in time of occurrence, prolonged relaxation time, and gastric contents with GERD: http://www.ncbi.nlm.nih.gov/pubmed/22460568
  19. A 2014 review of new standard protocols for treatment of non-erosive gastric reflux disease in light of the numerous adverse effects of common drugs used to treat gastric reflux and the marked decline in their use, includes acupuncture as a promising therapy. Other procedures listed are the Stretta procedure, transoral incisionless fundoplication, and magnetic sphincter augmentation device use: http://www.ncbi.nlm.nih.gov/pubmed/25000345
  20. In 2005, a study at the Royal Adelaide Hospital showed that electroacupuncture stimulation at P6 acupuncture point inhibited the frequency of transient lower esophageal sphincter relaxations (TLESR) in response to gastric distention. The study used human volunteers and was randomized: http://www.ncbi.nlm.nih.gov/pubmed/15831714s
  21. A 2011 randomized controlled study at Peking University First Hospital found that electroacupuncture at the point ST36 can significantly reduce both the frequency or transient lower esophageal sphincter relaxations and the percentage of common cavity findings in tissues: http://www.ncbi.nlm.nih.gov/pubmed/22379788
  22. A 2012 large randomized controlled human study at the Xinxiang Medical University, in Henan, China, showed that a combination of electroacupuncture and herbal medicine (Zhi zhu kuan zhong capsules), with short courses of frequent acupuncture stimulation at the points P6, Ren12, ST36, LV3 and SP4, produced significant benefits measured by decreased bile and acid reflux, endoscopic grading scores, and symptoms. This formula consists of Zhi shi (bitter orange peel), Bai zhu, Shan zha (hawthorn fruit) and Chai hu (Bupleurum) : http://www.ncbi.nlm.nih.gov/pubmed/23297557
  23. A 2012 review of scientific literature concerning the homeostasis of gastric acid and the complex hormonal feedback that regulates it by Virginia Commonwealth University Health System in Richmond, Virginia, reveals that modern medicine still has an incomplete understanding of the complex homeostatic mechanisms of gastric acid secretion. They acknowledge that normal and healthy gastric acid secretion is vitally important to digestion of difficult proteins, as well as absorption of a number of very important molecules vital to our health and well being. Gastric acid secretion also plays a vital role in immune protections and control of allergies. 5 systems interact to regulate the secretion of gastric acid: neural, hormonal, paracrine, chemical, and bacterial (biotic), and dysfunction of this complex array of systems is implicated in a number of common diseases. The implication is that restoration of gastric homeostasis is very important to our health: http://www.ncbi.nlm.nih.gov/pubmed/22954692
  24. A 2014 study at King Saud University Medical School, in Saudia Arabia, and associated hospitals, demonstrated that eosinophilic esophagitis associated with allergic asthma, and other allergies, is often seen in children diagnosed with gastroesophageal reflux disease (GERD). Eosinophilia is also associated with use of steroid medications, such as asthma inhalers, skin medications, and autoimmune medications to manage psoriasis and other disorders, and all of the children in this study were treated with steroids: http://www.ncbi.nlm.nih.gov/pubmed/24623210
  25. A large 2013 study at the University of Bucharest School of Medicine and associated Elias Hospital, in Bucharest, Romania, found that patients with both Metabolic Syndrome (Diabetes Type 2) and GERD (gastroesophageal reflux disease) showed signs of dysfunction and abnormal motility in the small intestinal duodenum and gallbladder (bile), as well as the stomach, and even patients without Metabolic Syndrome, but with a diagnosis of GERD, showed signs of abnormal motility dysfunction in the small intestinal duodenum and the bile secreting gallbladder. Patients with Metabolic Syndrome and GERD showed that levels of high serum glucose and cholesterol were associated with these motility disorders. From such study we may conclude that GERD needs to be treated with a more holistic treatment protocol than acid inhibition alone: http://www.ncbi.nlm.nih.gov/pubmed/24502023
  26. An overview of the acid-base metabolism in the body is available at this website: http://www.enotes.com/nursing-encyclopedia/acid-base-balance
  27. In 2009, as study at the Tohoku University Graduate School of Medicine in Japan identified low stomach acid, or hypochloridia, as a significant independent risk factor in esophageal cancer, contradicting earlier assumptions that only high stomach acid was a significant risk. http://www.ncbi.nlm.nih.gov/pubmed/19513836
  28. A 2012 FDA warning noted that the chronic use of stomach acid inhibiting drugs known as proton pump inhibitors (Prilosec, Nexium, Prevacid, Protonix, Omeprazole, AcipHex, Zegerid, Vimovo, and Dexilant) may be associated with increased risk of acute and chronic diarrhea attributed to overgrowth of Clostridium difficile, a problem now prevalent in nursing homes and hospitals and largely caused by antibiotic-resistant strains of the bacteria. Ongoing study of histamine H2 blockers in this regard is expected to also incur serious U.S. FDA warnings: http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm290838.htm
  29. A large 2013 study by Kaiser Permanente, in Oakland, California, confirmed that acid inhibiting medications are significantly associated with increased risk of hip fracture due to malabsorption of essential minerals, especially when at least one other risk factor for osteoporosis was present, such as concurrent use of steroid medications and/or immune suppressant drugs, perimenopausal hormone imbalance, hyperthyroidism, hyperparathyroidism, deficiency of testosterone and estrogen, eating disorders, use of various medications to treat seizures, depression, autoimmune disorders, or cancer, as well as aging and family history. Since the most prevalent side effects of drugs used to treat osteoporosis are gastric symptoms, the prescription of gastric acid inhibiting drugs has been a common practice when biphosphonates and other osteoporosis medications are prescribed. To counter medication side effects with immune suppressants, steroids, antidepressants, and pain medications, acid-inhibiting drugs are also routinely prescribed, creating increased risk for osteoporotic fractures: http://www.ncbi.nlm.nih.gov/pubmed/20353792
  30. A large 2010 study by Kaiser Permanente, in Oakland, California, confirmed that Vitamin B12 malabsorption was significantly associated with chronic use of gastric acid inhibiting medications, a finding that has been long disputed by the pharmaceutical companies manufacturing these drugs. This study reviewed the records of nearly 215,000 patients between 1997 and 2011: http://www.ncbi.nlm.nih.gov/pubmed/24327038
  31. A 2012 study at the Medical Institute of Sumy State University, in Sumy, Ukraine, found that chronic us of proton pump inhibitors to treat gastric acidity was associated with both Vitamin B12 deficiency and high homocysteine levels, one of the chief markers for cardiovascular disease: http://www.ncbi.nlm.nih.gov/pubmed/23293228
  32. A 2009 study at the GI Motility Program of Cedars-Sinai Medical Center in Los Angeles found that standard medication for acid reflux, the proton pump inhibitor, did not effect hydrogen production on lactulose breath tests in patients with Irritable Bowel Syndrome, a condition linked to hypochloridia, or poor stomach acid function. This signifies that either these drugs do not work, or that there is a condition of low stomach acid in IBS patients that would nullify the actions of the drugs, which include Prilosec, Prevacid, Nexium, Protonix, Aciphex and others.http://www.ncbi.nlm.nih.gov/pubmed/19834807
  33. A 2009 study at Kuwait University Department of Physiology found that omeprazole, a proton pump inhibitro (Prilosec et al), increased cellular uptake of adenosine to inhibit gastric acid secretion, potentially contributing to a deficiency of extracellular adenosine, a key inflammatory modulator that protects the intestines. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
  34. A 2009 study by the Digestive Health Center and Southern Tennessee Internal Medicine found that increased extracellular adenosine is an important modulator of inflammation that suppresses and resolves chronic inflammation in Irritable Bowel Disease. http://www.ncbi.nlm.nih.gov/pubmed/19777607
  35. A 2009 study published in the American Journal of Gastroenterology cites the link between chronic use of proton pumb inhibitors, the chief medication prescribed for GERD, and hip fractures. High homocysteine levels imply a dysfunction of the glutathione metabolism, and you may read more about this on the article on Glutathione on this website: http://www.ncbi.nlm.nih.gov/pubmed/19240711
  36. A 2009 study at the Hacettepe University Department of Internal Medicine in Turkey found that the proton pump inhibitor omeprazole (Prilosec et al) is associated with low bone mineral density by inhibition of the absorption of calcium as well as inhibition of proton pumps in the bone, which imparied osteoclastic activity, or the absorption of calcium into the bone: http://www.ncbi.nlm.nih.gov/pubmed/19196364
  37. A large cohort study designed by experts at The Johns Hopkins University School of Medicine, entitled the Risk in Communities study, found that chronic use of proton pump inhibiting drugs to treat gastric dysfunction was associated with a significantly higher risk of acquiring chronic kidney disease: http://archinte.jamanetwork.com/article.aspx?articleid=2481157
  38. A 2012 study at Woosuk University in Chonbuk, South Korea, found that electroacupuncture stimulation at a single point, ST36, improved mucosal health, production of gastrin, serotonin, and calcitonin gene-related peptide, as well as insulin and pancreatic peptide. These were determined by immunohistochemical staining methods on biopsied tissue of the stomach and small intestine: http://www.ncbi.nlm.nih.gov/pubmed/22483184
  39. A 2010 study at Tsukuba University of Technology in Japan found that either manual or electroacupuncture stimulation has been proven in laboratory studies to improve gastrointestinal motility via spinal reflex and activation of sympathetic nerve responses, or the vagal nerve, depending on the points used: http://www.ncbi.nlm.nih.gov/pubmed/20663717
  40. A 2011 review of acupuncture in the treatment of gastrointestinal diseases by the Medical College of Wisconsin and Zablocki VA Medical Center in Milwaukee, Wisconsin, notes that acupuncture presents much promise in Integrative Medicine, exerting a number of scientifically proven responses to treat these diseases, and that the traditional explanation of balancing of Yin and Yang appears to correlate with modulating imbalances between the parasympathetic and sympathetic activity of the autonomic nervous system: http://www.ncbi.nlm.nih.gov/pubmed/21992155
  41. A 2012 randomized study of 500 patients with GERD, at Xinxiang Medical College in Weihui, China, found that a combination of herbal therapy and acupuncture stimulation provided better efficacy and long-term benefit, and better long-term results than standard medication (Mosapride, Omeprazole, Amitriptyline). The effects on refluxing times, times of long-term reflux, pH < 4 time per 24 hour period, bilirubin absorbance value, symptoms, endoscopic score, and quality of life were measured. A standardized electroacupuncture was used at ST36, Ren12, P6, LV3, and SP4, and Dalitong tablets (Chai hu, Zhi ke, Chen pi, Ban xia, Pu gong ying, hawthorn, Bing lang, Paederia scandens, Dang shen, Yan hu suo), a typical formula for gastic hypofunction and inflammation: http://www.ncbi.nlm.nih.gov/pubmed/22741253
  42. A 2012 study at Chengdu University, in Sichuan, China, found in a randomized controlled human clinical trial, that acupuncture stimulation improved the symptoms of dyspepsia, and improved quality of life, with significant benefit over sham acupuncture. The true acupuncture was also found, with neuroimaging, to deactivate related cerebral activities, modulating effects related to dyspepsia in the brainstem, anterior cingulate cortex, insula, thalamus, and hypothalamus, while the sham acupuncture had no effect in these areas: http://www.ncbi.nlm.nih.gov/pubmed/22641307
  43. Another 2012 study at Chengdu University, in Sichuan, China, found in a randomized controlled human clinical trial of patients with dyspepsia, that acupuncture stimulation showed a 70 percent response rate, compared to 35 percent with sham acupuncture, and compared with pharmacological treatment. The true acupuncture group showed significantly better results in symptom decrease and increase in quality of life: http://www.ncbi.nlm.nih.gov/pubmed/22243034
  44. A 2009 study at the Rio Preto Medical College, in Sao Jose do Rio Preto, Brazil, found that simple acupuncture stimulation may alleviate dyspepsia during pregnancy, safely. The patients were randomly chosen and assigned to treatment or no treatment groups for comparison: http://www.ncbi.nlm.nih.gov/pubmed/19502459
  45. A 2005 study at National Chung-Hsing University, in Taiwan, found a number of common herbal extracts to be significantly inhibitory to H. Pylori overgrowth, including Alpinia species (Cao dou kou and Gao liang jiang) and Artemisia argvi (Ai ye): http://www.ncbi.nlm.nih.gov/pubmed/15681161
  46. A 2005 study at the University of Illinois at Chicago found that a number of herbal extracts were significantly inhibitory of Helicobacter Pylori, including Curcuma longa (Jiang huang) and ginger, Gentiana lutea, Juniper berry, Melissa officianalis, and Mentha piperita (Kava), in alcohol extracts: http://www.ncbi.nlm.nih.gov/pubmed/16317658