Gastritis & Dyspepsia

CPP Seminar Apr 09

Christina Stapley

CPP Seminar Apr 09 Christina Stapley

 Understanding Possible Causes
Gastritis
• Damage to mucosa from aspirin, NSAID’s or alcohol.
• Helicobacter pylori, first discovered in 1982 and found to be important in the
etiology of gastritis, peptic ulcers and malignancy.
• Underlying Causes, stress and anxiety.
• Raised risk of reflux disease associated with SERMs [selective estrogen
receptor modulators] or OTC hormone preparations.
• Arch Intern Med 2008;168:1798-1804.

Dyspepsia with or without acid regurgitation may be exacerbated by a sliding

hiatus hernia trapping acid in the hernial sac.
• Increased oesophageal mucosal sensitivity.
• Low tone in the lower oesophageal sphincter.
• Poor oesophageal peristalsis.
• Delayed gastric emptying. [Pregnancy and obesity may contribute to this].

CPP Seminar Apr 09 Christina Stapley

 Case 1: Gastritis & Dyspepsia
Patient Details.
•55 year old hynotherapist. Good appetite. Poor sleep. Energy
low by 7pm.
•Anxious. Postmenopausal.
Diet.
•Wholemeal, fresh fruit. Fish twice weekly. M&S “healthy” fast
foods.
•Addiction to cheese. Chocolate as comfort food.
•Decaffeinated coffee 6 cups daily. Some water.
Lifestyle and Family History.
•Has never smoked. Some walking exercise 4 days a week.
•Multi-vitamin supplement.
•Now drinks under 14 units alcohol a week. Husband heavy
drinker.
•Family History of heart disease and drink dependency.
CPP Seminar Apr 09 Christina Stapley
 First Visit 5.3.2008.
Epigastric pain, worse when hungry, began Nov.’07 after regular heavy drinking.
Heartburn with associated coughing and throat clearing, worse at night.
Linked pain described as “lurking” in R.U.Q.

Physical Examination.
• Some hepatic and epigastric tenderness. Mapped tongue. Poor circulation.
• Bp 120/89. Pulse 76.
Past Medical History.
• Multiple allergies. Poor sleep and bone aches since menopause began 6 years ago.
• Palpitations since childhood, severe when stressed. Had refused a pacemaker.
• 3 haemorrhages each after surgery.
Advice on Management.
• To reduce cheese, chocolate, acidic and fast foods.
• Drink more water and less coffee.
• Raise bed-head.
• Walk daily for heart and to lower stress.
• Meditation or coping strategies for stress.
• If prescription brought no significant relief of “lurking pain” in 3 weeks to go to her GP
as this might be from gall-stones.
• He might wish to send her for a scan.
CPP Seminar Apr 09 Christina Stapley
 Prescription.
Rx.
• Scutellaria Lat. 1:2 25 Sig 7.5ml
• Leonorus Cardiaca 1:2 20 b.i.d cum
• Crategus oxycanth 1:3 20 aq.a.c
• Carduus marianus 1:3 30
105 ml
Rx. Tea
• Marshmallow leaf 30g
• Meadowsweet herb 30g Sig 1 tsp. per cup,1 cup p.c & p.r.n
60 g
Mouth wash
• Sage 15g 1 tsp. per cup p.r.n

CPP Seminar Apr 09 Christina Stapley

 Ongoing . 7.4.08
Patient reported
• Herbs very soothing
• Better able to cope with her problems
• Symptoms reduced but “lurking pain” still present
• GP was booking her for CT scan to check for gallstones
• GP prescribed Omeprazole (which she intended to take)

CPP Seminar Apr 09 Christina Stapley

 Results. 2.5.08
• CT Clear for gallstones
• Stomach hidden by gas
• GP Offered further investigation
• Patient did not want this
• Informed her G.P since the ppi Omeprazole was not helping
• She wished to return to herbal medicine for one more month, before
aggreeing to further investigation

CPP Seminar Apr 09 Christina Stapley

 Prescription . 2.5.08
Tincture as before
Rx tea
• Marshmallow leaf 14g
• Meadowsweet 24g
• Calendula 10g
• Fennel seed 10g
• Lavender 2g
60g
Sig 1-2 tsp. per cup.
1 cup p.c b.i.d or p.r.n

CPP Seminar Apr 09 Christina Stapley

 Final contact 10.8.08
• Drinking still controlled
• Better diet
• Less anxious
• Coping well with life
• “Lurking pain” now gone
• Stomach completely settled

CPP Seminar Apr 09 Christina Stapley

 Mucilages.
• These coat the oesophageal lining, so protecting it from acid reflux.
• Form a protective layer over the stomach contents helping to
discourage reflux.
• If reflux still occurs, this layer of mucilage meets with the
oesophageal lining before the acid, giving extra protection.
Ulmus fulva
• Mucilage, starch and tannin.
Actions.
• Demulcent Nutrient Antitussive.
Indications.
• Inflammation or ulceration of stomach or duodenum.
• Can be combined with Althaea.

CPP Seminar Apr 09 Christina Stapley

 Althaea officinalis
Historically
• It is excellent for blunting and sheathing those sharp acrimonious
humours which occasion tickling coughs, hoarseness, erosions of
the stomach and intestines..Merrick 1790, quoting Lewis.
Althaea off. rad.
• Mucilage in rad 15-20%.
• Indicated for gastritis, gastric or peptic ulceration.
• Hiatus hernia. Dry cough.
• A recent randomised, double-blind, placebo-controlled trial using
marshmallow root (3ml per day) to treat patients with persistent dry
coughs caused by taking ACE inhibitors, found significant
improvement. Mediherb e-monitor No.22 July 2008.
• Mucilage in fol 10%.
• Indicated for respiratory catarrh associated with digestive weakness.
• Historically used for “easing the belly”.

CPP Seminar Apr 09 Christina Stapley

 Lavandula officinalis.
Constituents.
• 1-3% essential oil, consisting mainly of linalyl acetate and linalool,
phenolic compounds and flavonoids.
Actions.
• Carminative. Spasmolytic.
Indication.
• Flatulent dyspepsia. Nervous stomach irritations, including
diarrhoea.
Specifically.
• Depression associated with digestive dysfunction.
• No clinical studies for dried flowers. A pinch of lavender to 1 cup
boiling water, infused, covered for 5 minutes has been reported to
stop nervous diarrhoea.

CPP Seminar Apr 09 Christina Stapley

 Case: 2. Gastritis & Dyspepsia
Patient Details.
• 50 year old mother of 2. Hypertensive and overweight. Prone to
“melancholy”.
• Poor sleep.
Diet
• Wholefoods. Healthy breakfast and lunch.
• Dinner only at week-ends.
• Snacks apples, hummus.
• Constant tea drinking through the day.
• 2 pints of water taken to bed for night thirst.
Lifestyle and Family History.
• 10 cigarettes & bottle white wine each evening.
• Vitamin B supplement. Co-enzyme Q10. Cider vinegar am. No
drugs.
• Intermittent visits to gym.
• 3 close relatives died young of heart attacks. Sister high cholesterol.
Brother hypertensive and diabetic.
CPP Seminar Apr 09 Christina Stapley
First Visit for 3 years. 1.6.08.
• Very painful dyspepsia at night. Worse for food. Drinking and
smoking during the evening, often on an empty stomach.
• Ache in R.U.Q.
• Feeling trapped by her circumstances.
• Bp.148/90. pulse 60.
Past medical History.
• Generally healthy. Previous consultations for slight menopausal
symptoms.
• Also concern at mild hypertension and ache RUQ.
• Failed to follow lifestyle advice, stopped coming.
Management Advice.
• Asked her to make a rule to eat something before starting to drink.
• To reduce tea drinking and drink herb tea or water instead in the
day.
• To drink water between glasses of wine. Exercise regularly.
• Time spent on counselling, including reducing smoking.

CPP Seminar Apr 09 Christina Stapley

 Prescription.

Rx1 Rx2
• Carduus marianus 1:3 20 • Tea Marshmallow leaf 24
• Thymus vulgaris 1:2 15 • Chamomile 10
• Stachys betonica 1:4 25 • Meadowsweet 16
• Crataegus oxycanth. 1:1 10 • -------
• Viburnum opulus 1:3 20 • 50g
• Rosa damascena 1:1 25 2 teasp.per cup b.i.d.
• ----- p.c.
115ml Rx3
• 10ml b.i.d. • Atomiser 100ml distilled
Aromatic
• Rosewater.

CPP Seminar Apr 09 Christina Stapley

18.7.08.
• Great improvement in appetite.
• Eating raw foods at breakfast and lunch.
• Enjoying cooked dinner every day.
• Dyspepsia rare.
• Found rosewater really helpful & calming.

20.8.08.
• Long-standing ache in RUQ gone.
• Stomach now fine.
• Managing 2 nights without alcohol, drinking on third.

10.2.09.
• Very well, eating healthily.
• Bp normal.
• Drinks only at week-ends.
• Gave up smoking last month.
• Exercising regularly. Calm in herself.

CPP Seminar Apr 09 Christina Stapley

 Aromatic Water of Rose
History
• As early as 1525 rose water was described as having the virtue of
comforting and constraining the stomach. Over the centuries it was
also included in surfeit waters taken for indigestion after rich food
and overindulging in alcohol.
• Physiology of digestion was not understood at this time, use was
due to empirical results.
Constituents.
• Geraniol, nerol, citronellol, eugenol, phenyl ethanol, farnesol,
geranic acid, stearopten, myrcene.
Actions.
• Calming and uplifting, cooling and anti-inflammatory, antiviral,
hypotensive.
• Triple action of rose on vascular, digestive and nervous systems
recorded for the essential oil parts of which are dispersed in the
aromatic water. Tisserand.

CPP Seminar Apr 09 Christina Stapley

 Aromatic Water of Rose (cont..)
Indications
• Anxiety and depression. Pelvic congestion. Gastro-intestinal
ulceration.
Research
• In 2005 study showed Antimicrobial activities of Eugenol and
Cinnamaldehyde against the human gastric pathogen Helicobacter
pylori.
Annals of Clinical Microbiology and Antimicrobials. http://www.ann-
clinmicrob.com/content/4/1/20

CPP Seminar Apr 09 Christina Stapley

 Stachys betonica
Key Constituents.
• Alkaloids including betonicine and stachydrine.
• Flavonoids, rosmarinic acid, 15% tannins, betaine, choline.
Actions.
• Bitter. Stomachic. Choleretic.
• Flavonoid glycosides have sedative and hypotensive effects. Aids
clear thought, restoring nerves.
Indications.
• Anxiety states, poor appetite, weak digestion and heartburn.
• Hiatus hernia.Chronic depression, poor concentration and
nightmares.
• Historically for “sour belchings”, or continual risings in their
stomachs”.
Research.
• Observable hypotensive activity from the glycosides. Zinchenko
T.V. & Fefer I.M. Investigation of glycosides from betonica
officinalis” Farmatsevt. Zhurnal 17 (3) 35-38. 1962.
CPP Seminar Apr 09 Christina Stapley
 Thymus vulgaris.
Key Constituents.
• Not less than 1% essential oil, principal components carvacrol and thymol,
rosmarinic acid, caprylic acid, apigenin, flavonoids 10% tannins.
Phenylalanine, thiamine, magnesium.
Actions.
• Carminative, spasmolytic, digestive. Anthelmintic, antibacterial and antifungal
effects from thymol and carvacrol. Astringent myorelaxant, hypotensive.
Indications. Dyspepsia and chronic gastritis, sluggish digestion, colic and
flatulence. Intestinal dysbiosis with microbial toxicosis, candidiasis.
• Absent-mindedness, cerebral deficiency. Hypotensive. To break alcohol habit
and nightmare. (Bartram).
Historically
• It is excellent for blunting and sheathing those sharp acrimonious humours
which occasion tickling coughs, hoarseness, erosions of the stomach and
intestines
Contraindications.
• In gastric ulcers.
Research
• Aqueous and ethanolic extracts of Thymus demonstrated significant inhibition
of Helicobacter pylori in vitro. (Tabak, M and co-workers: Journal Applied
Bacteriol 80, 667-672, 1996).
CPP Seminar Apr 09 Christina Stapley