Acne

There are many types of skin diseases in this world, the most common one is acne. Most people know acne is caused by dirt in oily skin pores, but little is known that acne is also caused by the system of toxins in the body. If our liver and kidney can not cleanse all toxins in the body, then our skin become the third source for cleansing the remainder of toxins.

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Types of Skin Acne
1. Acne vulgaris
Acne vulgaris are most commonly skin diseases in puberty, as a result of an increase in testosterone, typically of the face and shoulders, chest, back, etc., according to the article of "Acne" by Dr.William D. James, M.D. posted in The NeW England Journal of Medicine, the author indicated that acne affects more than 85 percent of teenagers but frequently continues into adulthood....

2. Acne rosacea
Acne rosacea is a chronic condition of a red rash predominantly on the face as a result of the increase of blood flow of the capillaries in the lower layers of the skin.

3. Acne conglobata
Acne conglobata is an uncommon and unusually severe and highly inflammatory form of acne presenting with comedones, nodules and abscesses found on the chest, the shoulders, the back, the buttocks, etc. According to the article of " Mutilating Facial Acne Conglobata by Patterson WM, Stibich AS, Dobke M, Schwartz RA posted in Cutis. 2000;66:139-140, that authors indicated that Acne conglobata, a severe form of acne vulgaris, often produces pronounced disfigurement. We describe a 23-year-old man with acne conglobata. Although this type of acne is often more marked on the back rather than on the face, our patient was unusual in that it was localized mainly to the cheeks.

4. Acne cosmetica
Acne are caused by the use of cosmetic products, including making the acne problem worse. the disease mostly happens to individuals who use cosmetics on a daily or frequent user.

5. Acne fulminans
Acne fulminan is an sever form of acne conglobata occurs after unsuccessful treatment for another form of acne. Many researchers believe that ance fulminan is a result of immunologically induced disease causes a rise in sebum and Propionibacterium acnes bacteria due to elevation of the level of testosterone.

6. Acne medicamentosa -
Acne medicamentosa are caused by starting or stopping a medicine caused by hormone change such as corticosteroids.

7. Baby acne
Baby acne as the name, it is a rash on the cheeks, chin, and forehead of approximately 20% of infants. Many researchers believe it is caused by increased sensitivity of sebaceous glands to maternal hormones in pregnancy.

8. Etc.

Symptoms
1. Blackheads
As a result of excesive oils accumulated in the sebaceous gland's duct which have undergone through a chemical reaction cause of oxidation. Sebaceous gland is a small gland responsible for secreting of the greasiness of the skin.

2. Cystic Acne
Cystic acne is large acne lesions and develops when untreated nodules advance in growth and development as a result of inflammation.

3. Papules (small red bumps)
Papule is type of a solid, elevated spot on the skin that is less than 1 cm wide with either either brown, purple, pink or red in color.

4. Pustules
Pustule is a small elevation of the skin consisting of necrotic inflammatory cells as a result of inducing a sterile inflammatory response of the cells.

5. Scarring of the skin
As a result of an inflamed lesion of papules, pustules, or cysts have damaged the inner layer of skin that can not heal properly.

6. Whiteheads
As a result of excessive oils accumulated in the sebaceous gland's duct which have not undergone through a chemical reaction cause of oxidation. Sebaceous gland is a small gland responsible for secreting of the greasiness of the skin.

7. Etc.

Causes
A. External cause of acne
Acne caused by dirt and oil plug up your skin's pores. If the bacteria gets trapped, then the skin gets red and inflamed and you get pimples. This generally is a result of improper diet.

B. Internal cause of acne
1. Berms and bacteria
Acne caused by excessive amounts of germs existing in a person's system. The liver and kidney working to cleanse the system of toxins are unable to remove all germs completely, the extra burden is placed on the skin to remove them.
2. Family history
Person with family history of acne are at higher risk to develop acne him/herself.
3. Oily skin
Oily skin can result of clogging the pores.
4. Medication
The begin and stop using of certain medication can cause hormone change causing acne. Intake of certain medication such as corticosteroids or testosterone pill increases the risk of acne.

5. Unsuitable cosmetic products

Certain cosmetic product may contains comodogenic ingredients that worsens the problem of acne.

6. Excessive and constant sweating

As excessive and constant sweating can result of clogging the pores.
7. Heredity
Acne can be genetic passing through from parent to their child, If both of your parents had acne, you're even more likely to have it.
8. Weather and working environment
Hot, humid climates and work condition can increase the risk of acne.
9. Etc.

Treatments

A. Conventional medicine
1. Antibiotics
Antibiotic is a type of a chemical substance produced by a microorganism, which has the capacity to inhibit the growth of or to kill other microorganisms to decrease in the number of bacteria in and around the follicle, including
1.1. Oral antibiotics (taken by mouth)
a. Tetracycline
Tetracycline is produced by the Streptomyces genus of Actinobacteria, used treat acne and against bacterial infections.
b. Doxycycline
Doxycycline, a member of the tetracycline antibiotics group produced by Pfizer Inc., commonly used to treat a variety of infections, including acne.
c. Minocycline
A It is a bacteriostatic antibiotic used to treat acne.
d. Etc.

1.2. Topical antibiotics
Topical antibiotics applied to the surface to treat infections of the skin as a result of acne. Most common types of topical antibiotics includes
a. Clindamycin
It is a lincosamide antibiotic used to treat acne caused by infections.

b. Erythromycin
Erythromycin is a macrolide antibiotic, similar to the penicillin used to treat acne.

c. Dapsone Creams or gels
According to the "Dapsone Gel Shows Benefit for Treatment of Acne Vulgaris" by Peggy Pecka. From Medscape Medical News, the author wrote that both studies showed that the dapsone resulted in a substantial reduction in both inflammatory and noninflammatory acne with minor adverse effects, such as mild to moderate reactions at the site of treatment, headache, and runny nose.

d. Retinoic acid cream or gel
According to the study of "Retinoic acid in acne therapy." by F. W. Danby, the author wrote that since that time v has been used in millions doses in US. and Canada. It is superb material when used as directed and have protential of reducing the cost of acne care substantially.

b. Benzoyl peroxide
Benzoyl peroxide is an genetic compound in the peroxide family used to treat acne by introducing oxygen into the pore to treat bacteria cause of acne breakouts.

c. Topical azelaic acid
Azelaic acid is an genetic compound with the formula (CH2)7(CO2H) used to treat moderate cases of comedonal and inflammatory acne as a result of growth of skin bacteria. In a study of Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials." by Liu RH, Smith MK, Basta SA, Farmer ER., Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA. posted in US National Library of Medicine National Institutes of Health, reseachers found that Azelaic acid in 20% cream and 15% gel formulations appears to be effective in the treatment of papulopustular rosacea, particularly in regard to decreases in mean inflammatory lesion count and erythema severity. Compared with metronidazole, azelaic acid appears to be an equally effective, if not better, treatment option.

2. Acne as a result of hormone change
2.1. Spironolactone
If acne is caused by androgen production stimulates sebaceous glands by inhibiting the biologic effects of androgens. Spironolactone is a diuretic and used as an antiandrogen.

2.2.Birth control pills
Birth control pill can reduce the production of androgens, thus reducing the risk of acne.
According to the study of "Pharmacology of hormonal contraceptives and acne." by O'Connell K, Westhoff C. Columbia University College of Physicians and Surgeons, New York, New York,USA. posted in US National Library of Medicine National Institutes of Health, researchers found that Oral contraceptives (OCs) decrease free testosterone levels by reducing testosterone production by the ovaries and adrenal glands, increasing SHBG, and inhibiting conversion of free testosterone to dihydrotestosterone. Studies have shown that the progestin component of OCs lowers androgen levels, which are directly associated with the development of acne lesions. Currently, 3 OCs have received approval for acne from the US Food and Drug Administration. For patients with acne who are already benefiting from OC treatment, there is no need to change the OC; however, when an OC proves insufficient against sebum production, switching to a formulation that is approved for acne is recommended.

3. Other treatments
1. A laser procedure called photodynamic therapy
Photodynamic theray is a procedure in which a photosensitizing agent (Levulan) is applied to the infected skin by activating a special wavelength of light to treat a variety of different skin conditions, including acne.

2. Cortisone
It is the procedure to removal, drainage, or injection of cysts with cortisone.

3. Isotretinoin (Accutane)
It is a medication used to treat severe cystic acne vulgaris.

4. Etc.

B. In common approach
Always wash your body immediately after exercise, work out, etc. with mild soap and tepid water. Keep your skin clean all the time, specially your face. For acne treatment and cure you might want to try some of the following natural remedies mixtures.
1. Cream and lotion
Be sure before applying skin cream or lotion in acne effected area, wash it with mild soap and tepid water because water too hot or too cold might cause the breaking of capillaries (small veins). The best choice of acne cream and lotion is the one made by using ingredients of natural remedies that exist in the kitchen of your home for cost effectiveness and little or no side effect. You can find some acne formulas in this article. For convenience, there are plenty of acne creams and lotions in pharmacy drug stores. Be sure to choose one that does not contain chemicals causing side effects to your sensitive skin. Ask the pharmacist in the drug store which is the best approach. Please note that chemicals help to preserve the product might cause side effects to your sensitive skin.

2. Reducing the intake of saturated fat
Saturated fat intake causing the build up of cholesterol in capillaries, the small veins in your skin. Without giving enough oxygen to it, your skin becomes oily and easy to attract dirt, causing acne. To avoid this, you should substitute your red meat intake by 4- 8 servings every week with fish. They not only have good sources of protein as meat but also guards against the cholesterol build up in small veins in your skin.

3. Lower your body toxins
The system of toxins in your body exist in result of poor diet. If the liver and kidney are not able to get rid of these toxins completely, the skin becomes an extra burden to remove them, causing acne. To avoid this, adding some delicious antioxidants super-foods in your diet will help to solve this problem quickly such as garlic, ginger, etc.

4. Eat foods that purify your blood
Foods that help to purify your blood stream will increase the circulation of blood to your skin, helping the skin to become more healthy and immune from any skin problems such as acne. you can find these foods in these articles.

C. Diet
1. Diet Change
In order to reduce the toxins in the body and prevent acne in the first place, everyday diet becomes one important factor. Reducing the excessive amount of processed fatty and fried foods intake. These are the main factors causing your skin to become oily and increases the risk of acne. The Carb Rotation Diet (this is a diet in which you change the amount of daily carbohydrates calories that you consume from one day to the next and also change the type of food that you eat),and the Mediterranean diet (it follows a dietary pattern in which exercise, fruits, vegetables, carbohydrates, fish and olive oil are the main ingredients.) would help to reduce the intake of toxins in your body therefore without giving the liver and kidney extra burden to cleanse the system of toxins.

2. Green Foods:
Green foods contain amino acids, plus vitamin A , E, beta-carotene, and other important vitamins and minerals such as wheat-grass, broccoli, and water algae that helps to purify your blood thus helping liver and kidney to clean the body of toxins that can trigger acne.

3. Red Tea:
Red tea has some powerful natural antioxidants and enzymes that help in renewed skin health following the removal of dead skin cells. Also flavonoids in red tea help in treating assorted skin and circulatory problems. In general, drinking red tea would help in keeping skin healthy and removes the chance of acne.

4. Natural Remedies:
a) Silymarin in milk thistle improves the function of the liver, protecting the liver from damage caused by viruses, toxins, and alcohol.
b) The kidneys are stimulated by the dandelion and at the same time it enables the rapid removal of toxins through the urine produced.
c) Garlic and onion
Garlic and onion For blood fortifier. Raw garlic and onion are said to do a super job of blood fortifying. These two super-foods also have the power in helping liver and kidney to cleanse the system of toxins. Since the liver and kidney are able to remove all toxins completely from the body, there is no burden for the skin. That means you get healthy skin with no acne.
d) Water and Juice:
Be sure to drink a combined of at least 8 ounces of water and juice each day to help the kidney to remove toxins through urine produced. Without enough liquids, high concentrations of crystal in the urine will cause the formation of kidney stones.

5. Etc.

D. Home made remedies
1. Believe or not, the number one choice is baby urine. Apply wet baby diaper to the affected area and you will see amazing results in a few weeks.

2. Boil 1/2 cup of buttermilk, add some honey while it is still hot to get a thick, creamy consistency and apply the warm mixture on the effected area. Leave it on for 15 minutes then wash it off with tepid water.

3. Extract cucumber juice from organic cucumber and apply the juice to the affected area everyday. Leave it for 15 minutes then wash it off with tepid water.

4. Wash your face with mild soap and tepid water, then apply a thin layer of extra-virgin olive oil. Do not wash it off. Let the skin completely absorb the olive oil. Do it everyday.

5. Mash 1 cup of strawberry and 2 cups of apple cider vinegar, strain the pulp and seeds after 4 hours then massage the liquid on your face. After 15 minutes, wash it off with tepid water.

6. Etc.

E. Traditional Chinese medicine
Huang Lian Shang Qing Pian (Wan)
1. Tradition Chinese medicine is defined acne as a condition caused by an excess of heat and dampness according to Pharmacopoeia Commission of the Ministry of Health of the People's Republic of China, is an official compendium of drugs, covering Traditional Chinese and western medicines, and giving information on the standards of purity, description, test, dosage, precaution, storage, and the strength for each drug.
2. Ingredients
a. Chuan Xiong (Szechuan lovage)
Main use: Moves Blood, Moves Qi, Expels Wind, Calms pain...
b. Man Jin Zi (Chastetree Fruit)
Main use: Drains Wind-Heat, Disperses Wind-Heat, Eliminates and Clears Heat...
c. Qiang Huo (Notopterygium Root)
Main use: Releases the Exterior, Expels Wind, Disperses Dampness, Calms pain...
d. Gao Ben (Chinese Lovage Root)
Main use: Releases the Exterior, Expels Wind, Disperses Dampness, Calms pain...
e. Jie Geng (Platycodon Root)
Main use: Stimulates the Lung,Transforms Phlegm...
f. Fang Feng (Ledebouriella Root)
Main use: Expels Wind, Releases the Exterior, Disperses Dampness, Calms pain...
g. Gan Cao ( Licorice Root)
Main use: Tonifies the Spleen, Benefits the Qi, Moistens the Lungs, Calms cough...
h. Bai Zhi (Angelica Root)
Main use: Releases the Exterior, Expels Wind, Dries Dampness, Resolves oedema, Expels pus...
i. Ju Hua (Chrysanthemum Flower)
Main use: Drains Wind, Clears Heat, Expels toxins....
j. Huang Lian (Figwort Flower)
Main use: Clears Heat, Dries Dampness, Disperses Fire, Expels toxins....
k. Da Huang (Rhubarb Root)
Main use: Eliminates Heat, Disperses Fire, Expels toxins, Invigorates Blood, Eliminates Blood. accumulation....
l. Huang Qin (Skullcap Root)
Main use: Clears Heatm Dries Dampness, Disperses Fire, Expels toxins....
m. Xuan Shen ( Figwort Root)
Main use: Clears Heat, Expels toxins, Nourishes Yin...
n. Jing Jie (Schizonepeta Stem)
Main use: Expels Wind, Releases the Exterior,Stops bleeding...
o. Bo He ( Peppermint)
Main use: Disperses Wind-Heat, Drains Wind-Heat, Eliminates Fire...
p. Zhi Zi (gardenia fruit)
Main use: Disperses Fire, Clears Heat, Drains Dampness, Cools Blood, Expels toxins...
q. Lian Qiao (Forsythia Fruit)
Main use: Clears Heat, Expels toxins, Resolves abscesses, Dissolves nodules...

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Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD), also known as gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease, is defined as a chronic condition of liquid stomach acid refluxing back up from the stomach into the esophagus, causing heartburn. According to the study of "Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease." by DeVault KR, Castell DO; American College of Gastroenterology, GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.

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Symptoms
A. Gastroesophageal reflux disease (GERD) in Adult
A.1. Symptoms
1. Heartburn
Heart burn is one of common symptom of Gastroesophageal reflux disease (GERD) in adult, as a result of acid reflux cause of burning sensation or pain in the middle of the chest mostly after meal.

2. Regurgitation
In gastroesophageal reflux disease (GERD), regurgitation is the expulsion of a small amount of digested foods to the mouth from esophagus. frequent or prolonged regurgitation can lead to acid-induced erosion of the teeth, bad breath or damage to the esophagus.

3. Trouble swallowing
It is caused by damage of the muscles and tissues that must flex for swallowing, as a result of prolonged period of acid reflux that has left untreated.

4. Nausea

It is one of uncommon of Gastroesophageal Reflux Disease (GERD), but is is associated to some people with the disease.

5. Pain when swallow
It may be caused by the damage or infection of the esophagus.

6. Asthma
In a study of The association between gastro-oesophageal reflux disease and asthma: a systematic review" by B D Havemann, C A Henderson, H B El-Serag, posted in a international journal of gastroenteroloy and hepatology, researchers found that this systematic review indicates that there is a significant association between GORD and asthma, but a paucity of data on the direction of causality.

7. Etc.

A.2. Complication
In some severe cases as a result of frequent acid reflux.
1. Ulcers
Damage of the esophagus can lead to result of ulcers as a result of inflammation forming of scar.

2. Esophageal strictures
Prolonged period and frequent acid reflux, if keft untreated can lead to inflammation cause of narrowing of the esophagus

3. Barrett's esophagus
In a study of . "Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus" by Kenneth K. Wang, M.D. and Richard E. Sampliner, M.D.
The Practice Parameters Committee of the American College of Gastroenterology, researchers wrote that screening for Barrett’s esophagus remains controversial because of the lack of documented impact on mortality from EAC. The large number of patients that lack reflux symptoms but have Barrett’s esophagus provides a diagnosis challenge. The highest yield for Barrett’s is in older (age 50 or more) Caucasian males with longstanding heartburn.

4. Esophageal adenocarcinoma
In GICS 2009: EGF Genetic Variant Increases Risk for GERD-Associated Esophageal Adenocarcinoma " by Roxanne Nelson posted by Medscape Newa Today, the author wrote that January 16, 2009 (San Francisco, California) — Specific mutations in the epidermal growth factor (EGF) gene appear to increase the risk for esophageal cancer in patients with gastroesophageal reflux disease (GERD), according to research presented here at the 2009 Gastrointestinal Cancers Symposium. Compared with the EGF wild-type A/A genotype, presence of the G/G variant was associated with an odds ratio (OR) of 1.90 for esophageal cancer, but the correlation between the G/G genotype and esophageal cancer risk was evident only among patients who also had GERD.

5. Etc.

B. Gastroesophageal reflux disease (GERD) in Children
According to statistic, over 35% of 4 million babies born in the U.S. each year have some kinds of splitting up after feeding in the first few months of their life.
1. Vomiting
Acid reflux can cause repeated vomiting in children
2. A sore, raw throat or hoarse voice
These may be result of acid reflux causing damage of the voice box.
3. Sour taste of acid
Frequent acid reflux that lead sour taste in the mouth
4. Trouble swallowing
It may be caused by inflammation of the the esophagus
5. Bad breath
6. Frequent coughing
It can be caused by foods entering the air way during acid reflux
7. Failure to gain weight
As a result of loss of appetite
8. Etc.


Causes
1. Slower in emptying of the stomach after eating
Most uncommon causes of Gastroesophageal reflux disease (GERD) is due to the distention of the stomach with food over prolonged period of time that can lead to reflux. Approximately 20% of Gastroesophageal reflux disease (GERD) are caused the reason above.

2. Cardia
Cardia is the area between the part of the stomach and the esophagus. It is angle where the esophagus enters the stomach and acts as a valve to prevent foods and others to reflux back to the esophagus. If the cardia is not functioning well, it can cause Gastroesophageal reflux disease (GERD with burning sensation of the esophagus.

3. Esophageal contractile defection
If the esophageal contraction fails to performed its function of proper swallowing food, it may not generate enough waves of contractions to push the foods down to the stomach after swallowing and the acid back into the stomach.

4. Hiatal hernia
Hiatal hernia is a condition of a portion of the stomach protrudes upward into the chest, through a tear or weakness in the diaphragm. According to the study of Nocturnal Reflux Episodes Following the Administration of a Standardized Meal. Does Timing Matter?Michael Piesman, M.D.; Inku Hwang, M.D.; Corinne Maydonovitch, B.S.; Roy K.H. Wong, M.D, posted in Medscape news Today, researchers found that GERD patients consuming a late-evening meal had significantly greater supine acid reflux compared to when they consumed an early meal, especially in overweight patients, and in patients with esophagitis or HH. These findings support the recommendations to our GERD patients to eat dinner early and to lose weight.

5. Obesity
Obesity increase the risk of Gastroesophageal reflux disease (GERD). In a sudy of "The association between gastroesophageal reflux disease and obesity." by Friedenberg FK, Xanthopoulos M, Foster GD, Richter JE., the authors wrote that weight loss, through caloric restriction and behavioral modification, has been studied infrequently as a means of improving reflux. Bariatric surgery and its effects on a number of obesity-related disorders have been studied more extensively. Roux-en-Y gastric bypass (RYGB) has been consistently associated with improvement in the symptoms and findings of GERD.

6. Esophageal mucosa
In a study of "Halimeter ppb Levels as the Predictor of Erosive Gastroesophageal Reflux Disease." by Kim JG, Kim YJ, Yoo SH, Lee SJ, Chung JW, Kim MH, Park DK, Hahm KB. posted in US National Library of Medicine National Institutes of Health, researchers found that Erosive changes in the esophageal mucosa were strongly associated with VSC levels, supporting the hypothesis that halitosis can be a potential biomarker for the discrimination between ERD and NERD, reflecting the presence of erosive change in the lower esophagogastric junction.

7. Medication
The use of medication such as prednisolone acetate ophthalmic suspension, an adrenocortical steroid product can increase the risk of Gastroesophageal reflux disease (GERD).

8. Chronic diseases
Chronic diseases, including cough, pulmonary fibrosis, earache, and asthma are also associated with the higher risk of develop Gastroesophageal reflux disease (GERD)

9. Infection
Infection caused by H. pylori can increase the risk of Gastroesophageal reflux disease (GERD). According to the study of "Helicobacter pylori infection and chronic gastric acid hyposecretion" by EM El-Omar, K Oien, A El-Nujumi, D Gillen, A Wirz, S Dahill, C Williams, JE Ardill, KE McColl posted in Gastroenterology, researchers concluded that in some subjects, chronic H. pylori infection produces a body-predominant gastritis and profound suppression of gastric acid secretion that is partially reversible with eradication therapy. (Gastroenterology 1997 Jul;113(1):15-24).

10. Etc.

Diagnosis and tests
If you are experience some of the above symptoms, after recording your family history and physical exam, the following test may be recommended by your doctor
1. Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy (EGD) also known as upper gastrointestinal endoscopy is a diagnosis procedure allowing your doctor to check for any abnormality in the lining of the esophagus, stomach, and upper duodenum after a flexible endoscope inserted down the throat.
If any abnormality is found, your doctor order further examinations.

2. Barium swallow
Barium swallow is a medical imaging procedure which allows your doctor to examine the upper GI (gastrointestinal) tract, to exam the lining of the esophagus and the stomach, after you have drunk a suspension of barium sulfate.

3. Chest X-rays
A chest x-ray is an x-ray of the chest that allows your doctor to examine the lining of the esophagus, stomach, and upper duodenum.

4. Biopsy
A biopsy is a test of removal sample of cells or tissues for examination and determination of the grade and type of the tumors by examining them under a microscope by a pathologist or chemically, if the location of the tumor allows the test to be done without major risk to the patient.

4. Esophageal manometry
Esophageal manometry is a test with the use of a pressure-sensitive tube-like thin instrument passed through your mouth or nose and into your stomach to allow your doctor to examine the motor function of the Upper Esophageal Sphincter (UES), Esophageal body and Lower Esophageal Sphincter (LES).

5. Etc.

Prevention
A. GERD Diet
According to the The GERD Diet (Gastroesophageal Reflux Disease) in McKinley Health Center of The university of Illinois at Urbana-Champaign
Dietary modifications are recommended to lessen the likelihood of reflux and to avoid irritation of sensitive or inflamed esophageal tissue. Listed below are several recommendations that may help to manage GERD:
1. Decrease total fat intake - High fat meals and fried foods tend to decrease LES pressure and delay
2. Avoid large meals - Large meals increase the likelihood of increased gastric (stomach) pressure and reflux.
3. Decrease total caloric intake if weight loss is desired - Since obesity may promote reflux, weight loss
may be suggested by your healthcare provider to control reflux. Reducing both total fat and caloric intake will aid in weight loss.
4. Avoid chocolate - Chocolate contains methylxanthine, which has been shown to reduce LES pressure by causing relaxation of smooth muscle.
5. Avoid coffee depending on individual tolerance - Coffee, with or without caffeine, may promote gastroesophageal reflux. Coffee may be consumed if it is well tolerated.
6. Avoid other known irritants - Alcohol, mint, carbonated beverages, citrus juices, and tomato products all may aggravate GERD. These products may be consumed depending on individual tolerance.
B. Other modifications for treating GERD
7. Maintain upright posture during and after eating.
8. Stop smoking.
9. Avoid clothing that is tight in the abdominal area.
10. Avoid eating within 3 hours before bedtime.
11. Lose weight if you are overweight.
12. Sleep on your left side.
13. Chew non-mint gum which will increase saliva production and decrease acid in the esophagus.
14. Elevate the head of your bed 4-6 inches by placing bricks under the headboard. (Source)


Treatments
A. Conventional medicine
A.1. Medication
1. Proton-pump inhibitors
Proton-pump inhibitors including omeprazole, esomeprazole, pantoprazole, are used to reduce the production of gastric acid in the stomach.

2. H₂ receptor blockers
H₂ receptor blockers include ranitidine, famotidine, cimetidine, etc.. In a study of " Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies." by Tran T, Lowry AM, El-Serag HB., posted in US National Library of Medicine National Institutes of Health , researchers found that Over-the-counter medications are effective in treating symptomatic gastro-oesophageal reflux disease. Compared with the placebo response, which ranged between 37% and 64%, the relative benefit increase was up to 41% with histamine-2 receptor antagonists, 60% with alginate/antacid combinations, and 11% with antacids.

3. 5HT₄ agonist
According to the study of "The effect of mosapride, a novel prokinetic, on acid reflux variables in patients with gastro-oesophageal reflux disease." by Ruth M, Hamelin B, Röhss K, Lundell L., posted in US National Library of Medicine National Institutes of Health, researchers found that
Mosapride 40 mg q.d.s. is effective in decreasing acid reflux in the oesophagus in patients with GERD and therefore has the potential to be effective in the treatment of this disease.

4. GABA-B Receptor Agonists
In an article of "Medical Management of GERD" From Medscape Gastroenterology by Ronnie Fass, MD, FACP, FACG., the author wrote that Richard Holloway from Adelaide, Australia, reviewed the current studies assessing the role of baclofen, a GABA-B agonist, in the treatment of patients with GERD. He emphasized that the drug inhibits 34% to 60% of the TLESRs and improves basal lower esophageal sphincter pressure.

5. Antacids
Antacids are oral medicine used to relieve symptom of heartburn of gastroesophageal reflux disease (GERB).

4. Promotility Agents
Promotility Agents are used to improve GERD symptoms for patients with slow gastric emptying by stimulating the muscles of the gastrointestinal tract to reduce acid reflux into the esophagus.

5. Etc.

A.2. Surgery
1. Fundoplication Surgery
The aim of the sugery is to reduce heartburn caused by acid reflux, in severe case of inflammation, hiatal hernia, damage of esophagus, etc.. Fundoplication surgery is the procedure to treat Gastroesophageal Reflux Disease (GERD) by strengthening the valve between the esophagus and stomach as the upper curve of the stomach is wrapped and satured around the lower end of the esophagus to prevent acid from backing up into the esophagus with a laparoscopic with a small tunnel made from the stomach muscle to allow foods of the lower part of the esophagus to pass through. The sugery is also by times for the esophagus to heal. Acccording to the artilce of "Barrett's esophagus: the role of laparoscopic fundoplication" by Abbas E. Abbas MD, Claude Deschamps MD, Stephen D. Cassivi MD, Mark S. Allen MD, Francis C. Nichols, III MD, Daniel L. Miller MD and Peter C. Pairolero MD, posted in ScienceDirect, researcher found that laparoscopic fundoplication is effective in controlling symptoms in the majority of patients with BE. While disappearance of BE may occur in some patients, the possibility of developing esophageal adenocarcinoma is not eliminated by laparoscopic fundoplication. Therefore, endoscopic surveillance should continue.

B. Herbs
1. Deglycyrrhizinated licorice
Deglycyrrhizinated licorice has been used by people with gastric and peptic ulcers for nearly a hundred years. in a study of "Secretin as a potential mediator of antiulcer actions of mucosal protective agents." by Takeuchi T, Shiratori K, Watanabe S, Chang JH, Moriyoshi Y, Shimizu K., posted in US National Library of Medicine National Institutes of Health, researcher found that the three antiulcer agents FM 100, plaunotol, and teprenon have been shown to increase the content of endogenous prostaglandins in the gastric mucosa, endogenous secretin released by these agents may play a significant role in their mucosal protective action. It is concluded that the antiulcer effect of these drugs could in part be attributable to their unique ability to release endogenous secretin, and that secretin is a potential mediator of the antiulcer actions of mucosal protective agents

2. Aloe Vera
According to the article of "Effect Of Orally Consumed Aloe Vera Juice On Gastrointestinal Function In Normal Humans, excerpts By Jeffrey Bland, Ph.D. (Linus Pauling Institute of Science & Medicine) involved ten healthy subjects - five men (median age: 42; standard deviation: 14 years), and five women (median age: 32; standard deviation: 5 years) - engaged in a semicontrolled Aloe vera juice oral supplementation study protocol., researchers found that The function of Aloe vera juice in promoting, proper gastrointestinal function, based upon the
information from this preliminary study, may be to regulate gastrointestinal pH while improving
gastrointestinal motility, increasing stool specific gravity, and reducing populations of certain fecal micro-organisms, including yeast.

3. Mastic gum
According to the article of Strategies to Protect Against Potential Bone-Destroying Effects"By Chris D. Meletis, ND, the aithor wrote that While much of the research on mastic gum revolves around its ability to support the health of patients with ulcers and its ability to inhibit the bacteria H. pylori, clinically it has been equally useful in patients with GERD and acid reflux.

4. Ginger
Ginger has been used for thousands of years to enhance the function of digestive system and treat stomach distress including nausea, vomiting, diarrhea and in digestion, acid reflux, motion sickness, dyspepsia, etc. due to its due to its anti-inflammatory, antimicrobial and analgesic properties. According to the study of " Ginger (Zingiber officinale Roscoe) and the gingerols inhibit the growth of Cag A+ strains of Helicobacter pylori." by Mahady GB, Pendland SL, Yun GS, Lu ZZ, Stoia A., researchers found that The methanol extract of ginger rhizome inhibited the growth of all 19 strains in vitro with a minimum inhibitory concentration range of 6.25-50 micrograms/ml. One fraction of the crude extract, containing the gingerols, was active and inhibited the growth of all HP strains with an MIC range of 0.78 to 12.5 micrograms/ml and with significant activity against the CagA+ strains.

5. Peppermint
According to the study of A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.)." by McKay DL, Blumberg JB. posted in , researchers wrote that In vitro, peppermint has significant antimicrobial and antiviral activities, strong antioxidant and antitumor actions, and some antiallergenic potential. Animal model studies demonstrate a relaxation effect on gastrointestinal (GI) tissue, analgesic and anesthetic effects in the central and peripheral nervous system... However, human studies of peppermint leaf are limited and clinical trials of peppermint tea are absent. Adverse reactions to peppermint tea have not been reported, although caution has been urged for peppermint oil therapy in patients with GI reflux, hiatal hernia or kidney stones.

6. Etc.

C. Traditional Chinese medicine
a. Ban Xia Xie Xin Wan, also known as "Pinellia Drain Epigastrium Pills" was recorded in classic texts around 210 C.E. Though often referred to as heartburn in classical Chinese medical literature, has been used in TCM to treat various gastrointestinal disorders such as gastritis, enteritis, gastric ulcer, gastralgia. In a study of "The effects of hange-shashin-to on gastric function in comparison with sho-saiko-to." by Y Kase, M Yuzurihara, S Iizuka, A Ishige, Y Komatsu, researchers suggested that suggest that TJ-14 exhibits an anti-ulcer action (probably based on its ability to protect the gastric mucosa), improvement of gastric emptying and an anti-emetic action. TJ-9 also showed anti-ulcer effects, probably based on its ability to suppress gastric secretion and to protect the gastric mucosa. Thus, the present study demonstrated the effectiveness of TJ-14 and TJ-9 against gastric disease, and provided basic data which explain the differences in clinical application between these two kampo medicines.

b. Ingredients
b.1. Ban Xia (Pinellia Tuber)
Main use: Dries Dampness, Transforms Phlegm, Stops vomiting, Resolves masses, Disperses nodules....
b.2. Huang Qin (Skullcap Root)
Main use: Clears Heat, Dries Dampness, Expels toxins, Stops bleeding...
b.3. Dang Shen (Codonopsis Root)
Main use: Tonifies the Middle Burner, Strengthens Qi, Promotes generation of Body Fluids, Nourishes Blood....
b.4. Gan Cao ( Licorice Root)
Main use: Tonifies the Spleen, Benefits the Qi, Moistens the Lungs, Calms cough...
b.5. Huang Lian (Coptis Rhizome)
Main use: Clears Heat, Dries Dampness, Expels toxins...
b.6. Bai Shao
Main use: Nourishes Blood, Preserves the Yin, Nourishes the Liver, Calms pain....

b.7. Chen Pi
Main use: Regulates the Qi, Regulates the Middle, Dries Dampness, Transforms Phlegm...

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