gastritis case history - christina stapley

8/14/2019 Gastritis Case History - Christina Stapley

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CPP Seminar Apr 09 Christi

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 slidinghiatus 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].




Case 1: Gastritis & Dyspepsia

Patient Details.•55 year old hynotherapist. Good appetite. Poor sleep. Energylow by 7pm.•Anxious. Postmenopausal.

Diet.•Wholemeal, fresh fruit. Fish twice weekly. M&S “healthy” fastfoods.•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 heavydrinker.•Family History of heart disease and drink dependency.




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.




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)




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




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




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.




Althaea officinalis

Historically

• It is excellent for blunting and sheathing those sharp acrimonioushumours 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 drycoughs caused by taking ACE inhibitors, found significantimprovement. 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”.




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 cupboiling water, infused, covered for 5 minutes has been reported tostop nervous diarrhoea.




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. Nodrugs.

• Intermittent visits to gym.• 3 close relatives died young of heart attacks. Sister high cholesterol.

Brother hypertensive and diabetic.




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.




Prescription.

Rx1• Carduus marianus 1:3 20• Thymus vulgaris 1:2 15• Stachys betonica 1:4 25• Crataegus oxycanth. 1:1 10

• Viburnum opulus 1:3 20• Rosa damascena 1:1 25• -----

115ml• 10ml b.i.d.

Rx2• Tea Marshmallow leaf 24• Chamomile 10• Meadowsweet 16• -------

• 50g2 teasp.per cup b.i.d.

p.c.

Rx3• Atomiser 100ml distilled

Aromatic• Rosewater.




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.




Aromatic Water of RoseHistory• As early as 1525 rose water was described as having the virtue of

comforting and constraining the stomach. Over the centuries it wasalso included in surfeit waters taken for indigestion after rich foodand overindulging in alcohol.

• Physiology of digestion was not understood at this time, use wasdue 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 thearomatic water. Tisserand.




Aromatic Water of Rose (cont..)

Indications

• Anxiety and depression. Pelvic congestion. Gastro-intestinalulceration.

Research

• In 2005 study showed Antimicrobial activities of Eugenol andCinnamaldehyde against the human gastric pathogen Helicobacter

pylori.Annals of Clinical Microbiology and Antimicrobials. http://www.ann-

clinmicrob.com/content/4/1/20




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 betonicaofficinalis” Farmatsevt. Zhurnal 17 (3) 35-38. 1962.

gastritis case history - christina stapley

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