Acid Peptic Disease (APD)

• Since how many months or years?
• What are the symptoms?
• Which medicines does he / she take?
• H/o Hurry – Curry – Worry
  • Acid peptic disease is a state of imbalance of Acid peptic secretion and protective mechanism of gastric mucosa.
  • Mucus secretion by mucous cells protects the gastric mucosa. (Inner Layer)
  • Acid secretion has 2 phases – Basal and Stimulated.
  • Basal phase is also called the interdigestive phase present, when the stomach is empty, Basal secretion is maximum during night, is controlled by vagus, local histamine stimulation and affected by emotions.
  • Normally basal secretion is rich in mucus, small in pepsin & almost no acid.
  • Emotions like worry increase basal acid secretion by vagal stimulation. ✓ Stimulated phase is when food is present in the stomach. It is mediated by vagus, histamine, and gastrin.
  • Histamine is produced by special cells in the stomach and gastrin is produced by gastric cells near the pyloric antrum. Stimulated phase secretion is rich in acid, pepsin & mucus
• How does stress induce APD?
  • Stress mainly, extensive burns & emotions, lead to high levels of ACTH and corticotropin secreted by pituitary & cortisol secreted by adrenal cortex. These two leads to decrease in mucus secretion. (This action is mediated by inhibiting the release of Arachidonic acid from membrane lipids .Physiologically the Arachidonic acid is converted by Cyclooxygenase (COX 1) into prostaglandins which participate in mucus production by gastric mucosa. NSAIDS inhibit COX 1 & 2 to minimize the production of inflammatory prostaglandins, to exhibit their effect, but while doing so damage the gastric mucosa)
  • Stress leads to hypothalamic stimulation of vagal activity causing increase in basal acid secretion & some of the stimulated one. Emotional stimuli often lead to increase in basal (inter digestive)secretion by the Cephalic pathway of vagal stimulation. This is rich in pepsin & acid.
  • (Gastric secretion occurs in three phases, Cephalic, Gastric & Intestinal. Cephalic is the one which occurs before food enters the stomach. Sight, smell, taste & thought of food are the neurogenic signals, which originate in cerebral cortex & appetite centers of amygdala & hypothalamus & are transmitted through vagi to stomach)
• Thus both factors together lead to an imbalance between acid peptic secretion and mucus protection leading to acid peptic disease
• Symptoms of APD - Heartburn (retrosternal burning, epigastric pain, nausea, vomiting, headache, lethargy, drowsiness, bloating, regurgitation.

Mode of Action of Medical Yoga Therapy

• Standard program changes breathing pattern, which corrects autonomic arousal.
• Conscious Abdominal Breathing increases the strength of diaphragm. Esophagus enters the abdominal cavity by passing through the right crus of diaphragm. It is compressed during expiration (refer to Anatomy Vol 2 - 30.6) preventing the regurgitation of contents of stomach into esophagus. (GERD Gastro-esophageal reflux disease)
• Pranayam sequence helps in emotional stability & cognitive corrections leading to less incidents of autonomic arousals

Benefits of Medical Yoga Therapy

• Medical yoga therapy helps in stress management.
• Medical yoga therapy helps in dietary discipline.
• Medical yoga therapy improves sleep patterns.