Indian Gooseberry Improves Heartburn in Patients with Non-Erosive Reflux Disease

by | Sep 24, 2020 | 2018, Botanicals, Digestive Health

Written by Angeline A. De Leon, Staff Writer. This study demonstrated that Amla or Indian gooseberry (Phyllanthus emblica L.) reduced the frequencies of heartburn and regurgitation and improved heartburn and regurgitation severity in patients with NERD.

digestive healthIn Western countries like the U.S., the prevalence of gastroesophageal reflux disease (GERD) is nearly 30% 1, making it one of the most common gastrointestinal issues today 2. A long-term digestive condition involving the reflux of stomach acid into the esophagus, GERD is associated with symptoms such as nausea, heartburn, and regurgitation 3. The disease not only impacts the quality of life for many patients, but also poses a significant socioeconomic burden 4. Conventional treatment of GERD is primarily limited to the use of acid suppressive drugs, and research indicates a high relapse rate among GERD patients following the discontinuation of such a treatment regimen 5. In herbal medicine, symptoms such as reflux and regurgitation have long been treated using Indian gooseberry (Phyllanthus emblica L.), one of the most widely used herbs in Ayurvedic medicine 6,7. Indian gooseberry has traditionally been utilized for its gastrotonic and gastroprotective properties, which modern research now shows may be related to its cytoprotective, antiulcer, and antisecretory components 8. Despite its historical use for the treatment of various conditions 9 and the growing number of animal and experimental studies supporting its efficacy 8,10, clinical studies looking at the efficacy of Indian gooseberry in human subjects are still scarce. In a 2018 study 11 published in the Journal of Integrative Medicine, researchers evaluated the potential of Indian gooseberry to improve symptoms of a subtype of GERD, non-erosive reflux disease (NERD).

A total of 68 participants (mean age = 42.5 years) with classic symptoms of GERD (heartburn, epigastralgia, and regurgitation persisting at least 3 months prior to the start of the study) and a confirmed diagnosis of NERD from a gastroenterologist were enrolled in a randomized, double-arm, double-blind, placebo-controlled trial. Subjects were randomized to receive 500 mg of Indian gooseberry or matching placebo twice daily for 4 weeks. At baseline, Week 2, and at the end of Week 4, subjects reported the frequency and severity of NERD symptoms using the Quality of Life in Reflux-Associated Disease (QOLRAD) questionnaire.

Both groups exhibited significant reduction in the frequency of heartburn (3.78 +/- 0.78 to 1.27 +/- 0.59 for treatment group; 4.10 +/- 1.06 to 3.17 +/- 0.86 for placebo) and regurgitation (3.58 +/- 0.98 to 1.45 +/- 0.82 for treatment group; 3.79 +/- 0.13 to 2.86 +/- 0.95 for placebo) from baseline to the end of the study period (p < 0.001 for both). However, a repeated measures regression analysis indicated that, compared to placebo, the Indian gooseberry group demonstrated more significant diminishment in frequency of heartburn and regurgitation, as well as severity of heartburn and regurgitation over the course of the study (p < 0.001 for all). No adverse effects were reported by subjects.

Findings from the present study corroborate the gastroprotective properties associated with Indian gooseberry. Treatment with Indian gooseberry for a relatively short period of time (4 weeks) proved sufficient to lower the frequency and severity of heartburn and regurgitation (by almost 50%) among patients with NERD. Moreover, supplementation appeared to be safe and well-tolerated by all subjects. As a preliminary trial, limitations of the current study are mainly its small sample size, short treatment duration, and relatively limited exploration of NERD symptomology (looking at only heartburn and regurgitation using a self-report measure). Thus, future studies are necessary not only to replicate findings, but to also more deeply explore the underlying mechanisms associated with the gastrotonic effects of Indian gooseberry.

Source: Varnosfaderani SK, Hashem-Dagabhian F, Amin G, et al. Efficacy and safety of Amla (Phyllanthus emblica L.) in non-erosive reflux disease: a double-blind, randomized, placebo-controlled clinical trial. Journal of Integrative Medicine. 2018; 16: 126-131. DOI: 10.1016/j.joim.2018.02.008.

© 2018 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.

Posted September 24, 2020.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

References:

  1. Fazel M, Keshteli AH, Jahangiri P, Daneshpajouhnejad P, Adibi P. Gastroesophageal Reflux Disease in Iran: SEPAHAN Systematic Review No. 2. Int J Prev Med. 2012;3(Suppl 1):S10-17.
  2. Saberi-Firoozi M, Khademolhosseini F, Yousefi M, Mehrabani D, Zare N, Heydari ST. Risk factors of gastroesophageal reflux disease in Shiraz, southern Iran. World J Gastroenterol. 2007;13(41):5486-5491.
  3. Taghavi SA, Ghasedi M, Saberi-Firoozi M, et al. Symptom association probability and symptom sensitivity index: preferable but still suboptimal predictors of response to high dose omeprazole. Gut. 2005;54(8):1067-1071.
  4. Khodamoradi Z, Gandomkar A, Poustchi H, et al. Prevalence and Correlates of Gastroesophageal Reflux Disease in Southern Iran: Pars Cohort Study. Middle East journal of digestive diseases. 2017;9(3):129-138.
  5. Fass R, Sifrim D. Management of heartburn not responding to proton pump inhibitors. Gut. 2009;58(2):295-309.
  6. Hamedi A, Zarshenas MM, Sohrabpour M, Zargaran A. Herbal medicinal oils in traditional Persian medicine. Pharm Biol. 2013;51(9):1208-1218.
  7. Farzaei MH, Shams-Ardekani MR, Abbasabadi Z, Rahimi R. Scientific evaluation of edible fruits and spices used for the treatment of peptic ulcer in traditional Iranian medicine. ISRN gastroenterology. 2013;2013:136932.
  8. Al-Rehaily AJ, Al-Howiriny TA, Al-Sohaibani MO, Rafatullah S. Gastroprotective effects of ‘Amla’ Emblica officinalis on in vivo test models in rats. Phytomedicine. 2002;9(6):515-522.
  9. Niazi M, Hashempur MH, Taghizadeh M, Heydari M, Shariat A. Efficacy of topical Rose (Rosa damascena Mill.) oil for migraine headache: A randomized double-blinded placebo-controlled cross-over trial. Complement Ther Med. 2017;34:35-41.
  10. Pramyothin P, Samosorn P, Poungshompoo S, Chaichantipyuth C. The protective effects of Phyllanthus emblica Linn. extract on ethanol induced rat hepatic injury. J Ethnopharmacol. 2006;107(3):361-364.
  11. Karkon Varnosfaderani S, Hashem-Dabaghian F, Amin G, et al. Efficacy and safety of Amla (Phyllanthus emblica L.) in non-erosive reflux disease: a double-blind, randomized, placebo-controlled clinical trial. J Integr Med. 2018;16(2):126-131.