Homeopathy in gastroesophageal reflux in children

Gastroesophageal reflux is a pathology frequently diagnosed with typical and atypical symptoms in an increasing number of children. The analysis of some pediatric clinical cases highlights the role of homeopathy in children with gastroesophageal reflux. Homeopathy can be very effective in the therapy of children suffering from gastroesophageal reflux by intervening on the miasmatic predispositions underlying the pathology. Gastroesophageal reflux is a proteiform pathology which, in addition to gastrointestinal symptoms, can also present a series of symptoms in other body areas. The miasmatic basis in such patients is particularly evident. The clinical cases reported show that this pathology can be effectively treated with homeopathic therapy very deeply.

KEYWORDS
Gastroesophageal reflux, Miasmi, Homeopathy, Pediatrics, children.

SUMMARY
Gastroesophageal reflux is a very frequent diagnosis with typical and atypical symptoms in Pediatrics. Some clinical cases of Gastrointestinal Reflux succesfully treated by homeopathy are illustrated in this research. Furthermore Homeopathy is able to cure the miasmatic predisposition of children at the basis of this pathology. Gastroesophageal reflux is a proteiform disease with possible symptoms in many organs. Miasmatic predisposition is very important in this disease and homeopathy can cure these children very deeply.

KEYWORDS
Gastroesophageal Reflux, Miasms, Homeopathy, Pediatry, Children.

Introduction
In pediatric age, gastroesophageal reflux represents a diagnosis that is increasingly found in daily clinical practice. It can present itself as a physiological phenomenon (GER or Gastroesophageal Reflux) which is part of the normal process of maturation of the lower esophageal sphincter and cardial continence but can also manifest itself as gastroesophageal reflux disease (GERD or Gastroesophageal Reflux Disease) which can be particularly severe and occur in children suffering from particularly serious neurological pathologies such as infantile cerebral palsy going to further compromise the growth and health of children affected by these pathologies.

Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux (GER or Gastroesophageal Reflux) is the passage of gastric contents into the esophagus with or without regurgitation or vomiting. The appearance of simple reflux can be a normal process that occurs several times a day in healthy infants, children and adults.
Gastroesophageal reflux disease (GERD or Gastro Esophageal Reflux Disease) occurs instead when the reflux of gastric contents causes disturbance, symptoms or complications. It is important to differentiate these two clinical conditions (1). Simple reflux is a condition that spontaneously tends to resolve itself and that would not require allopathic therapies especially in infants. However an excessive medicalization of the symptom can lead to an excess of diagnosis of GERD and therefore of therapies that are still quite important also because it is in an age in which many drugs are used off label, that is outside of the therapeutic indications approved by scientific authorities. All this has also aroused second thoughts and discussions even among pediatricians (2).

Differential diagnosis between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD)
Gastroesophageal reflux may also be present physiologically in the first months of life as the cardial junction may not have yet fully matured, and with some precautions related to the frequency of meals and the position after feeding, this problem can be resolved spontaneously. It is a normal process that occurs several times a day in healthy infants, children and adults. Most episodes last less than 3 minutes, occur in the postprandial period and do not cause other symptoms. Physiological gastresophageal reflux is very frequent and affects about 10% of infants in the first months of life (3). According to some studies, in basic clinical practice, simple reflux is even more frequent and would affect about 50% of infants under three months, but already at 10/12 months the percentage decreases below 5% (4) and the majority of infants who suffer from it undergo recovery when the continence of cardias is reached. Simple gastroesophageal reflux does not cause other problems.

The situation in Gastroesophageal Reflux Disease is very different. This clinical condition is characterized not only by the presence of reflux but also by a series of symptoms that create a significant impact on the health of young patients. It differs from simple reflux due to the presence of additional symptoms and complications. The presence of poor growth as well as recurrent vomiting is one of the first signs that point towards the possibility of diagnosing a GERD. The atypical symptoms associated with reflux in GERD are very numerous considering that respiratory, neurological, dental, otolaryngological and other specialization symptoms are also often affected in GERD and although there are some discussions among different specialists in the

In reality, from a miasmatic point of view, it could be assessed that starting from a banal symptom that a large part of infants have, reflux can manifest a whole series of even very serious symptoms that characterize GERD in different locations of the organism and that they go hand in hand with the load of active miasms that are present in the child. In addition to poor psoric growth, respiratory symptoms can range from persistent cough and asthma to the possibility of recurrent pneumonia and interstitial lung disease, consequences of inhalation. At the otolaryngological level in children, reflux can be associated and determine many symptoms such as laryngitis, chronic rhinitis, sinusitis, pharyngeal bolus, stridor, otalgia, cord diseases and dysphagia (6).

Gastric and esophageal complications may occur such as esophagitis, Barret’s esophagus and others. Neurological symptoms can be important especially in the most serious cases of secondary reflux in children who have neurological pathologies such as infantile cerebral palsy which represent one of the main risk factors. But symptoms such as inconsolable crying or apneas that are directly related to reflux and that are often the clinical expression of miasma in action may be present in GERD. A characteristic neurological syndrome that may be due to GERD is Sandifer syndrome which is a paroxysmal dystonic disease of movement associated with gastroesophageal reflux and, in some cases, hiatal hernia. Dystonic movements are characterized by a abnormal posture of the head and neck (twisted neck) and severe bowing of the dorsal spine. The seizures usually last 1-3 minutes and can occur more than 10 times a day. By treating reflux, Sandifer’s syndrome also disappears.

Other atypical symptoms that may be present are anemia, dental erosions, episodes of ALTE (Apparent Life Threatening Event), i.e. a critical event that occurs acutely in sleep or wakefulness and that occurs in subjects under the age of one year in which, together with the apparent interruption of respiratory activity, the most evident and worrying symptom for those who attend the event, other symptoms are detected such as the change in the skin color of the face and / or trunk and limbs (cyanotic or pale with or without curl), alteration of muscle tone (hypotonia, flacidity, hypertonia), sometimes loss of consciousness lasting from a minute to about 10 minutes.Reflux also appears in forms secondary to pathologies such as hypertrophic pyloric stenosis, esophageal atresia, intestinal malrotation or cerebropathies in which a very important miasmatic impact is already present from birth.

Materials and methods
Two main pediatric clinical cases that are particularly representative are examined, as well as a series of short clinical cases which highlight some of the problems frequently encountered in clinical practice. The first clinical case will deal with the problem of excess medicalization of reflux and the role that homeopathy can play in allowing the patient to recover fully without running the risk of triggering suppressive effects and miasmatic activation with allopathic drugs. The second clinical case describes a severe and complicated gastroesophageal reflux disease in a child suffering from infantile cerebropathy and allows to highlight the role of homeopathy both in treating the side effects of allopathic drugs as well as, through a miasma therapy, to treat gastroesophageal reflux disease by improving the patient globally also on a neurological and general level. Other brief clinical cases illustrate other homeopathic therapeutic possibilities in which this pathology has been successfully treated.

Results

Clinical Case 1
R. born preterm with birth induced by fetal distress at cardiotocographic monitoring. After 72 hours from the breaking of the bag, it was not channeled despite attempts with the sucker. Jaundice in the first days of life that required an incubator with phototherapy. The mother reports that she is looking for warmth and loves to bathe with hot water, if with the stroller she walks in the sunny part she calms down and calms down. Love the light and the sun. The mother and grandmother who are apprehensive about the baby tend to give an addition of milk powder that would not be necessary because the child has regained his weight and is growing regularly. there is a hypospadias at birth which will be checked for possible intervention in the future.

I visit the child at 20 days of life and in addition to the reported symptoms, he has mild subterbus of the sclerae, slight conjunctival irritation, milky crust very evident on the scalp. The color of the urine is reported to be slightly on the orange. The neonatal reflexes of Moro, the automatic march, the prehension and the other reflexes are as normal as the Ortolani maneuver. The liver has slightly increased in volume and the child is irritable, does not like to be visited except when in direct light from the lamp.
Based on the irritability, the color of the urine, the history of jaundice, the increase in the volume of the liver and the coldness with general improvement with the heat, I prescribe LYCOPODIUM 4-6 LM CURE half capsule per day. At the next check-up at about 2 months the situation improved markedly, the child grows up, feeds well, no longer has gaseous colic, the healer is regular, more peaceful and no longer suffers submission to the sclera.

The hypothesis of possible hypertrophic pyloric stenosis of the pylorus so on the second day of vomiting the infant is taken to the hospital PS where with an ultrasound they exclude the hypertrophic stenosis of the pylorus but as a precaution they hospitalize the child who in the meantime had a slight fever rise. In the hospital, everything is negative, but on return from his primary pediatrician, a pathological gastroesophageal reflux with suspected esophagitis is diagnosed and raniditine syrup and an anti-reflux syrup are prescribed.

At the fourth month of life, the mother returns to visit not knowing how to go on. After an in-depth interview he confesses that feeling guilty he had increased the addition of milk powder just before all this happened. The hollow is completely irregular, the child does not sleep and does not grow well. Only the heat, the hot water or the hot air of the hair dryer calm him for a short time otherwise he cries and complains continuously. Mum reports that after crying he is exhausted and is very downcast. When I visit him, he cries and screams. Just putting your finger on the stomach mouth and massaging in a certain way calms you down immediately. Acid regurgitation is particularly evident and it is enough to change the position of the child to visit it to provoke such regurgitation. The extreme coldness and the improvement with the heat remain.

At the 5 month check, the baby is much better, he has stopped allopathic therapy and the reflux has almost completely disappeared, except in the afternoon.
MURIATICUM ACIDUM MK single-dose + 35 K for 28 days. In the sixth month he is fine, has no reflux, only a little irritable, especially in the afternoon. LYCOPODIUM 7-9 LM CURE half capsule per day.

Clinical case 2
L. born preterm strongly underweight. The mother was hospitalized at the age of 25 weeks for suspected maternal fetal hemolytic pathology, and a placenta previa was highlighted which made it grow little. The pregnancy is twinned but compared to the little brother it grows less. Born at 30 weeks with cesarean section presenting hypospadias, scalp angioma and neurological problems. At birth Apgar 7 and 9. On the brain ultrasound there was a slight hyperechogenicity diffused in different brain areas, asymmetry of the lateral ventricles and increase in the spaces of the liquor. In 2 days echocardiogram highlights patency of the oval foramen. Surfactant is prescribed to promote lung maturation and alveoli opening and hospitalized in neonatology in an incubator. L’

Gastroesophageal reflux is diagnosed from birth and is treated from the outset with ranitidine to ward off the danger of pneumonia ad ingestis. In this situation, reflux can be an additional danger for the possible complications that may occur and for the possible esophagitis which further prevents feeding and getting out of a rather complex clinical condition. One year of life rotavirus gastroenteritis with further gastrointestinal repercussions. Gastroesophageal reflux worsens and requires the transition from ranitidine to omeprazole which, however, worsens the situation further causing a bronchospasm associated with reflux itself. The reflux is almost constant and comes to visit in this situation in which the

First visit at 1 year and 2 months of life. Cough as soon as he lies down. Since birth he has tics, especially when he sleeps, jerks that are further worsened after the first doses of vaccines. The joints are very loose and assume unnatural positions with very wide joint excursions. He does not walk and drags himself on the floor. The legs are hypertonic showing an important neurological deficit. During the night, tremors, jolts, hands clenched into fists refer to me. He has to do neurological checks for a suspected form of muscular dystrophy that is not found but the problems are attributable to the central neurological situation. Scream in your sleep. Curved, it is closed as in an egg. In order to allow the suspension of ranitidine, which has been taking for over a year now, in order to mitigate the side effects and the risk of a rebound of acidity, I prescribe NUX VOMICA 30 CH two granules three times a day first in combination and then scaling and removing the allopathic drug. Furthermore, the NUX VOMICA is also useful for decreasing the state of muscular hypertonicity and contractures which, especially during the night, were evident throughout their expression. After about a month, the clinical conditions had improved and there were no longer any effects of ranitidine superimposed on the clinical picture. Improved reflux, he still had neurological symptoms. I prescribe CALCAREA FLUORICA 6LM drops. Three drops a day. moreover, it is also useful for decreasing the state of muscular hypertonicity and contractures which, especially during the night, were evident in all their expression. After about a month, the clinical conditions had improved and there were no longer any effects of ranitidine superimposed on the clinical picture. Improved reflux, he still had neurological symptoms. I prescribe CALCAREA FLUORICA 6LM drops. Three drops a day. moreover, it is also useful for decreasing the state of muscular hypertonicity and contractures which, especially during the night, were evident in all their expression. After about a month, the clinical conditions had improved and there were no longer any effects of ranitidine superimposed on the clinical picture. Improved reflux, he still had neurological symptoms. I prescribe CALCAREA FLUORICA 6LM drops. Three drops a day.

Follow-up visit after 1 month: improved growth, the joints have less excursions and the musculoskeletal structure is more solid. Unnatural attitudes and postures have diminished However, sleep jerks and tics persist. Not speaking, he emits incomprehensible guttural verses and tends to repeat with a babble of the verses he listens to. From time to time he remains stunned, does not hear the noises around him and the mother is worried that there are hearing problems which are excluded by audiologists. In these phases he appears distant and is not in the least involved by his surroundings. If he is scolded he enchants and does not react, stammering some incomprehensible verse. It needs a lot of rest. Occasionally he rocks his head in a characteristic way.

HELLEBORUS NIGER MK + 35 K Follow-up
visit after 1 month. Much improved. It no longer has reflux. it is more involved in the outside world, it is as it flourished again. It started to open up with the other kids. He also starts talking and making small sentences. He no longer shook during sleep and no longer swings his head.
HELLEBORUS NIGER XMK + 35K
Subsequent check after 3 months: further improvement of relationship skills, posture, and neurological situation. He sleeps all night without problems. It continues to grow and improve and no longer has the reflux that had been a constant in the first year of life.
HELLEBORUS NIGER XMK + 35 K

Other clinical cases in brief
A clinical case of atypical ENT symptoms is that of M. boy who comes to visit at 5 years of age because in addition to reflux he has frequent episodes of barking and spasmodic cough since the first year of life, which greatly limited his relationship skills and that after repeated checks Specialists had also been attributed by the otolaryngologist to a laryngospasm secondary to gastroesophageal reflux being all other negative tests. M. is a shy child who tends to retain emotions within himself. On the first visit it is difficult to ask him something because he is hiding behind his mother. If he is scolded, especially by the mother, he is mortified. He suffered from nosebleeds, he has a systolic murmur to the heart. he is very neat, picky. It gets worse at the sea and in the hottest hours. He loves chips and raw ham. Therapy with NATRUM MURIATICUM 4-6 LM CURE a capsule a day and then 7-9 LM CURE a capsule a day completely unlocked the situation not only at the level of the cough that has disappeared but also at the mental level as it has opened up more, especially at school and with classmates. He no longer presents a blockage of the emotions that keep him in dealing with his environment and with others and is much more serene also in the family. Often the mother says that she is respected much more even with her companions and her character has come out in the family: she struggles to keep up with him while before she was more docile and submissive.

Another clinical case in which reflux is associated with other symptoms is that of an 8-year-old G. who is suffering from a specific language disorder with school difficulties so he must be followed with a support teacher and carry out speech therapy to recover the acquisitions school. Mum says that he has difficulty managing the information that comes to him and that he often has episodes in which he seems absent. Negative EEG for little evil. He has difficulty imagining information, more with letters than numbers. It has to associate the name with the visual image in order to go on otherwise it misspelled the names. He is very anxious and afraid of making mistakes. He loves sugar and sweets a lot. He has had mononucleosis which has greatly weakened him and has many moles. Grits your teeth in your sleep. Go around the mother continuously if she gets bored. In addition to a phase of CARCINOSINUM MKmonodose, therapy with SILICEA MK single-dose repeated three times every 15 days and then SILICEA XMK single-dose had a marked general improvement in addition to the disappearance of gastroesophageal reflux. He also removed the refined sugar from the diet and carried out a period of therapy with SACCHARUM OFFICINALIS 9 CH three granules a day, to antidote the effects of the refined sugar that in children with attention deficit problems can play a role.

Another interesting case is that of D. who was born preterm, in addition to the diagnosis of reflux he had laryngomalacia, plagiocephaly, delay in psychomotor acquisitions and muscle hypertonus after birth. It has photophobia, it is lean, slender and long-limbed while eating a lot. Chilly, he loves to cover himself very much, he has very frequent regurgitation and vomiting. After the therapy with CALCAREA PHOSPHORICA 4-6LM CURE one capsule per day and then 7-9 LM always in CURE one capsule per day, the disappearance of the reflux was accompanied by a profound change of character: it became calmer and more reflective and above all much more affectionate and less capricious. he has grown a lot and has recovered many stages in language and movement.

Another clinical case is that of a three-year-old P. in which reflux was associated with Von Recklinghausen’s neurofibromatosis. Mild child, slightly overweight with constipation and with a lot of sweat in the head, facial dissymmetry, insomnia, nocturnal bone pain and recurrent respiratory infections, has considerably improved after THUJA MK single-dose + 35K and CALCAREA FLUORICA 6LM CURE three drops per day.

Another clinical case that provides interesting food for thought is that of B. a 6 year old girl in whom gastroesophageal reflux disease was diagnosed together with a hiatal hernia. She has been on ranitidine therapy for a long time before arriving at the visit. After such therapy he often had recurrent sore throats treated with ever-increasing doses of antibiotics and cortisone drugs, despite reflux. The girl was overweight and had had a clear push towards sicosis from all previous therapies. Constipated alvo, pavor nocturnus, abundant head sweating, full moon facies with diffuse redness especially in the cheeks. After NUX VOMICA to antidote the effects of allopathic therapies.

Discussion
Meaning of reflux in children
Our species comes to light in a situation where many of the functions of adulthood are not yet fully developed. All this derives from the fact that the rapid growth of the head circumference in our species and the disproportion with the dimensions of the woman’s pelvic cavity makes it impossible to leave the birth canal. While the other species at birth are ready and from the first day of life they are able to stand and walk as happens for example for the foal, newborn in the horse species, our species at birth is still quite immature and manifest still the fetal characteristics rather than those of the older child. Moreover, the survival of the horse is linked to the ability to run and run away, while for our species survival derives above all from the capacities of our brain, linked to the size of the skull, which also oblige the birth in a period of relative immaturity of the individual. According to the fourth-trimester theory of the US pediatrician MD Harvey Karp (7) since in our species the human fetus must be born after 9 months for the size of the brain, many of the newborn’s functions are not yet adequately developed due to the lack of a fourth trimester of pregnancy that would allow to solve many of the problems that appear in the first three months of life including gastroesophageal reflux, in addition to gaseous colic and many other disorders of the first three months.

As regards gastroesophageal reflux specifically, the evolution of the human species compared to other mammals has created another critical point: for the development of the capacities of the organs of speech and phonation, the region of the larynx that has occupied a position has expanded caudal while the digestive tracts, at the point where the pathways cross, are more restricted exposing to a greater risk of reflux and possible complications such as infections ab ingestis (8). Other aspects are related to the beginning of nutrition through the digestive canal after birth, which is a very delicate phase. Through the esophageal canal and the stomach, the vital force that is connected to the foods themselves is also transmitted along with the food. The stomach occupies a central position for the

In this phase the infant so delicate and defenseless needs all the greatest attention to be cared for with all the necessary precautions, as if he were still inside the uterus, according to the theory of the fourth trimester, otherwise he can be more exposed to risk that the pressure of family miasms or miasmatic activation will come forward in this very delicate period.

In the older child an increasingly poor diet of foods with vital force but also full of toxic factors, reflux may initially appear as an effort by the organism’s vital force to regain control in the event that there are avoidable harmful factors (9 ). However, after the exonerative salutary efforts have exhausted their effectiveness and in the presence of the active miasma, the appearance of a GERD may occur which must necessarily be treated in its miasmatic basis to allow the body to recover health. But let’s see in detail the miasmatic aspects related to the problem.

Reflux and miasms
From a miasmatic point of view, it can be noted that starting from a trivial symptom that falls within the normal development of children, depending on the miasmatic load present in the child and transmitted by the families of origin, it is possible to have completely different pictures, which range from to deeply affect and undermine the child’s development and growth. The first signal that indicates that something is wrong and that it is not a simple reflux, but that we are in the presence of something more important, so as to indicate the presence of a real GERD, is the delay in the growth that occurs it shows with a progressive slowing down of the growth rate and that indicates the presence of a psoric condition.

In its simplest clinical manifestation reflux can be the expression of a latent psora. As identified by Hahnemann, unequivocal signs of latent psora are the lack of appetite and the presence of acid taste in the mouth as well as an acid smell (10). Latent psora should not be suppressed with allopathic medications that can run the risk of chronicizing the disease and slatentising this miasma as well as superimposing other miasms on the psora, as will be shown below. Numerous symptoms affecting the pathology we are treating belong to the manifested psora, such as: a jet of salivary fluid flows into the mouth and comes back from the stomach, after pains that take all around this organ, nausea that almost cause syncope and salivary flow in mouth, … nausea in the morning,

As you can see the stomach can be one of the targets affected from a miasmatic point of view and in this district of the organism it is possible to witness a passage from a latent psora still under the control of the Vital Force to the manifest psora with the appearance also of numerous symptoms that are part of GERD, in which the overlapping and intertwining of the other miasms can also be found. In fact, in this pathology it is even more evident the possibility that with the ignition of the miasma a whole series of clinical symptoms and manifestations may occur which in allopathy are described as atypical reflux symptoms which are nothing more than further manifestations of the ignition of the psora that will develop its action in a proteiform way in different districts of

For example, numerous respiratory symptoms are currently being considered in complicated forms of reflux. Also in the ENT field, reflux cough or inflammation of the upper secondary airways secondary to reflux are often diagnosed. In reality often in clinical practice the respiratory symptoms described by Hahnemann for psora are present, such as: short cough in the morning, frequent accesses of asthma, very frequent or chronic hoarseness. These symptoms, when no other causes are found, are currently often diagnosed as secondary to a reflux but in reality they are nothing more than the clinical expression of the psora present in the organism. But there are many body districts that can present atypical symptoms of gastroesophageal reflux as many expressions of the psora.

Helicobacter eradication and sycotic miasma
Ever more frequent is the eradication of Helicobacter which is carried out through a therapy that combines antisecretors and antibiotics, which have among their effects those of giving a sycotic boost, as they have many side effects and adverse events that have a miasmatic imprint of this type and that, for the limitations of the relationship, there is no way to further investigate. In addition to the action of allopathic drugs, it is also very interesting that the Helicobacter is a microorganism with which we have lived for millennia and that, as homeopaths well know, it can be asymptomatic or give more or less serious clinical manifestations in relation to the individual terrain. This microorganism affects the balance of hormones present in the digestive system and it has been seen that the eradication of Helicobacter reduces the expression of the gastric leptin genes (12), which is a gastrointestinal hormone that is involved in the sense of satiety after eating. This hormonal modification is accompanied by an increase in the Body Mass Index, as evidenced by these studies so as to constitute also for this reason a further boost to sycosis and may be related to weight gain after eradication from Helicobacter.

Syphilis and severe and secondary reflux
In some children, reflux occurs from the beginning in a very serious way with erosive esophagitis which compromises the child’s chances of nourishment and growth. In such cases the thrust of the syphilis is particularly evident as well as in the cases of secondary reflux that appear in children suffering from cerebropathy or from very serious organic pathologies. Even when the gastroesophageal reflux disease is expressed by the manifestations of sleep apnea or the so-called episodes of ALTE (Apparent Life Threatening Event) that we have described above, they can fully be an expression of the activation of the miasma of the syphilis.

Discussion of clinical cases
The first clinical case highlights a very frequent situation linked to the overdiagnosis of gastroesophageal reflux disease in the presence of simple, uncomplicated gastroesophageal reflux. Sometimes a vomiting that lasts a little longer is enough to trigger a therapeutic diagnostic process that with the prescription of allopathic drugs becomes complicated and determines the activation of the miasma and / or an even more complex miasmatic interweaving.

The little patient, born prematurely after a difficult birth and with fetal suffering, had recovered very well with a constitutional remedy such as LYCOPODIUM which had also treated scleral subteroid, liver congestion and alterations of urinary sediment as well as mental symptoms related to irritability and to the generals with the worsening afternoon and the coldness. But after an excessive addition of milk powder for a sense of maternal guilt in not being able to look after and feed the baby, family dynamics took over (even the grandmother played a role). L’ the accentuation of a gastric symptomatology following a probable viral infectious episode triggered a succession of events that led the patient to a hospitalization that showed no organic pathologies or further complications. However, ranitidine, a gastric antisecretory, was prescribed, which worsened reflux symptoms, as well as altering the sleep and wakefulness rhythm. Not having used the allopathic drug for an extended period of time, the patient was able to stop it without problems. The Muriaticum Acidum remedy corresponds to hydrochloric acid which is one of the fundamental constituents of gastric juice. It presents numerous symptoms in the medical field concerning gastric acidity. which worsened the symptoms of reflux, as well as altering the sleep wake rhythm. Not having used the allopathic drug for an extended period of time, the patient was able to stop it without problems. The Muriaticum Acidum remedy corresponds to hydrochloric acid which is one of the fundamental constituents of gastric juice. It presents numerous symptoms in the medical field concerning gastric acidity. which worsened the symptoms of reflux, as well as altering the sleep wake rhythm. Not having used the allopathic drug for an extended period of time, the patient was able to stop it without problems. The Muriaticum Acidum remedy corresponds to hydrochloric acid which is one of the fundamental constituents of gastric juice. It presents numerous symptoms in the medical field concerning gastric acidity.

As Grandgeorge (13) points out in Muriaticum Acidum there is a very particular relationship with the maternal line in which there can be conflicting feelings (in this case of a rather intrusive grandmother) and in which forced nutrition is rejected to resume a normal diet that goes hand in hand with the regularization of the mother-child relationship. Some symptoms of Muriaticum Acidum from Hahnemann’s proving that were present in the case are frequent awakening from sleep with agitation in the bed, feeling of emptiness in the region of the stomach, especially in the esophagus, which does not disappear by eating, together with noise of the intestine, nausea and tendency to vomit (after 1 hour), a taste in the mouth, at the same time violent and putrid, almost like rotten eggs, with flow of saliva. (14) But the remedy also adapted as regards the picture of mental symptoms and in particular for the difficult relationship with the mother. Following the therapy with Muriaticum Acidum my mother confided that I had saved her because she was in a dead end with no way out while the administration of the remedy had allowed her to get out of the vicious circle fueled by the sense of guilt and by the interference of her grandmother.

The child reacted to this imposition by manifesting with the regurgitation a real rejection of the excessive interference of relatives and doctors in what was his relationship with his mother.

The excessive medicalization of simple gastroesophageal reflux and the side effects of allopathic reflux drugs
The excess diagnosis of gastroesophageal reflux disease compared to a simple reflux is also discussed in the pediatric field, especially as regards premature infants. In an article published in Pediatrics the comparison on this issue of reflux among neonatologists, gastroenterologists and pulmonologists gave rise to very different opinions on the criteria of diagnosis of gastroesophageal reflux disease (15). Often atypical symptoms are attributed to gastroesophageal reflux which do not find a recognizable cause in other areas of the body and there is a discussion among the various specialists regarding the criteria for intervening with the therapy and in what circumstances. The use of pump inhibitors or antacids as an ex adiuvatibus criterion, foreseen by the previous guidelines,

It should also be considered that in pediatrics some proton pump inhibitors are used off-label, that is to say with the use in clinical practice of drugs already registered but used in situations which, due to pathology, population or dosage, are prescribed in a way that does not itself and therefore without an approval of the Ministry of Health present on the technical data sheet and on the package insert. Pediatric clinical studies are lacking and adult studies cannot be adapted to children who are not small adults. Furthermore, the evidence of the ex-adjuvant bus use of these drugs is far from unassailable. In this regard, in a recent double-blind randomized parallel group study, Infants investigated for symptoms attributed to Gastroesophageal Reflux Disease were treated with lansoprazole or placebo for 4 weeks: there was no difference in terms of clinical response between the 2 groups (approximately 50% response in both groups) (16). After repeated studies that confirmed this type of results, the same guidelines for the use of proton pump inhibitors have been modified and no longer provide for the use of these drugs in the absence of a precise diagnosis, let alone the ex-adjuvant bus criterion that was admitted by the previous guidelines. (17) After repeated studies that confirmed this type of results, the same guidelines for the use of proton pump inhibitors have been modified and no longer provide for the use of these drugs in the absence of a precise diagnosis, let alone the ex-adjuvant bus criterion that was admitted by the previous guidelines. (17) After repeated studies that confirmed this type of results, the same guidelines for the use of proton pump inhibitors have been modified and no longer provide for the use of these drugs in the absence of a precise diagnosis, let alone the ex-adjuvant bus criterion that was admitted by the previous guidelines. (17)

In the previous guidelines it was enough to suspect that there were different symptoms such as crying or coughing which could not otherwise be explained in order to be able to prescribe drugs of this power by the base pediatricians. On the contrary, the use off label in the first year of life is plausible according to recent acquisitions only when dramatic events related to hydrochloride secretion such as ALTE (Apparent Life Threatening Events) (cyanosis and apnea from GERD) in which reflux has a course occur aggressive with impaired growth and state of health and it would be appropriate that the administration of these drugs should take place according to directives issued by a third level center specialized in pediatric gastroenterology and not on an empirical basis.

Ranitidine is part of the H2 antisecretory which are drugs that have approved indications for Gastroesophageal Reflux Disease in children. However their use is not free from possible complications. A recent study shows that the use of ranitidine in infants is associated with an increased risk of infections, necrotizing enterocolitis and fatal events and the use of these drugs in neonatal age should also be conducted with extreme caution (18). Furthermore, any drug introduced into the organism can determine in sensitive patients a “homeopathic” pathogenesis which must also be considered in the diagnosis and in the choice of the most suitable homeopathic therapy. For ranitidine, possible side effects that also affect the mental sphere are reported in the literature. a case of auditory and visual hallucinations has been reported after a single dose of ranitidine in a 72-year-old patient (19). It is reported in the literature that cimetidine, another H2 receptor antagonist, has resulted in 47 cases of neurological and psychiatric side effects (20). In any case, it is reported in the literature (21) that ranitidine can cause agitation, delirium, hallucinations, hostility, paranoia, depression, disorientation among its side effects. Cases have been reported in adults where Helicobacter eradication therapy resulted in transient episodes of psychosis that regressed after cessation of therapy (22) (23) it resulted in 47 cases of neurological and psychiatric side effects (20). In any case, it is reported in the literature (21) that ranitidine can cause agitation, delirium, hallucinations, hostility, paranoia, depression, disorientation among its side effects. Cases have been reported in adults where Helicobacter eradication therapy resulted in transient episodes of psychosis that regressed after cessation of therapy (22) (23) it resulted in 47 cases of neurological and psychiatric side effects (20). In any case, it is reported in the literature (21) that ranitidine can cause agitation, delirium, hallucinations, hostility, paranoia, depression, disorientation among its side effects. Cases have been reported in adults where Helicobacter eradication therapy resulted in transient episodes of psychosis that regressed after cessation of therapy (22) (23)

As for ranitidine, it is interesting to note that the reduction of gastric secretion is accompanied by an increase in gastrin and that the substances similar to gastrin perform the function of neurotransmitters at the level of the central nervous system (24) present in a brain areas that are related with behavior and affectivity.

In the clinical case reported, after the introduction of ranitidine, the baby had completely changed his sleep-wake rhythm, was irritable and had more and more prolonged crying episodes. Although it is difficult to attribute the symptom to reflux or the drug, however, stopping the drug and starting homeopathic therapy had quickly led to the disappearance of these mental symptoms.

In the second case, the administration of Ranitidine had been much more prolonged, given the clinical conditions of the child, and therefore it had been necessary to antidote the allopathic drug homeopathically through a phase in which Nux Vomica had been administered which, in addition to being a general antidote as regards the side effects of drugs, it is also a specific antidote for H2 antisecretors in my experience and has a significant effect in promoting the transition to the most appropriate homeopathic therapy. In the case of proton pump inhibitors, in my clinical practice they were more effective as specific antidotes of remedies such as Magnesium Muriaticum and Magnesium Carbonicum depending on the single proton pump inhibitor involved.

There are notable similarities between the remedies and the aforementioned drugs that we do not have the space to investigate but that clearly link the remedies to the drugs according to the studies on the homeopathic symptoms of the allopathic drugs that I have carried out and which have been partially reported in other Congresses (25) Proton pump inhibitors can also cause central side effects. In this case too, recent studies hypothesize an association between protastr pump inhibitor-induced hyperastrinemia and the activation of gastrin releasing peptide (GRP) receptors, located at the hippocampus and amygdala levels (26). There have been reports of lethargy after taking omeprazole (27) in addition to other side effects. All of this highlights how proton pump inhibitors,

In the second clinical case we are in the presence without a shadow of a doubt of a GERD that arose in a child with cerebropathy. In such cases, GERD can be very serious and prevent the child’s feeding and growth by also hindering reflux oesophagitis which in these cases complicates the recovery of the child’s growth and psychomotor acquisitions.

The child also had a symptomatology characterized by jerks and jerks of the head which closely resembled Sandifer’s syndrome which is a paroxysmal dystonic disease of movement associated with gastroesophageal reflux. Such dystonic movements are characterized by an abnormal posture of the head and neck and by severe bowing of the dorsal spine. The seizures usually last 1-3 minutes and can occur more than 10 times a day, however they are generally related to the ingestion of food. Vomiting, malnutrition, anemia, epigastric disorders, hematemesis and abnormal eye movements have also been observed.

Reflux esophagitis is common. In this disease, reflux therapy generally makes this syndrome totally disappear. This syndrome is thought to be due to a pathological reflex that occurs in response to abdominal pain caused by gastroesophageal reflux and esophagitis. Although discordant results have been obtained, some authors have speculated that dystonic posture reduces abdominal pain. Sandifer’s syndrome is diagnosed based on the association between gastroesophageal reflux and characteristic movement disorders (28). Although the patient did not have the typical movements of this syndrome, he nevertheless had tremors and jolts as well as tics that could in part be related to the existence of reflux.

Initially the phase of therapy with Nux Vomica was necessary to allow the suspension of ranitidine both for its action as a general antidote as well as specific to this molecule but also to avoid paroxysmal phenomena of increase in acidity at the suspension of therapy which are always possible, as Goodman-Gilman also states, pharmacology reference text (29). Subsequently, the resumption of growth was important thanks to a constitutional and antimiasmatic remedy such as Calcarea Fluorica which went to turn off the syphilis present from the beginning for the child. Calcarea Fluorica also corresponded to the laxity of the joints and to the disharmonious and unnatural positions that the child assumed, together with the other syphilitic symptoms that he had presented since birth.

Helleborus Niger, as reported in medical subjects, presents characteristic movements of the head with a rocking back and forth as well as presenting a detachment of reality and an indifference to the external world (30) which closely resembled the situations in which the patient found himself as dazed and unresponsive to external stimuli as well as having rocking movements of the head forward and backward along with nocturnal jolts and tics with muscle twitches. After the administration of Helleborus these symptoms disappeared and the child opened up to the outside world and to the other children by participating in the games. The night’s rest has improved, the child grows and even the reflux has never reappeared. The other cases described in brief are further demonstrations of the importance of anti-miasmatic therapy to bring children back to the best chance of growth and health. Homeopathic reflux therapy in children must not be limited to symptom control but must necessarily include this pathology in the wider context of the miasmatic evaluation. The atypical symptoms of reflux are as many manifestations that have the same miasmatic basis and that express in different forms the same perturbation of the vital force that has invaded the organism. Only through a deep homeopathic therapy that affects this basis can the symptom not only be cured but the child redirected towards health and recovery of his / her own possibilities.

Conclusions
Gastroesophageal reflux, so frequent in current diagnoses, is nothing more than a miasmatic manifestation and can be in the early stages simply the expression of a latent psora symptom as indicated by Hahnemann. Excess medicalization of the problem can lead to an activation and chronicization of the miasma. When it is associated with atypical symptoms affecting many areas of the body, it can well represent the ignition of the psora which in a proteiform way affects the organism with many different manifestations but which has the same miasmatic pathological process at its base. The push towards sicosis is often evident in particular in patients undergoing allopathic therapies.

In some cases, such as a part of those described, gastroesophageal reflux manifests itself from birth in a serious way, threatening the possibility of feeding, testifying that from the beginning the presence of a family as well as individual miasma of the syphilis type, which it manifests itself in all its seriousness and clinical expression in a context of miasmatic overlap from the beginning more complex.
Homeopathic therapy can play an important role in pediatric gastroesophageal reflux. The miasmatic evaluation represents the basis for planning the best therapeutic conduct in the individual clinical case. In this case, it is possible to identify the presence of symptoms of latent psora from the beginning and check that it does not manifest itself over time with clinical manifestations in some district of the organism.

Homeopathic therapy can also bring the psora back to latency in cases where reflux occurs from the beginning with its activation in the clinical pictures diagnosed as GERD or gastroesophageal reflux disease. It is able to specifically antidote the possible side effects of allopathic drugs if they have been used. Often the allopathic suppression of an exonerative symptom such as vomiting or reflux by drugs can be the first point of ignition of the miasma. Finally, homeopathy is able to treat serious pathologies that have a complex miasmatic basis in which the disease occurs in patients affected by other important pathologies such as cerebropathies and in which the burden of family miasms is particularly evident from birth.
As stated by Ortega (31) the psora is a fundamental pathological condition that the human being has produced over his innumerable generations … consequence of the transgressions to the limitations that nature itself imposes on the human being ….. a brake or impediment to the total expression of being.

Gastroesophageal reflux is a pathology in which the miasmatic component is particularly evident and which through its various manifestations limits and hinders the free expression of children’s vital force in children and homeopathic therapy must always keep this nature in mind in order to rebalance and re-harmonize the miasmatic perturbation of the small patients allowing to fully recover the free expression of their potential.

 

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