Homeopathic management of Erosive pangastritis with polyp and hiatus hernia

Dr Abhishek M Sutrave

Abstract
This case report describes erosive pangastritis with a superimposed diminutive fundal polyp and a small hiatus hernia, along with Helicobacter pylori infection. A 35-year-old male presented with a constellation of symptoms, including abdominal bloating, epigastric pain, increased appetite, hunger headaches, and bilious vomiting, along with a concurrent sensation of rectal burning. The patient had been undergoing conventional treatment with proton pump inhibitors twice a day. Endoscopic evaluation revealed a positive Rapid Urease Test (RUT), confirming Helicobacter pylori infection, as well as a small hiatus hernia, diminutive fundal polyp, and erosive pangastritis. Skin eruptions that had occurred in the past reappeared after two and a half months of homeopathic treatment, illustrating Hering’s Law of Cure. Holistic homeopathic treatment led to a remarkable improvement in the patient’s quality of life, marked by the relief of all symptoms, ultimately resulting in the discontinuation of conventional medications, including homeopathy, within a timeframe of 6 months, with no recurrence observed during the subsequent 6 months of follow-up.

Introduction
Erosive pan gastritis is a medical condition characterised by inflammation and erosion of entire stomach lining, involving both the antrum and fundus of the stomach. This is a more severe form of gastritis diagnosed through endoscopy. Common cause of gastritis includes Helicobacter pylori (H. Pylori) infection, Prolonged use of NSAIDs, Alcohol abuse, stress trauma and autoimmune conditions. H. Pylori infection affects around 50% of the population world-wide with higher prevalence in developing countries. Majority of patients with H. Pylori infection remain asymptomatic, if symptoms are present, usually abdominal pain, nausea, vomiting or dyspepsia. But not everyone who is exposed to H. pylori will develop infection and the reason why some individuals become infected while others don’t is still unknown. Erosive gastritis is classified in ICD-10 diagnostic manual under the code 2023 ICD-10-CM Diagnosis Code K29.60

The urease activity of H. pylori plays an important role in countering the acidic environment of the stomach. The flagella-mediated motility helps H. pylori bacterium move towards the host gastric epithelial cells, followed by the bacterial adhesins interacting with the host cell receptors, leading to successful colonization and persistent infection. There are many effector proteins/toxins that are released by H. pylori that lead to host tissue damage. Both acute and chronic inflammation is seen in H. pylori gastritis as eosinophils, neutrophils, mast cells, and dendritic cells are stimulated. The gastric epithelial layer also secretes chemokines to initiate innate immunity and activates neutrophils that further damages the host tissue leading to the formation of gastritis. H. Pylori infection can lead to pangastritis and can increase the risk of hiatus hernia due to inflammation and irritation of stomach lining have weakened the LES over time.

Long-term Proton pump inhibitor (PPI) use can promote development of fundal gland polyp in the stomach because the decrease in stomach acidity leads to increased production of gastrin. Gastrin has trophic effects that lead to parietal cell and enterochromaffin-like cell hyperplasia and the formation of fundic gland polyps (FGPs) are seen. This case presented endoscopy findings are diminutive fundal polyp i.e., >5 mm.

Case report

• Name- Mr. A
• Age- 35 yr.
• Sex- Male
• Occupation – Bank employee
• Marital status- married
• Religion- Hindu
• Address-
• Date- 22.9.22

Presenting Complaint
C/o epigastric pain, increased appetite, rectal burning, bilious vomiting, hunger headache since 6 months.

History Of Presenting Complaints
Patient was apparently well 6 months ago. The started the pain in the epigastric region with increased appetite and was taking Proton pump inhibitors twice a day for 6 months with not much amelioration of symptoms. Then consulted the doctor and advised to go through endoscopy.

Location	sensation	Modalitiy	concomitant
1.     Abdomen- epigastric and stomach	pain	<hunger during, midnight after >eating, eructation	Appetite increased.
2.     Rectum	burning	<during stools
3.     Head	Pain	<hunger >vomiting > eating	Bilious Vomiting

Past History

• Inguinal eruption from age of 20 -24 (Rx conventional medicine with external application)
• Recurrent mouth ulcer during exams from 10-23 years of age.

Family History

Father- lung CA

Mother – apparently healthy.

Elder Sister- Allergic tendencies.

Personal History

• Diet- Mixed
• Appetite- increased since 6 months
• Hunger – increased since 6 months
• Thirst – Thirsty+
• Desire- Sour fruits since childhood
• Aversion – Nothing specific (N.S)
• Urine- 3-4 times / day, no burning & itching
• Bowel movement – once a day with no associated complaints.
• Perspiration – generalised
• Sleep –good
• Dreams – N.S
• Thermals – chilly patient +

Life Space Investigation

Patient was introvert since childhood. Had few friends because he could not go and talk to new people, and the reason for not being able to make new friends or talk to people would be he was not courageous enough. He had tremendous anticipatory fear before exams since his childhood, was not able to sleep the day before, but the performance in the exams would be quite good. He always developed mouth ulcer before exams. Never was confident enough to go on stage on talk. He knows he has the capability to take up the task and perform, he knows he has experience but he is not confident enough and ends up not taking up the task. He is fast in learning new things. He was finally got a job as assistant manager in a bank. Right before patient developed Gastric disturbances there was an accountancy issue in the office, and a notice was sent to him to acknowledge and address the issue, he was summoned by higher authority to give an explanation about the situation. Patient was so stressed out about this, he was not able to approach the higher authority even though he was summoned to do so, had lost confidence in his job which he had been doing since almost 4 years. He ended up and trying to solve it although it was a small issue, he feels he can solve it but had no confidence to go and approach superiors and talk it out. Whenever he is tensed about any situation he tends to eat a lot sometimes with hunger and sometimes without hunger and he feels better.

General Physical Examination And Vitals

• Conscious & oriented with time, place and person.
• No edema, clubbing, cyanosis, icterus, pallor
• BP- 110/70mm Hg
• PR – 76 beats/ min
• Temp – afebrile at the time of examination

Systemic Examination

• Respiratory system -B/L normal vesicular breathing sounds, heard No added sounds
• Cardiac system – S1 & S2 heard, no murmur heard.
• Gastrointestinal system

Inspection: no scar, no lump, no visible pulsation

Palpation: no tenderness

Percussion: tympanic note heard

Auscultation: 3 to 5 bowel sounds heard per minute

Laboratory Investigation & Findings

• Endoscopy done on September 2022 –

Erosive pangastritis

RUT positive

Small hiatus hernia

Diminutive fundal polyp

Provisional Diagnosis: Erosive pangastritis

Classification Of Disease: Chronic Miasmatic Pseudo-Psora

School of Philosophy – Kent School of Philosophy

Analysis Of Case

Common symptoms	Uncommon symptoms
Epigastric pain Stomach pain < midnight after+ < hunger + Rectum burning< stool during+ Headache < hunger during +, > eating++	Stomach pain > eructation++ > eating+++   Appetite increased ++ Headache > bilious vomiting +

Evaluation Of Symptoms

Mental generals	Physical generals	Characteristic particulars
Low confidence+++	Sour fruits desire+ Appetite increased. ++ Eating amelioration +++	Epigastric pain Stomach pain < midnight after+ Rectum burning< stool during+ Headache < hunger during + > eating++ Stomach pain > eating +++ > eructation ++ Headache >bilious vomiting

 Totality Of Symptoms

• Low confidence+++
• Epigastric pain
• Stomach pain < midnight after+ < hunger during+
• Stomach pain > eating +++, > eructation ++
• Rectum burning< stool during+
• Headache < hunger during + > eating++
• Headache > bilious vomiting+
• Stomach pain > eating +++, > eructation ++
• Stomach appetite increased++
• Generalities> eating +++

Repertorial Approach- Vithoulkas compass

Repertorial Totality

• Low confidence+++
• Epigastric pain
• Stomach pain < midnight after+ < hunger during+
• Stomach pain > eating +++, > eructation ++
• Rectum burning< stool during+
• Headache < hunger during +
• Headache > bilious vomiting
• Generalities > eating +++

Repertorization Proper

• Anacardium orientale 6/13
• Baryta carbonicum 6/13
• Iodium 7/13

Prescription

• Anacardium orientale 10M one dose
• Natrum sulphuricum (NS) 6x 2-2-2
• Rubrum TID

Basis Of Prescription
Based on analysis of mental generals, physical generals, particulars and reportorial result Anacardium was prescribed. Even though both Anacardium and Baryta carb both have low confidence in the same intensity, Baryta carb there is immaturity, slowness in grasping things (which was not seen in this case) but Anacardium don’t have slowness in perception or learning. There was also characteristic symptom which was eating amelioration was seen for headache, gastric complaints and when he is generally tensed eating makes him feel better. Eating amelioration and increased appetite is not a common symptom in gastric ulcer or erosive conditions of stomach whereas it is quite common in duodenal ulcers (endoscopy shows that the duodenum is normal) hence this particular symptom has greater value in this case. 10 M was chosen because the pathology was mainly in mental level i.e., low confidence.

Follow up

Date	Symptoms	Conventional medicine	Prescription
1/11/22	➢    Gastric complaints better by 50 % ➢    increased appetite is reduced	➢    PPIs once a day	Rubrum TID NS 6x TID
10/12/22	➢    Gastric complaints better by 90% ➢    Low confidence improved. ➢    Inguinal eruptions reappeared (old complaint)	➢    PPIs once/twice a week	Rubrum TID NS 6x TID
25/1/23	➢    Gastric complaints almost absent. ➢    Inguinal eruptions better by 80%	➢    PPIs last 15 days one tablet	Rubrum TID NS 6x TID
23/3/23	➢    No complaints ➢    Gastric complaints absent ➢    Inguinal eruptions absent.	➢    No PPIs in last 1 month	Stopped homeopathic medicines

Conclusion
Homoeopathy is a individualised treatment. Most of the gastric complaints stem from affections on mental plane. In this case striking mental features were elicited and used to prescribe. Betterment in this physical pathology was marked seen once the old complaints appeared i.e., skin eruption and after which reliability on the PPIs were drastically reduced. Skin eruptions were left untreated with any change of remedy because there was drastic improvement in the gastric pathology. Pathological changes could not be seen due to unwillingness of patient to get an endoscopy done. Homeopathy can stop the further advancement in the condition with improvement in quality of life too.

Conflict of interest – Nil

Funding – Nil

Consent for publication– written informed consent was obtained from the patient for publication of this case report.

Dr Abhishek M S
PG Scholar, Department of Practice Of Medicine
Government Homoeopathic College & Hospital Bangalore- 560079
abhishekm.nov1996@gmail.com

Under The Guidance Of
Dr Praveen Kumar PD
HOD & Professor Department of Practice of Medicine
Government Homoeopathic College & Hospital Bangalore- 560079