Panahi Y, Khedmat H, Valizadegan G, Mohtashami R, Sahebkar A. Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: a pilot randomized positive-controlled trial. J Tradit Chin Med. 2015;35(6):632-636.
To assess the efficacy of aloe vera in reducing symptoms of gastroesophageal reflux disease (GERD), and to compare it with the efficacy of omeprazole, a proton pump inhibitor (PPI), and ranitidine, a histamine 2 receptor antagonist (H2RA)
Randomized, open-label, positive-controlled trial
Participants received either 10 ml of aloe vera syrup per day (standardized to 5.0 mg polysaccharide per mL), an omeprazole capsule (20 mg per day), or ranitidine tablets (150 mg in the morning and 150 mg before sleep at night) for a period of 4 weeks.
Participants were between the ages of 18 and 65, diagnosed with GERD, and referred for endoscopy. A total of 79 participants were enrolled in the study; however, 4 participants dropped out due to adverse events (2 in the ranitidine group and 2 in the omeprazole group). Exclusion criteria included pregnancy, breastfeeding, and presence of hematemesis, odynophagia, treatment-resistance GERD, other gastrointestinal disorders, hepatic disease, hematological diseases, use of muscle relaxant medications, or history of sensitivity to aloe vera.
Study Parameters & Primary Outcomes
A modified Reflux Disease Questionnaire consisting of 8 key symptoms of GERD (heartburn, food regurgitation, flatulence, belching, dysphagia, nausea, vomiting, and acid regurgitation) was used to evaluate the efficacy of each treatment. These symptoms were assessed at weeks 2 and 4 of the trial, and then compared among treatment groups.
The group who received aloe vera syrup experienced reduced frequency of all assessed GERD symptoms at weeks 2 and 4 compared to baseline, without any intolerable effects. However, when compared to both conventional treatment groups, aloe vera syrup was less effective at reducing frequency of heartburn, flatulence, and belching. While perhaps less effective for those specific symptoms, aloe vera syrup was found to be a safe, effective, and well-tolerated treatment option.
The results of this study show that aloe vera syrup is a safe, effective, and well-tolerated treatment for common symptoms of GERD.
Both groups treated with conventional medication (omeprazole and ranitidine) experienced a more significant reduction in the frequency of all assessed GERD symptoms at both assessment intervals when compared to baseline, and compared to the aloe vera. However, each group in the conventional arm had 2 patients drop out due to adverse effects, while the aloe vera arm had no dropouts.
The results of this study show that aloe vera syrup is a safe, effective, and well-tolerated treatment for common symptoms of GERD. While symptomology was more reliably improved with acid-blocking drugs, this appeared to have a greater risk of intolerable side effects as well.
Other studies support the use of aloe vera in the treatment of GERD. A recent study published in JAMA suggests that the pathogenesis of reflux esophagitis may be due to inflammation rather than chemical injury caused by gastric acid.1 In 2007, Yoshida published a study also implicating inflammation and oxidative stress in GERD.2 Aloe vera has proven anti-inflammatory and antioxidant properties,3 so these actions may contribute to its benefits for symptoms of GERD. A study published in 2012 showed that Faringel, an antacid supplement containing aloe vera gel, reduced heartburn in patients with erosive and non-erosive esophagitis.4 Given its anti-inflammatory effects, aloe vera may be beneficial for long-term complications associated with GERD, such as Barrett's esophagus. However, there are no clinical trials published to date on that topic. Numerous animal and human studies have demonstrated positive effects of aloe vera in other gastrointestinal conditions such as Helicobacter pylori infection,5-6 irritable bowel syndrome,7 ulcerative colitis,8-9 and peptic ulcer.10-11
Although aloe vera syrup was overall less effective in reducing the assessed GERD symptoms compared to both conventional treatment options, these types of medications have numerous adverse effects. Recent studies have linked use of PPIs with an increased risk of hip fracture,12-13 dementia,14 enteric infection and overgrowth,15 myocardial infarction and overall cardiovascular mortality,16 kidney disease,17 cellular aging,18 and others. Despite having a milder adverse effects profile than PPIs, H2RAs have been linked with an increased risk of bacterial overgrowth,19 rebound hypersecretion,20 and vitamin B12 deficiency.21 Histamine 2 receptor antagonists, especially cimetidine, also inhibit the liver enzyme cytochrome P450 which can significantly impact metabolism of numerous drugs.22
In addition to aloe vera, many other natural therapies have been shown to have positive effects on GERD, including diet and lifestyle modifications,23-26 d-limonene,27 melatonin,28 and Iberogast.29 In addition, numerous articles reviewing natural treatments for GERD are available.30-32
- Dunbar KB, Agoston AT, Odze RD, et al. Association of acute gastroesophageal reflux disease with esophageal histologic changes. JAMA. 2016;315(19):2104-2112.
- Yoshida N. Inflammation and oxidative stress in gastroesophageal reflux disease. J Clin Biochem Nutr. 2007;40(1):13-23.
- Surjushe A, Vasani R, Saple D. Aloe vera: a short review. Indian J Dermatol. 2008;53(4):163-166.
- Savarino E, de Bortoli N, Zentilin P, et al. Alginate controls heartburn in patients with erosive and nonerosive reflux disease. World J Gastroenterol. 2012;18(32):4371-4378.
- Kumari CS, Prasad CVN, Ramulu JS. Determination of in-vitro and in-vivo activities of Aloe vera L. against H. pylori. Int J Pharma Bio Sci. 2010;1(2):1-8.
- Cellini L, Di Bartolomeo S, Di Campli E, Genovese S, Locatelli M, Di Giulio M. In vitro activity of Aloe vera inner gel against Helicobacter pylori strains. Lett Appl Microbiol. 2014;59(1):43-48.
- Asadi-Shahmirzadi A, Mozaffari S, Sanei Y, et al. Benefit of Aloe vera and Matricaria recutita mixture in rat irritable bowel syndrome: combination of antioxidant and spasmolytic effects [published online ahead of print December 21, 2012]. Chin J Integr Med. doi:10.1007/s11655-012-1027-9.
- Langmead L, Feakins RM, Goldthorpe S, et al. Randomized, double-blind, placebo-controlled trial of oral aloe vera gel for active ulcerative colitis. Aliment Pharmacol Ther. 2004;19(7):739-747.
- Korkina L, Suprun M, Petrova A, Mikhal'chik E, Luci A, De Luca C. The protective and healing effects of a natural antioxidant formulation based on ubiquinol and Aloe vera against dextran sulfate-induced ulcerative colitis in rats. Biofactors. 2003;18(1-4):255-264.
- Yusuf S, Agunu A, Diana M. The effect of Aloe vera A. Berger (Liliaceae) on gastric acid secretion and acute gastric mucosal injury in rats. J Ethnopharmacol. 2004;93(1):33-37.
- Borra SK, Lagisetty RK, Mallela GR. Anti-ulcer effect of Aloe vera in non-steroidal anti-inflammatory drug induced peptic ulcers in rats. Afr J Pharm Pharmacol. 2011;5:1867–1871.
- Yu EW, Bauer SR, Bain PA, Bauer DC. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med. 2011;124(6):519-526.
- Khalili H, Huang ES, Jacobson BC, Camargo CA, Feskanich D, Chan AT. Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ. 2012;344:e372.
- Gomm W, von Holt K, Thomé F, et al. Association of proton pump inhibitors with risk of dementia: a pharmacoepidemiological claims data analysis. JAMA Neurol. 2016;73(4):410-416.
- Seto CT, Jeraldo P, Orenstein R, Chia N, DiBaise JK. Prolonged use of a proton pump inhibitor reduces microbial diversity: implications for Clostridium difficile susceptibility. Microbiome. 2014;2:42.
- Shah NH, LePendu P, Bauer-Mehren A, et al. Proton pump inhibitor usage and the risk of myocardial infarction in the general population. PLoS One. 2015;10(6):e0124653.
- Lazarus B, Chen Y, Wilson FP, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med. 2016;176(2):238-246.
- Yepuri G, Sukhovershin R, Nazari-Shafti TZ, Petrascheck M, Ghebre YT, Cooke JP. Proton pump inhibitors accelerate endothelial senescence. Circ Res. 2016;118(12);e36-42.
- Thorens J, Froehlich F, Schwizer W, et al. Bacterial overgrowth during treatment with omeprazole compared with cimetidine: a prospective randomised double blind study. Gut. 1996;39(1):54-59.
- Fullarton GM, McLauchlan G, Macdonald A, Crean GP, McColl KE. Rebound nocturnal hypersecretion after four weeks treatment with an H2 receptor antagonist. Gut. 1989;30(4):449-454.
- Valuck RJ, Ruscin JM. A case-control study on adverse effects: H2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults. J Clin Epidemiol. 2004;57(4):422-428.
- Penston J, Wormsley KG. Adverse reactions and interactions with H2-receptor antagonists. Med Toxicol. 1986;1(3):192-216.
- Festi D, Scaioli E, Baldi F, et al. Body weight, lifestyle, dietary habits and gastroesophageal reflux disease. World J Gastroenterol. 2009;15(14):1690-1701.
- Song JH, Chung SJ, Lee JH, et al. Relationship between gastroesophageal reflux symptoms and dietary factors in Korea. J Neurogastroenterol Motil. 2011;17(1):54-60.
- Austin GL, Thiny MT, Westman EC, Yancy WS Jr, Shaheen NJ. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis Sci. 2006;51(8):1307-1312.
- Singh M, Lee J, Gupta N, et al. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial. Obesity (Silver Spring). 2013;21(2):284-290.
- Sun J. D-Limonene: safety and clinical applications. Altern Med Rev. 2007;12(3):259-264.
- Kandil TS, Mousa AA, El-Gendy AA, Abbas AM. The potential therapeutic effect of melatonin in gastro-esophageal reflux disease. BMC Gastroenterol. 2010;10:7.
- Melzer J, Rosch W, Reichling J, Brignoli R, Saller R. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther. 2004;20(11-12):1279-1287.
- Meletis CD, Zabriskie N. Natural approaches for gastroesophageal reflux disease and related disorders. Altern Complement Ther. 2007;13(2):64-70.
- Sandberg-Lewis S. Proton pump inhibitors-a risky experiment? Townsend Letter for Doctors and Patients. http://www.townsendletter.com/FebMarch2011/protonpump0211.html. Published February, 2011. Accessed July 8, 2016.
- Patrick L. Gastroesophageal reflux disease (GERD): a review of conventional and alternative treatments. Altern Med Rev. 2011;16(2):116-133.