Integrative Unani pharmacotherapy in chronic gastroesophageal reflux disease: A case report

Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder that often requires prolonged proton pump inhibitor (PPI) therapy. It frequently coexists with Helicobacter pylori-associated gastritis. Limitations of long-term PPI use, symptom recurrence, and patient adherence have increased interest in complementary medical systems. Unani system of medicine (USM) conceptualizes reflux-like disorders as disturbances of digestion and gastric temperament, emphasizing mucosal protection and physiological restoration.

A 39-year-old man with a four-year history of severe GERD presented with persistent heartburn, regurgitation, epigastric burning, nausea, and sleep disturbance. Baseline investigations revealed H. pylori associated pangastritis in endoscopy, and Grade II-III reflux on barium swallow. After a brief course of conventional triple therapy for background gastritis, a structured 12-week Unani regimen was initiated as the primary intervention for GERD. Lifestyle corrections and dietary counseling were also provided. PPI therapy was discontinued after two weeks. Clinical symptoms, quality of life scores, imaging findings, and safety parameters were monitored.

The patient demonstrated progressive and clinically meaningful improvement with marked reduction in GERD-HRQL scores. Follow-up endoscopy showed descriptive improvement in gastric mucosa, and barium swallow findings normalized by week 14. The laboratory test results remained normal, and no adverse effects were reported. Clinical improvement was maintained at six-month follow-up without PPI use.

In this case, a structured Unani regimen administered after short-term conventional therapy was temporally associated with improvement in chronic GERD symptoms and functional outcomes. Although gastritis improved descriptively, post-treatment H. pylori eradication was not assessed. Given the inherent limitations of a single-patient design, controlled clinical studies are required to confirm the efficacy and elucidate the mechanisms.