A detailed treatise of gastroesophageal
reflux (GERD) is not within the scope of this
website, which deals with adverse reactions to
food. However, as GERD is in a large
proportion of patients exacerbated by certain
foods, the link between GERD and food is
discussed below.
Causes and symptoms
GERD is defined as a condition which
develops when content of the stomach flows back (reflux) into the esophagus causing
symptoms and / or complications. These include
heartburn, pain in the upper abdomen, chest or
behind the breastbone, acid or bitter taste
and swallowing difficulties. Damage to the
esophagus, such as inflammation, stricture
(narrowing due to scarring), cancer, or damage
to other organs, including teeth, sinuses,
lungs or throat may occur. Reflux signifies
the flow of stomach contents into the
esophagus, which may or may not be perceived.
The increased reflux can be due to mechanical
reasons, such as reduced closure of the end of
the esophagus (e.g. hiatal hernia) or
increased pressure in the abdomen (e.g.
obesity, pregnancy), as well as dysfunction of
the nervous control of the esophagus (e.g.
transient relaxations of the lower esophageal
sphincter muscle). Certain foods are known to
affect the:
- production of stomach secretions and
acid
- emptying of the stomach
- sensitivity of the
esophagus and the stomach
- control of the opening of the lower end
of the esophagus
- immune reaction of the mouth and
the esophagus (allergic reaction)
Frequency in population
- Approximately 15% of adults have GERD
at least once per week and 7% have GERD at
least once daily.
- It is the commonest gastrointestinal
disorder next to functional bowel disease.
Testing and diagnosis
A detailed history is important and in
younger patients an initial trial of
acid-blocking drugs together with lifestyle
modifications (avoidance of exacerbating
foods, weight loss, and elevation of head of
bed) can be tried. In older patients and in
those not responding to a trial of the above
measures, endoscopy should be undertaken. In
case of uncertainty, measuring the amount of
acid reflux using pH-metry or pH-impedance is
warranted.
Management
The foods most commonly reported to
increase GERD include caffeine or coffee,
black or peppermint tea, citrus fruit
products, chocolate, spicy or fatty foods,
mint products, carbonated beverages and
alcohol. While studies of the detrimental
effects of many of these foods on underlying
GERD mechanisms have been reported, there is
no conclusive evidence from high quality
studies in patients demonstrating a beneficial
effect on symptoms or complications of GERD
with reduction or abstinence from these foods.
Therefore, the verdict is currently still out.
However, in case of GERD symptoms a probatory
reduction of the above listed foods, as well
as avoiding late night meals and tobacco use
is reasonable, besides seeking medical advice
for necessary diagnostics and drug treatment.
Weight loss and sleeping on your left side
have been shown to effectively reduce GERD.
Links to literature