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 reflux of stomach content causes 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 sensation of the esophagus and the stomach
- control of the opening of the lower end of the esophagus.
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