Gastroesophageal reflux disease

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 often exacerbated by certain food, the link between GERD and food is discussed below.

GERD is defined as a condition which develops when content of the stomach flows back (reflux) into the esophagus causing symptoms and / or complications.

Reflux may or may not be consciously perceived.

Increased reflux can be due to mechanical reasons, such as reduced closure of the end of the esophagus (e.g. hiatal hernia), increased pressure in the abdomen (e.g. obesity, pregnancy), or 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, and the immune reaction of the mouth and the esophagus (allergic reactions).

Approximately 15% of adults have GERD at least once per week and 7% have GERD at least once daily. It is the most common gastrointestinal disorder next to functional bowel disease.

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, with corresponding symptoms. These may include chronic cough or sinusitis, sore throat, hoarseness, voice changes, sensitive teeth and post nasal drip.

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. Biopsies can be taken during endoscopy to exclude changes in the lining (Barrett’s mucosa), as well as eosinophilic esophagitis.

In case of uncertainty regarding the diagnosis or severity of reflux, measuring the amount of acid reflux using pH-metry or pH-impedance is warranted.

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. Other lifestyle modifications are:

• If overweight, lose weight.
• Avoid tight clothing.
• Limit the consumption of coffee, nicotine and alcohol (especially red and white wine).
• Eat smaller meals. If necessary increase meal frequency rather than size
• Do not eat a full meal before going to bed.
• Some medicines can intensify acid reflux. Consult your GP. In some cases it may be possible to switch to less predisposing medication.

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 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.