Different effects of dietary factors on reflux esophagitis and non-erosive reflux disease in 11,690 Korean subjects

Risk factors and 26-years worldwide prevalence of endoscopic erosive esophagitis from 1997 to 2022: a meta-analysis

Erosive esophagitis (EE) is the part of gastroesophageal reflux disease (GERD) spectrum and may progress to esophageal adenocarcinoma. Due to its progressivity and unclear prevalence, we aim to identify the factors contributing in EE to decide the need for further examination. We performed a PRISMA 2020-based systematic search through PubMed and other resources up to June 2, 2022. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). The odds ratio (OR) of each factor and worldwide prevalence of EE were measured. There are 114 observational studies included with a total of 759,100 participants. Out of 29 factors, the significant risk factors are age ≥ 60 y.o. (OR 2.03 [1.81-2.28]), White/Caucasian (OR 1.67 [1.40-1.99]), unmarried (OR 1.08 [1.03-1.14]), having GERD ≥ 5 years (OR 1.27 [1.14-1.42]), general obesity (OR 1.78 [1.61-1.98]), central obesity (OR 1.29 [1.18-1.42]), diabetes mellitus (DM) (OR 1.24 [1.17-1.32]), hypertension (OR 1.16 [1.09-1.23]), dyslipidemia (OR 1.15 [1.06-1.24]), hypertriglyceridemia (OR 1.42 [1.29-1.57]), hiatal hernia (HH) (OR 4.07 [3.21-5.17]), and non-alcoholic fatty liver disease (NAFLD) (OR 1.26 [1.18-1.34]). However, H. pylori infection (OR 0.56 [0.48-0.66]) and atrophic gastritis (OR 0.51 [0.31-0.86]) are protective towards EE. This study demonstrates that age, ethnicity, unmarried, long-term GERD, metabolic diseases, HH, and NAFLD act as risk factors for EE, whereas H. pylori infection and atrophic gastritis act as protective factors. These findings may enable a better understanding of EE and increase greater awareness to address its growing burden.

Differences in Dietary and Lifestyle Triggers between Non-Erosive Reflux Disease and Reflux Esophagitis-A Multicenter Cross-Sectional Survey in China

The occurrence of gastroesophageal reflux disease (GERD) and symptom onset are closely associated with diet. We aimed to compare the dietary and lifestyle triggers between non-erosive reflux disease (NERD) and reflux esophagitis (RE) in Chinese patients and to provide evidence for development of practical dietary modifications for GERD. A multicenter cross-sectional survey was conducted. A total of 396 GERD patients with typical gastroesophageal reflux symptoms who received upper endoscopy in the previous month were enrolled, including 203 cases of NERD patients and 193 cases of RE patients. All participants completed questionnaires including demographic data, reflux symptoms, previous management, dietary and lifestyle habits, triggers of reflux symptoms, psychological status, and quality of life. There were no significant differences in GERD symptom scores between NERD and RE. RE patients had a higher male proportion and smoking/drinking and overeating rates than NERD patients. In the NERD group, more patients reported that fruits, dairy products, yogurt, bean products, cold food, and carbonated beverages sometimes and often induced reflux symptoms and had more triggers compared to RE patients. The number of triggers was positively correlated to GERD symptom score and GERD-HRQL score in both NERD and RE patients. However, 74.0% of GERD patients still often consumed the triggering foods, even those foods that sometimes and often induced their reflux symptoms, which might be related to the reflux relapse after PPI withdrawal considering NERD and RE patients had similar GERD symptom severity. There were some differences in terms of dietary habits, dietary and lifestyle triggers, and related quality of life between NERD and RE, and these results may provide evidence of different approaches toward the dietary modification of NERD and RE patients.

Optimizing the treatment of patients with gastroesophageal reflux disease: focus on nutritional risk factors and nutritional approaches

Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disease characterized by occurrence of typical symptoms associated with an increase in esophageal acid exposure. The transient lower esophageal sphincter relaxations (TLESRs) and hypotension is the key pathophysiological mechanisms of the development of reflux disease. For a long time, it was assumed that certain nutritional and lifestyle factors affect the mechanisms of the onset and progress of GERD. However, the accumulated scientific findings show contradicting results regarding contribution of these factors to the development of reflux disease. The treatment of GERD requires lifestyle modifications, diet therapy, pharmacotherapy, and, if necessary, surgery. Proton pump inhibitors (PPIs) form the basis of pharmacotherapy. Lifestyle modifications, including dietary therapy, is also part of the treatment plan for patients with reflux symptoms, however no clear guidelines in this regard are determined due to the lack of good evidence base. Yet, while the problems associated with the long-term use of PPIs are explored, patients and physicians are increasingly interested in the role of diet in the treatment of GERD. The article provides an overview of the dietary aspects in GERD with a focus on nutritional components and their impact on the pathophysiology and treatment of this disease. Although sequential food-group elimination in GERD is common in clinical practice, literature data demonstrate a broader approach, including reduction of sugar intake, increase of dietary fibres in the diet, and changes in patterns of eating habits as a general principle.

Prevalence and beverage-related risk factors of gastroesophageal reflux disease: An original study in Chinese college freshmen, a systemic review and meta-analysis

BACKGROUND

Beverage-drinking behavior could be a potential risk factor for gastroesophageal reflux disease (GERD) in young populations. However, GERD prevalence in this population has not been investigated, and beverage consumption's association with GERD remains inconclusive. This study aimed to evaluate the prevalence and beverage-related risk factors of GERD among Chinese college freshmen and in youth around the world.

METHODS

A cross-sectional survey was conducted in Chinese college freshmen in September 2019 using random cluster sampling method. Participants completed questionnaires on demographic information, food intake frequency, and GER symptoms. Multivariate logistic regression models were applied to assess the association between beverages and GERD. Studies were retrieved from multiple databases for systemic review. The prevalence of GERD in young populations and beverage-related risk factors were pooled using random-effect models.

KEY RESULTS

Based on the 3345 individuals who completed the questionnaires, GERD prevalence in Chinese college freshmen is 5.1%. Multivariate analysis showed students who drink green tea daily, and those who drink coffee regularly were more likely to develop GERD compared with those who never drink tea or coffee. The pooled prevalence of GERD in young populations is 18.0%, and frequent alcohol consumption is positively associated with GERD in general population.

CONCLUSIONS AND INFERENCES

The prevalence of GERD in Chinese college freshmen is significantly lower than that in worldwide youth populations. Alcohol, green tea, and coffee consumption could be potential risk factors for GERD. Future large-scale epidemiological studies are warranted for reliable identification of beverage-related risk factors for GERD in young populations.

The association between helicobacter pylori infection and erosive gastroesophageal reflux disease; a cross-sectional study

BACKGROUND

The association between H. pylori (Helicobacter pylori) infection and gastroesophageal reflux disease (GERD) is a complex and confusing subject. The aim of this study was to evaluate the association between helicobacter pylori infection and erosive gastroesophageal reflux disease.

METHOD

In a cross-sectional study, all patients referred for endoscopy due to dyspepsia were enrolled. The diagnosis of erosive GERD was made by endoscopy. Patients with normal esophagus were selected as comparison group. Random gastric biopsies were taken from all participants to diagnose H. pylori infection.

RESULT

In total, 1916 patients were included in this study, of whom 45.6% had GERD. The mean age (SD) was 42.95 (16.32). Overall, 1442 (75.3%) patients were positive for H. pylori infection. The frequency of H. pylori infection in mild GERD patients was higher than the severe GERD, but this difference was not significant (P = 0.214). Except for sociodemographic status (P < 0.001), other variables including gender, age, ethnicity, body mass index (BMI), smoking, and presence of hiatus hernia in patients had no significant association with the frequency of H. pylori infection. According to Robust Poisson regression models analysis, the association of H. pylori (PR 1.026; 95% CI 0.990-1.064; P = 0.158) and sociodemographic status were not significantly different between the two groups. But smoking, increased BMI, older age, presence of hiatus hernia, and peptic ulcer diseases were significantly associated with GERD compared with the non-GERD group.

CONCLUSION

In our results, there was no association between H. pylori infection and erosive GERD. Further studies are recommended.

The impact of low-fat and full-fat dairy foods on symptoms of gastroesophageal reflux disease: an exploratory analysis based on a randomized controlled trial

PURPOSE

Gastroesophageal reflux disease (GERD) is a widely prevalent condition. High consumption of dairy foods and dietary fat are associated with worse GERD symptoms. However, existing data are inconsistent and mostly based on observational studies. The purpose of this exploratory analysis of a randomized controlled trial was to investigate the impact of low-fat and full-fat dairy food consumption on GERD symptoms.

METHODS

Seventy-two participants with metabolic syndrome completed a 4-week wash-in diet during which dairy intake was limited to three servings of nonfat milk per week. Participants were then randomized to either continue the limited dairy diet or switch to a diet containing 3.3 servings per day of either low-fat or full-fat milk, yogurt and cheese for 12 weeks. Here, we report intervention effects on the frequency of acid reflux, and the frequency and severity of heartburn, exploratory endpoints assessed by a questionnaire administered before and after the 12-week intervention.

RESULTS

In the per-protocol analysis (n = 63), there was no differential intervention effect on a cumulative heartburn score (p = 0.443 for the time by diet interaction in the overall repeated measures analysis of variance). Similarly, the intervention groups did not differentially affect the odds of experiencing acid regurgitation (p = 0.651). The intent-to-treat analyses (n = 72) yielded similar results.

CONCLUSION

Our exploratory analyses suggest that, in men and women with the metabolic syndrome, increasing the consumption of either low-fat or full-fat dairy foods to at least three servings per day does not affect common symptoms of GERD, heartburn and acid regurgitation compared to a diet limited in dairy.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02663544, registered on January 26, 2016.

Systematic review with meta-analysis: association of Helicobacter pylori infection with gastro-oesophageal reflux and its complications

BACKGROUND

Conflicting results exist on the association between Helicobacter pylori infection and gastro-oesophageal reflux (GOR), and its complications, such as erosive oesophagitis (EO) and Barrett's oesophagus (BO).

AIMS

To explore the association of H. pylori infection with GOR symptoms and their complications METHODS: We searched Embase, PubMed, Web of Science and Scopus databases through December 2020 for relevant articles. Regarding the association between H. pylori and GOR symptoms (heartburn, regurgitation or reflux), we included observational studies comparing the prevalence of GOR symptoms between H. pylori-positive and -negative individuals. Concerning the association between H. pylori and complications of GOR, we included studies comparing the prevalence of EO or BO between H. pylori-positive and -negative individuals.

RESULTS

In total, 36 papers were eligible. Based on seven cross-sectional surveys, H. pylori infection was associated with a lower odds of GOR symptoms (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.61-0.90). However, in four case-control studies, H. pylori infection was not associated with odds of GOR symptoms (OR 1.10, 95% CI 0.85-0.1.43). In 26 cross-sectional studies in patients with GOR symptoms, the OR for EO was 0.70 (95% CI 0.58-0.84) in H. pylori-positive vs -negative cases. Based on nine cross-sectional studies in subjects with GOR complications, no significant association was found between H. pylori infection and either endoscopically-diagnosed (OR 1.84, 95% CI 0.67-5.02) or histologically confirmed (OR 0.85, 95% CI 0.60-1.20) BO.

CONCLUSIONS

Helicobacter pylori infection appears to be associated with a decreased odds of GOR symptoms and EO. In contrast, H. pylori infection did not seem to affect the odds of BO in patients with GER complications.

Elimination of Dietary Triggers Is Successful in Treating Symptoms of Gastroesophageal Reflux Disease

BACKGROUND

The relationship between aliments and pathophysiological abnormalities leading to gastroesophageal reflux disease (GERD) symptoms elicitation is unclear. Nevertheless, patients often report symptoms after ingestion of specific foods.

AIMS

To identify in primary care setting the presence of foods able to trigger GERD symptoms, and evaluate whether a consequent specific food elimination diet may result in clinical improvement.

METHODS

Diagnosis of GERD and quantification of reflux symptoms were done according to GERD-Q questionnaire (positive when > 8). During clinical data collection, patients were asked to report aliments associated with their symptoms. Also, a precompiled list of additional foods was administered to them. Then, patients were requested to eliminate the specific foods identified, and to come back for follow-up visit after 2 weeks when GERD-Q questionnaire and clinical data collection were repeated.

RESULTS

One-hundred GERD (mean GERD-Q score 11.6) patients (54 females, mean age 48.7 years) were enrolled. Eighty-five patients reported at least one triggering food, mostly spicy foods (62%), chocolate (55%), pizza (55%), tomato (52%), and fried foods (52%). At follow-up visit, the diagnosis of GERD was confirmed in only 55 patients, and the mean GERD-Q score decreased to 8.9. Heartburn reporting decreased from 93 to 44% of patients, while regurgitation decreased from 72 to 28%. About half of the patients agreed to continue with only dietary recommendations.

CONCLUSIONS

Most patients with GERD can identify at least one food triggering their symptoms. An approach based on abstention from identified food may be effective in the short term.

Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review

We performed this review to clarify which dietary and lifestyle factors are related to gastroesophageal reflux disease. Through a systematic search of the PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), and Chinese BioMedical Literature (CBM) databases, we identified articles with clear definitions of GERD, including nonerosive gastroesophageal reflux disease (NERD), reflux esophagitis (RE) and Barrett’s esophagus (BE), that included dietary and lifestyle factors as independent factors affecting the onset of GERD (expressed as odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs)). Due to heterogeneity among the studies, we used descriptive statistical analyses to analyze and synthesize each outcome based on the disease type. In total, 72 articles were included, conducted in ten Western countries (26 articles in total) and nine Eastern countries (46 articles in total). We categorized dietary factors into 20 items and lifestyle factors into 11 items. GERD is related to many irregular dietary and lifestyle habits (such as a habit of midnight snacking: OR=5.08, 95% CI 4.03–6.4; skipping breakfast: OR=2.7, 95% CI 2.17–3.35; eating quickly: OR=4.06, 95% CI 3.11–5.29; eating very hot foods: OR=1.81, 95% CI 1.37–2.4; and eating beyond fullness: OR=2.85, 95% CI 2.18–3.73). Vegetarian diets (consumption of nonvegetarian food (no/yes); OR=0.34, 95% CI 0.211–0.545) and no intake of meat (OR=0.841, 95% CI 0.715–0.990) were negatively related to GERD, while meat (daily meat, fish, and egg intake: OR=1.088, 95% CI 1.042-1.135) and fat (high–fat diet: OR=7.568, 95% CI 4.557–8.908) consumption were positively related to GERD. An interval of less than three hours between dinner and bedtime (OR=7.45, 95% CI 3.38–16.4) was positively related to GERD, and proper physical exercise (physical exercise >30 minutes (>3 times/week): OR=0.7, 95% CI 0.6–0.9) was negatively correlated with GERD. Smoking (OR=1.19, 95% CI 1.12–1.264), alcohol consumption (OR=1.278, 95% CI 1.207–1.353) and mental state (poor mental state: OR=1.278, 95% CI 1.207–1.353) were positively correlated with GERD. RE (vitamin C: OR=0.46, 95% CI=0.24–0.90) and BE (vitamin C: OR=0.44,95% CI 0.2-0.98; vitamin E: OR=0.46, 95% CI 0.26–0.83) were generally negatively correlated with antioxidant intake. In conclusion, many dietary and lifestyle factors affect the onset of GERD, and these factors differ among regions and disease types. These findings need to be further confirmed in subsequent studies.

Meat consumption and risk of 25 common conditions: outcome-wide analyses in 475,000 men and women in the UK Biobank study

BACKGROUND

There is limited prospective evidence on the association between meat consumption and many common, non-cancerous health outcomes. We examined associations of meat intake with risk of 25 common conditions (other than cancer).

METHODS

We used data from 474,985 middle-aged adults recruited into the UK Biobank study between 2006 and 2010 and followed up until 2017 (mean follow-up 8.0 years) with available information on meat intake at baseline (collected via touchscreen questionnaire), and linked hospital admissions and mortality data. For a large sub-sample (~ 69,000), dietary intakes were re-measured three or more times using an online, 24-h recall questionnaire.

RESULTS

On average, participants who reported consuming meat regularly (three or more times per week) had more adverse health behaviours and characteristics than participants who consumed meat less regularly, and most of the positive associations observed for meat consumption and health risks were substantially attenuated after adjustment for body mass index (BMI). In multi-variable adjusted (including BMI) Cox regression models corrected for multiple testing, higher consumption of unprocessed red and processed meat combined was associated with higher risks of ischaemic heart disease (hazard ratio (HRs) per 70 g/day higher intake 1.15, 95% confidence intervals (CIs) 1.07-1.23), pneumonia (1.31, 1.18-1.44), diverticular disease (1.19, 1.11-1.28), colon polyps (1.10, 1.06-1.15), and diabetes (1.30, 1.20-1.42); results were similar for unprocessed red meat and processed meat intakes separately. Higher consumption of unprocessed red meat alone was associated with a lower risk of iron deficiency anaemia (IDA: HR per 50 g/day higher intake 0.80, 95% CIs 0.72-0.90). Higher poultry meat intake was associated with higher risks of gastro-oesophageal reflux disease (HR per 30 g/day higher intake 1.17, 95% CIs 1.09-1.26), gastritis and duodenitis (1.12, 1.05-1.18), diverticular disease (1.10, 1.04-1.17), gallbladder disease (1.11, 1.04-1.19), and diabetes (1.14, 1.07-1.21), and a lower IDA risk (0.83, 0.76-0.90).

CONCLUSIONS

Higher unprocessed red meat, processed meat, and poultry meat consumption was associated with higher risks of several common conditions; higher BMI accounted for a substantial proportion of these increased risks suggesting that residual confounding or mediation by adiposity might account for some of these remaining associations. Higher unprocessed red meat and poultry meat consumption was associated with lower IDA risk.

[Food patterns in Russian patients with gastroesophageal reflux disease: the results of pilot comparative study]

AIM

To evaluate nutritional patterns in patients with gastroesophageal reflux disease (GERD) compared to the control group without GERD.

MATERIALS AND METHODS

The data of complex examination of patients referred to perform esophageal pH-impedance recording and who gave written informed consent to participate in the study served as a source data. All the participants underwent complex examination, including clinical data (presence of heartburn and acid regurgitation), symptom evaluation (GERD-Q questionnaire), esophagogastroscopy, esophageal pH-impedance recordings and food frequency questionnaire. Diagnosis of GERD was based on GERD-Q score 8, acid exposure time 6%, number of gastroesophageal refluxes 80/day by 24-hrs esophageal pH-impedance recordings. Nutritional patterns were assessed with the use of healthy eating pyramid principles.

RESULTS

Overall 165 patients were enrolled and the data of 150 of them (34 with confirmed GERD and 116 of the control group) were available for the final analysis. The patients of the both groups consumed lower compared to the recommended amounts of dairy and higher amounts of meat. Those with GERD consumed larger amounts of fruits (0.910.68 compared to the values of healthy eating pyramid vs 0.520.57 in the control group, p=0.001), and fats (0.690.55 vs 0.490.55, p=0.001). Compared to the controls, patients with GERD consumed lower amounts of vegetables (0.860.46 of the healthy eating pyramid vs 0.940.63 in the control group, р=0.004) and sugars confectionaries (0.380.39 vs 1.930.98, p=0.0001).

CONCLUSION

Nutritional patterns of patients with gastroesophageal reflux disease significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.

The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn

Gastroesophageal reflux disease (GERD) is a common esophageal disorder that is characterized by troublesome symptoms associated with increased esophageal acid exposure. Cornerstones of therapy include acid suppressive agents like proton pump inhibitors (PPI) and lifestyle modifications including dietary therapy, although the latter is not well defined. As concerns regarding long term PPI use continue to be explored, patients and providers are becoming increasingly interested in the role of diet in disease management. The following is a review of dietary therapy for GERD with an emphasis on the effect food components have on pathophysiology and management. Although sequential dietary elimination of food groups is common, literature supports broader manipulation including reduction of overall sugar intake, increase in dietary fiber, and changes in overall eating practices.

Popular Remedies for Esophageal Symptoms: a Critical Appraisal

PURPOSE OF REVIEW

Popular remedies are of ongoing interest to patients experiencing common esophageal symptoms, particularly as typical pharmacologic interventions have been subject to increased scrutiny. Herein we summarize the available data regarding potential risks and benefits of several such remedies.

RECENT FINDINGS

With emphasis on reflux and non-cardiac chest pain, research is ongoing into the clinical utility and diverse physiologic mechanisms underlying a variety of complementary and alternative modalities, including dietary manipulation, apple cider vinegar, melatonin, acupuncture, and various herbal products (rikkunshito, STW 5, slippery elm, licorice, and peppermint oil, among others). A substantial gap persists between anecdotal and empirical understandings of the majority of non-pharmacologic remedies for esophageal symptoms. This landscape of popular treatments nevertheless raises several interesting mechanistic hypotheses and compelling opportunities for future research.

Conventional treatment combined with Rehabilitation New Fluid and flupentixol and melitracen tablets for treatment of reflux esophagitis in elderly patients

BACKGROUND

Conventional treatment for reflux esophagitis (RE) is not very effective, because psychosocial factors have a certain impact on the disease progression and treatment outcome in RE patients. Exploring new treatments for RE on the basis of mental and psychological factors has become a hot spot in clinical research.

AIM

To investigate the efficacy and safety of conventional therapy combined with Rehabilitation New Fluid and flupentixol and melitracen tablets in the treatment of elderly patients with RE.

METHODS

A total of 120 elderly patients with RE who were treated at our hospital from October 2017 to October 2018 were enrolled. They were randomly divided into three groups (A, B, and C), with 40 cases in each group. Group A patients were treated with conventional therapy, group B patients were treated with conventional therapy combined with Rehabilitation New Fluid, and group C patients were treated with conventional therapy combined with Rehabilitation New Fluid and flupentixol and melitracen tablets. The clinical efficacy, reflux diagnostic questionnaire (RDQ) score, Hamilton anxiety scale (HAMA) score, Hamilton depression scale (HAMD) score, SF-36 score, and adverse reactions were compared among the three groups.

RESULTS

The total effective rates of groups B and C were significantly higher than that of group A (P < 0.05). After treatment, the RDQ score, HAMA score, and HAMD score of group C were significantly lower than those of groups A and B (P < 0.05). After treatment, the physical function, physical role, physical pain, and mental health scores of patients in group C were significantly higher than those of groups A and B (P < 0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P > 0.05).

CONCLUSION

Conventional treatment combined with Rehabilitation New Fluid and flupentixol and melitracen tablets has good clinical efficacy in the treatment of RE in elderly patients, which can effectively improve the clinical symptoms, depression and anxiety, and the quality of life of patients.

Visceral fat thickness of erosive and non-erosive reflux disease subjects in Indonesia's tertiary referral hospital

BACKGROUND

There has been an increasing number of reports regarding the correlation between obesity and gastroesophageal reflux disease (GERD). Visceral fat thickness is thought to be a risk factor for GERD and its severity. Several studies have conflicting results, so this study aimed to determine visceral fat thickness difference between erosive and non-erosive reflux disease.

METHODS

A cross-sectional study of 56 adult subjects with GERD symptoms was held at Cipto Mangunkusumo National General Hospital between April and November 2018. Gastroesophageal Reflux Disease Questionnaires (GERDQ) were utilized to determine the presence of GERD. Ultrasonography was used to determine visceral fat thickness. Esophageal erosions were diagnosed using upper gastrointestinal endoscopy. The difference in visceral fat thickness between esophagitis and non-esophagitis group was analysed using T-test.

RESULTS

From 56 total subjects, 55.4% have erosive reflux disease (ERD), in which were dominated by subjects with grade A esophagitis (64.5%) based on Los Angeles Classification of Esophagitis (LA classifications). There was no significant difference of visceral fat thickness between non-erosive reflux disease (NERD) and ERD (p = 0,831). There was, however, an increasing trend of visceral fat thickness with the advancing severity of esophagitis, although statistical significance was not reached.

CONCLUSION

Visceral fat thickness as measured by ultrasonography has no significant difference between NERD and ERD.

Gender-specific Effect of Micronutrient on Non-erosive Reflux Disease and Erosive Esophagitis

Background/Aims

The effect of dietary micronutrients on non-erosive reflux disease (NERD) and reflux esophagitis is unclear. We aim to evaluate the gender-specific effect of micronutrient on erosive esophagitis and NERD.

Methods

A total of 11 690 participants underwent endoscopy and completed 3-day recordings for dietary intake and questionnaires for reflux symptoms from 2004 to 2008. To evaluate the effect of dietary micronutrients on NERD or erosive esophagitis, adjusted regression analysis with odds ratio (OR) and 95% confidence interval (CI) was used. In addition, we performed gender-specific analysis.

Results

Prevalence of NERD and erosive esophagitis was 6.8% and 11.2% in men and 9.1% and 2.4% in women. In adjusted analysis, high intake of vitamin A (OR, 0.78; 95% CI, 0.64–0.96), retinol (OR, 0.73; 95% CI, 0.59–0.90), vitamin B2 (OR, 0.68; 95% CI, 0.54–0.87), vitamin B6 (OR, 0.75; 95% CI, 0.58–0.96), folic acid (OR, 0.77; 95% CI, 0.62–0.96), calcium (OR, 0.66; 95% CI, 0.53–0.82), and iron (OR, 0.68; 95% CI, 0.53–0.87) had an inverse association with NERD. However, erosive esophagitis has no relationship with micronutrients except vitamin C (OR, 0.78; 95% CI, 0.62–0.98). High dietary intake of calcium reduced the risk of NERD in men and high dietary intake of many micronutrients reduced NERD in women.

Conclusions

While many dietary micronutrients reduced NERD, they had no effect on erosive esophagitis. The effect of micronutrient on NERD was more prominent in women than men.

Reduction in Gastroesophageal Reflux Disease Symptoms Is Associated with Miso Soup Intake in a Population-Based Cross-Sectional Study: The Nagahama Study

Dietary habits and lifestyles are considered to affect the frequency of epigastric symptoms. In our previous study, we found that three amino acids in Japanese broth promoted gastric emptying. We hypothesized that a higher consumption of miso soup which was mainly composed of Japanese broth and miso paste would be associated with a lower frequency of epigastric symptoms. We conducted a cross-sectional study of the association between frequency of miso soup intake and reflux or dyspepsia symptoms in a general Japanese population. Sixteen items of dietary habits were assessed using a self-reported questionnaire, and epigastric symptoms were evaluated using the Frequency Scale for Symptoms of Gastroesophageal Reflux Disease (FSSG). We fitted generalized linear models to analyze the association between miso soup intake and FSSG, reflux, or dyspepsia scores adjusted by age, sex, body mass index (BMI), another 15 dietary habits, smoking, drinking alcohol, and unfavorable dietary behaviors. A total of 9,364 subjects were included in the analysis. Trend analysis revealed that higher frequency of miso soup intake was associated with lower FSSG scores (p<0.001). In a generalized linear model, daily intake of miso soup was associated with lower FSSG, reflux, and dyspepsia scores independent of age, sex, BMI, other 15 dietary habits, smoking, drinking alcohol, and unfavorable dietary behaviors (estimate=-0.46, -0.22, and -0.27, respectively; 95% CI=-0.83, -0.12; -0.38, -0.07; and -0.47, and -0.08, respectively). Dairy intake of miso soup was associated with lower epigastric symptoms.

Association between tea consumption and gastroesophageal reflux disease: A meta-analysis

BACKGROUND

Gastroesophageal reflux disease (GERD) is one of the most common digestive system diseases, which is associated with lifestyle and dietary factors. The main mechanism involved in GERD is affected by demographics, lifestyles, and dietary factors. Tea consumption is reported to be associated with GERD, especially in Asian population. However, the effect of tea drinking on GERD risk is still controversial. The aim of this study was to investigate the relationship between tea consumption and the risk of GERD by meta-analysis.

METHODS

We searched the published research databases such as PubMed and Embase for studies that were published up to March 2018. The search results were reviewed by 2 authors, and studies that complied with the criteria were selected. Odds ratio (OR) and 95% confidence interval (CI) were used to assess the association between tea consumption and the risk of GERD.

RESULTS

Twenty-three articles including 30 studies were included in the meta-analysis. The result of meta-analysis showed that tea drinking had no significant association with the risk of GERD. The odds ratio (OR) and 95% CI were 1.12 and (0.98-1.27). In subgroup analysis based on geographical region, tea consumption can increase the risk of GERD in East Asia (OR = 1.27, 95% CI = 1.07-1.51), while the risk of GERD was decreased in Middle Asia (OR = 0.77, 95% CI = 0.63-0.95). Besides, in the subgroup of study design, there was a significant association between tea intake and the GERD in cross-sectional study. In no symptom subgroup, the risk of GERD was increased (OR = 1.47, 95% CI = 1.11-1.93).

CONCLUSIONS

There was no significant relationship between tea consumption and the risk of GERD overall. However, in subgroup analysis, tea drinking may increase the risk of GERD in East Asia and decrease in Middle Asia. To clarify the causality between tea intake and GERD, a more precise study design will be needed.

Effect of high-fat, standard, and functional food meals on esophageal and gastric pH in patients with gastroesophageal reflux disease and healthy subjects

OBJECTIVES

To investigate the effects of different test meals on esophageal and intragastric pH in patients with gastroesophageal reflux disease (GERD) and healthy subjects and to demonstrate the relationship between esophageal acid exposure (EAE) and gastric pH.

METHODS

We enrolled patients with reflux esophagitis (RE; n = 15), nonerosive reflux disease (NERD; n = 12) and healthy subjects (n = 10). Four pH electrodes were used to monitor the pH of the distal esophagus, upper border of the lower esophageal sphincter, gastric fundus, and gastric body for 26 hours. Isocaloric and isovolumetric high-fat, standard, and functional meals were supplied randomly to the participants. The EAE and gastric acidity of each meal in fasting and postprandial states were compared.

RESULTS

High-fat meals significantly increased postprandial EAE in patients with RE and NERD. EAE was higher after a high-fat meal than after a standard or functional food meals at the fourth hour postprandially in patients with RE (P < 0.05). Patients with NERD reported fewer symptoms after a functional food meal than after high-fat and standard meals (0 [interquartile range {IQR} 0-1] vs 1 [IQR 0-2] vs 3 [IQR 1-4], P = 0.014). Compared with high-fat and standard meals, functional food meal significantly decreased gastric acidity in patients with RE. EAE was significantly related to gastric acidity in patients with RE.

CONCLUSIONS

High-fat meals increased EAE in patients with RE and NERD. Functional food could serve as adjuvant therapy in GERD patients. EAE was related to gastric acidity in RE patients.

Surgical outcomes and over one-year follow-up results of laparoscopic Nissen fundoplication for gastroesophageal reflux disease: Single-center experiences

BACKGROUND

Laparoscopic antireflux surgery is a standard surgical treatment method for gastroesophageal reflux disease (GERD) in Western countries. However, the procedure has not been actively carried out in Korea because of concerns regarding surgical complications. Here, we conducted this study to evaluate short-term surgical outcomes of laparoscopic Nissen fundoplication (LNF) performed at a single institution.

METHODS

From January 2010 to August 2016, totally 29 patients underwent LNF for GERD performed by three surgeons at Asan Medical Center, Korea. All patients participated in a telephonic survey including the presence of symptoms and the status of quality of life (QOL).

RESULTS

The median age at operation and BMI were 54 years and 23.8 kg/m², respectively. Preoperatively, 27 patients (93.1%) underwent PPI therapy. All patients had typical or atypical GERD symptoms. One patient (3.4%) required reoperation because of total gastroesophageal junction obstruction. 24 patients (82.8%) reported complete or partial resolution of symptoms, whereas 21 (72.4%) reported partial or complete improvement in quality of life. In patients with reflux esophagitis, GERD symptoms were significantly relieved after LNF (P = 0.005). LNF responders tended to perceive an improvement in quality of life post operation (P < 0.001).

CONCLUSION

LNF is a feasible, safe, and effective treatment option for controlling GERD symptoms as well as improving the quality of life. Presence of reflux esophagitis was a predictor of successful outcomes.

Helicobacter pylori and nonmalignant upper gastrointestinal diseases

The review of the most important recent publications concerning the relation of Helicobacter pylori with peptic ulcer disease (PUD), noninvestigated and functional dyspepsia, and gastroesophageal reflux disease (GERD) is presented. H. pylori remains the main etiopathogenetic factor in complicated and uncomplicated PUD. Nevertheless, the role of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin is increasing. The novel data did not confirm that PUD caused by NSAIDs and aspirin is less symptomatic. The role of glucocorticoids, immunosuppressants, and antidepressants seems to be of some importance. Although the involvement of H. pylori in functional dyspepsia is controversial, several data support the importance of H. pylori-induced gastritis in the pathogenesis of dyspeptic symptoms. Recent interventional studies have reported that H. pylori eradication improves dyspepsia mainly in areas with a high prevalence of this bacterium. Novel data regarding the relation of gastrointestinal peptides, ghrelin and obestatin, with H. pylori infection are also presented. Intriguing findings support the involvement of the gastric microbiota in the causation of chronic functional dyspepsia. Finally, some data concerning negative, positive, or neutral associations of H. pylori with gastroesophageal reflux disease (GERD) were published. In this context, today there is no evidence indicating that H. pylori eradication could worsen the symptoms or the course of GERD.

Can We Use Diet to Effectively Treat Esophageal Disease? A Review of the Current Literature

PURPOSE OF REVIEW

Esophageal diseases represent a wide variety of conditions affecting esophageal anatomy, physiology, and motility. Therapy focuses on pharmacotherapy and endoscopic or surgical management. Dietary therapy can be considered in management algorithms for specific esophageal diseases. This review focuses on outlining the literature related to dietary therapy in gastroesophageal reflux disease, eosinophilic esophagitis, Barrett's esophagus, and esophageal adenocarcinoma.

RECENT FINDINGS

Currently, data are strongest for dietary manipulation in eosinophilic esophagitis, specifically the six-food elimination diet. Dietary effects on gastroesophageal reflux disease are less clear, though newer research indicates that increased fiber with reduction in simple sugar intake may improve symptoms. In terms of Barrett's esophagus and esophageal adenocarcinoma, antioxidant intake may affect carcinogenesis, though to an unknown degree. Outcomes data regarding dietary manipulation for the management of esophageal diseases is heterogeneous. Given the rising interest in non-pharmacological treatment options for these patients, continued research is warranted.

Risk Factors for Gastroesophageal Reflux Disease in Saudi Arabia

Background

Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal tract diseases worldwide. GERD has an effect on the patients' quality of life as well as the health care system that can be prevented by identifying its risk factors among the population. Hence, we applied this study to assess the GERD's risk factors in Saudi Arabia.

Methods

A cross-sectional study was designed to assess the GERD's risk factors among the community of Saudi Arabia. The sample was collected randomly during the period from November to December 2016. Through a self-administered validated GERD questionnaire (GerdQ), GERD was diagnosed. Then, the GERD's risk factors were assessed among all participants. The data were analyzed using Statistical Package for Social Sciences version 21.0; the Student's t-test was used to assess the association of GERD and risk factors.

Results

A total of 2,043 subjects participated in the study. The characteristics and behaviors of participants statistically significant with GERD were positive family history (39.3%), obese (body mass index > 30 kg/m²) (39.4%), not performing weekly regular physical activities ≥ 30 min (31.1%) and smoking (39.3%). GERD was commonly noticed in participants on analgesics (38.4%), not taking fibers (37.4%), drinking tea (33.4%), eating greasy (31.2%) and fast food (32.7%), and these were statistically significant with GERD (P ≤ 0.05).

Conclusion

The characteristics and behaviors associated with GERD in Saudi population are family history of GERD, obesity, sedentary lifestyle and smoking. Other common risk factors correlated with GERD are analgesics intake, no fibers intake, drinking tea, greasy and fast food intake.

Relationship between obesity and development of erosive reflux disease: A mediation analysis of the role of cardiometabolic risk factors

This study aimed to evaluate whether the relationship between obesity and erosive reflux disease (ERD) is mediated by cardiometabolic risk factors. This cohort study included subjects who underwent repeated endoscopy. To assess whether the association between body mass index (BMI) and ERD development was mediated by cardiometabolic parameters, multivariate Cox proportional hazard models were fitted for mediation analysis. Of 15,154 subjects with negative index endoscopy findings during health check-up, 11,686 subjects who underwent repeated endoscopy were included. During follow-up, 1,367 incident ERD events (11.7%) were observed. Without mediation effect, the multivariate adjusted hazard ratio of BMI was 1.21 (95% CI, 1.03–1.42) in overweight and 1.39 (95% CI, 1.19–1.62) in obese individuals compared to normal weight individuals. When the metabolic syndrome was included as a mediator, the hazard ratio became 1.19 (95% CI, 1.00–1.40) in overweight and 1.29 (95% CI, 1.10–1.52) in obese individuals. Both systolic blood pressure and triglyceride level were found to fully mediate the effect of BMI on ERD. Fasting glucose level was a partial mediator. The estimated percentage of total effect mediated by cardiometabolic risk factors was 35.4%. Cardiometabolic parameters partially or fully mediate the association between overweight and obesity and incident ERD.