Dietary Intake in Relation to the Risk of Reflux Disease: A Systematic Review

A Descriptive Study on the Vocal Behaviors in Children With Attention Deficit Hyperactivity Disorder: Vocal Hygiene Knowledge and Phonotraumatic Behaviors

AIM

This study aimed to investigate the level of vocal hygiene knowledge and phonotraumatic behaviors in children diagnosed with attention deficit hyperactivity disorder (ADHD).

METHODS

The study included 25 children with ADHD, aged 8-11 years, and 25 age- and sex-matched typically developing children and their caregivers. All children were considered nondysphonic based on a Pediatric Voice Handicap Index (pVHI) score of <13. The children completed the Vocal Hygiene Knowledge Level Form, which was developed by the authors. Parents completed the Checklist Form, Conners's Parent Rating Scale-Revised Short Form, pVHI, and the Pediatric Phonotrauma Assessment Questions for Parents Form developed by the authors.

RESULTS

Children with ADHD had more frequent phonotraumatic behaviors than typically developing children (P = 0.014). There was no significant difference in vocal hygiene knowledge between the two groups (P = 0.162).

CONCLUSION

Although children with ADHD had similar levels of vocal hygiene knowledge compared to typically developing children, they had higher rates of phonotraumatic behaviors. These findings indicate a higher risk of dysphonia in children with ADHD. It is suggested that the results of the present study may increase the awareness of voice professions in developing preventive approaches for vocal health in children with ADHD.

Association between an energy-adjusted inflammatory diet index and gastroesophageal reflux disease: a retrospective cohort study

PURPOSE

To examine and quantify the association between an inflammatory diet index and gastroesophageal reflux disease (GERD) utilizing extensive data from a large cohort.

METHODS

This study included eligible UK Biobank participants recruited between 2006 and 2010 who had no prior history of GERD and no missing data for key covariates. The primary outcome was incident GERD, identified using the "first occurrence" dataset. 27 eligible food/nutrient parameters derived from the 24-h recall questionnaires in the UK Biobank were included to calculate the energy-adjusted dietary inflammation index (E-DII) score. The E-DII score was employed as a continuous variable in restricted cubic spline regression (RCS) analysis. To facilitate analysis, participants were then categorized into four groups based on quartile values in the subsequent Cox regression analysis adjusting varying degrees of confounding factors.

RESULTS

After exclusion, 154,590 participants were included in the primary analysis. Over a mean 12.36-year follow-up, a total of 12, 041(7.79%) participants experienced GERD. The results of multivariable RCS showed that the risk of GERD had a slightly overall increased trend along with E-DII after adjusting the confounding factors. The cumulative incidence of GERD in the four groups was significantly different (P < 0.001) and participants in higher quartiles determined by E-DII had a higher GERD incidence. Results from both univariate and multivariate Cox regression consistently revealed the most pro-inflammatory E-DII group (i.e. the fourth quartile) had a significantly heightened risk of GERD compared to those in the first quartile (crude HR [95% CI] 1.118 [1.063-1.175]; fully adjusted HR [95% CI] 1.136 [1.079-1.196]). Subgroup analyses revealed variations across populations, while sensitivity analyses confirmed the robustness of primary findings.

CONCLUSIONS

The current study revealed that that adherence to a diet with high pro-inflammatory potential might be associated with higher GERD incidence and further randomized controlled trials are needed to provide more conclusive evidence.

Natural Products in the Management of Gastroesophageal Reflux Disease: Mechanisms, Efficacy, and Future Directions

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that is defined by the reflux of gastric contents into the esophagus, and it results in symptoms such as esophageal inflammation, regurgitation, and indigestion. Although proton pump inhibitors (PPIs) and histamine-2 receptor antagonists are frequently employed to treat GERD, their prolonged administration is associated with adverse effects, necessitating the development of alternative therapeutic strategies. Natural products are now recognized as promising candidates for the management of GERD due to their bioactive compounds, which possess antioxidant, anti-inflammatory, and mucosal-protective properties. The potential of natural products in the treatment of GERD is comprehensively examined in this review, with a focus on their mechanisms of action, which include acid suppression, esophageal mucosal regeneration, anti-inflammatory activity, and gut microbiota modulation. Also, the efficacy and safety of key natural products, including flavonoids, polyphenols, plant-derived oils, herbal extracts, probiotics, and dietary components, in preclinical and clinical studies, are assessed. Additionally, this review addresses the barriers confronting the translation of natural therapies into clinical practice, such as regulatory obstacles, variability in bioavailability, and the need for dosage standardization. The integration of natural products into the management of GERD has the potential to enhance conventional therapies, providing a more comprehensive and secure approach for patients.

Adherence to global diet quality score in relation to gastroesophageal reflux disease and flatulence in Iranian adults

INTRODUCTION

Gastroesophageal reflux disease (GERD) and flatulence are both prevalent afflictions and negatively impact the quality of life. This study aims to determine the relationship between the Global Diet Quality Score (GDQS), a novel metric based on the Prime Diet Quality Score with GERD and flatulence in Iranian adults.

METHODS

The cross-sectional study was conducted among 6202 adults in the context of the Shahedieh cohort study accomplished. Dietary intakes of participants were collected by food frequency questionnaires (FFQs). To calculate GDQS, 25 food groups were comprised (16 healthy and 7 unhealthy food groups and two food groups categorized as unhealthy when consumed excessively). GERD and flatulence were assessed by a self-reported questionnaire. To examine the association between GDQS with GERD and flatulence, logistic regression was performed in crude and adjusted models (Model I: adjustments for age and energy intake; Model II: gender, physical activity, marital status, occupation, educational levels, WSI, and BMI; and Model III: smoking status, depression, diabetes, hypertension, and cardio events.) RESULTS: Participants in the highest quintile of GDQS had 20% higher odds of having GERD than individuals in the lowest one (OR: 1.20; 95% CI: 0.88-1.65, P trend = 0.508). Compared to the lowest quintile, the participants in the highest quintile had no significant reduction in probability of having flatulence in the crude model (OR: 0.94; 95% CI: 0.81-1.11, P trend = 0.578). These associations remained non-significant after adjustments for confounding variables.

CONCLUSION

No significant associations were observed between higher adherence to GDQS with odds of GERD and flatulence in Iranian adults. To better understand these findings, longitudinal studies especially randomized clinical trials are needed.

Unveiling the intricacies: Insight into gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) poses a substantial global health challenge, with prevalence rates exhibiting geographical variation. Despite its widespread recognition, the exact prevalence and associated risk factors remain elusive. This article comprehensively analyzed the global burden of GERD, shedding light on its risk factors, underlying pathophysiological mechanisms, current diagnostic modalities, evolving management strategies tailored to diverse patient profiles, and complex determinants contributing to treatment failures. A deeper comprehension of GERD is achieved by dissecting these intricate facets, paving the way for enhanced clinical management and improved patient outcomes.

Associations of Plant-Based Foods, Animal Products, and Selected Sociodemographic Factors with Gastroesophageal Reflux Disease Risk

BACKGROUND

Diet influences the symptoms of gastroesophageal reflux disease (GERD). Plant-based diets rich in vegetables, fruits, legumes, seeds, and nuts may reduce inflammation and improve gut health, while high-fat foods may worsen symptoms.

OBJECTIVE

We examined the association between plant-based and animal-based foods, selected demographic characteristics, and the likelihood of GERD in Al Madinah Al Munawarah, Saudi Arabia.

METHOD

A cross-sectional study using the GerdQ tool assessed the GERD likelihood among 303 adults. Dietary diversity scores were used to assess the quality of their diet. quality.

RESULTS

The participants were predominantly women (68.6%) and had low education levels (88.4%). Cereals were the most consumed plant-based foods, while vitamin A-rich fruits and vegetables were the least consumed. There was significant variation in the consumption of legumes, nuts, seeds, and milk and milk products among the GERD groups. The participants with a 50% GERD likelihood had the highest consumption (34.5%), followed by the 89% likelihood group (21.4%) and the 79% likelihood group (14.5%). The lowest consumption of milk and milk products was among those with an 89% GERD likelihood who also consumed more organ meat. In addition, GERD likelihood was inversely associated with age (r = -0.153; p = 0.008). The likelihood of GERD was negatively correlated with the intake of legumes, nuts, and seeds (r = -0.163; p = 0.005). Furthermore, the intake of cereals and tubers (r = 0.114; p = 0.047) and legumes, nuts, and seeds (r = 0.231; p = 0.0001) increased significantly with education.

CONCLUSION

GERD prevention programs should target women, those with a low education level, and individuals consuming fewer plant-based foods and more organ meats.

GERD: Latest update on acid-suppressant drugs

GERD is a very familiar diagnosis among health care providers due to its massive spread, and its symptoms can affect the quality of life for a respectable slice of its patients. Therefore, what can only be described as a logical consequence, a pursuit of a treatment that can both relieve symptoms and have minimal side effects is still ongoing to cover the large demographic affected by GERD. In the following review, analysis will be made of GERD, including possible regulatory activity, of certain drugs to the already discussed pathways involved in GERD patients.

Dietary Habits and Their Impact on Gastroesophageal Reflux Disease (GERD)

Introduction Gastroesophageal reflux disease (GERD) is marked by the frequent occurrence of stomach acid flowing back into the esophagus, causing symptoms such as heartburn and acid regurgitation at least once a week. When reflux leads to troublesome symptoms and esophageal damage and adversely affects quality of life, it is diagnosed as GERD. Age, gender, ethnicity, genetic predispositions, and aspects of diet and lifestyle, including factors like obesity and smoking, are associated with GERD. Methodology This cross-sectional study was conducted within the Departments of General Medicine, Surgery, and Gastroenterology at Khyber Teaching Hospital (KTH) in Peshawar, spanning from January 2024 to June 2024. Patients who visited these departments or the Outpatient Department within the specified period with GERD were included in the study. A non-probability purposive sampling technique was used. For the analysis, we utilized IBM SPSS Statistics version 21. Results This study consists of 280 participants. The mean age of the participants in this study was 44.60 years. GERD has a significant association with obesity (69.99) and lack of exercise (80%), and a negative association was found between other gastrointestinal conditions (55.71%) and smoking (64.28). Common symptoms among GERD patients were swallowing difficulty, regurgitation, heartburn, and chest pain. Conclusion Our study is the first to examine the relationship between lifestyle factors and GERD among Pakistani patients. Our findings highlight significant associations between GERD and several factors, including gender, BMI, dietary habits, and lack of exercise. Notably, cultural and regional differences appear to influence GERD prevalence and its risk factors, as demonstrated by the minimal impact of alcohol consumption in our study population.

Association of plant-based dietary patterns with the risk of type 2 diabetes mellitus using cross-sectional results from RaNCD cohort

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in middle- and low-income countries, and this disease is a burden on public health systems. Notably, dietary components are crucial regulatory factors in T2DM. Plant-based dietary patterns and certain food groups, such as whole grains, legumes, nuts, vegetables, and fruits, are inversely correlated with diabetes incidence. We conducted the present study to determine the association between adherence to a plant-based diet and the risk of diabetes among adults. We conducted a cross-sectional, population-based RaNCD cohort study involving 3401 men and 3699 women. The plant-based diet index (PDI) was developed using a 118-item food frequency questionnaire (FFQ). Logistic regression models were used to evaluate the association between the PDI score and the risk of T2DM. A total of 7100 participants with a mean age of 45.96 ± 7.78 years were analysed. The mean PDI scores in the first, second, and third tertiles (T) were 47.13 ± 3.41, 54.44 ± 1.69, and 61.57 ± 3.24, respectively. A lower PDI was significantly correlated with a greater incidence of T2DM (T1 = 7.50%, T2 = 4.85%, T3 = 4.63%; P value < 0.001). Higher PDI scores were associated with significantly increased intakes of fibre, vegetables, fruits, olives, olive oil, legumes, soy products, tea/coffee, whole grains, nuts, vitamin E, vitamin C, and omega-6 fatty acids (P value < 0.001). After adjusting for confounding variables, the odds of having T2DM were significantly lower (by 30%) at T3 of the PDI than at T1 (OR = 0.70; 95% CI = 0.51, 0.96; P value < 0.001). Our data suggest that adhering to plant-based diets comprising whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea/coffee can be recommended today to reduce the risk of T2DM.

The Efficacy of Dietary Interventions in Patients with Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Intervention Studies

BACKGROUND

International guidelines recommend dietary interventions as one of the most important treatments for patients with gastroesophageal reflux disease (GERD). Evidence to confirm the efficacy of these treatment modalities is lacking. The present study aims to evaluate the efficacy of dietary interventions on GERD-related outcomes evaluated in intervention studies on GERD patients.

METHODS

A systematic review and meta-analysis was performed according to PRISMA. The PubMed/MEDLINE, Web of Sciences, and Scopus databases were utilized for the literature search. Two independent researchers searched for relevant publications published up until June 2023. Intervention studies evaluating the efficacy of dietary interventions in patients with GERD were included.

RESULTS

A total of 577 articles were identified during the initial literature search. After reviewing, 21 studies with 16 different types of dietary interventions were included in the analysis. The interventions were divided into low-carbohydrate diets (3 studies), high-fat diets (2 studies), speed of eating studies (3 studies), low-FODMAP diets (2 studies), and other interventions (12 studies). A meta-analysis could be performed for low-carbohydrate diets and speed of eating interventions. Low-carbohydrate diets resulted in a significant reduction in esophageal acid exposure time (mean difference = -2.834%, 95% confidence interval (CI): -4.554 to -1.114), while a slow speed of eating did not lead to a lower percentage of reflux events compared to fast eating (risk ratio = 1.044, 95% CI: 0.543-2.004). Most other interventions showed positive effects in only a single study.

CONCLUSION

Low-carbohydrate diets showed a significant improvement in GERD-related outcomes, while a slow eating speed did not result in a reduction in reflux events. The overall evidence regarding dietary interventions in GERD remains scarce. High-quality, long-term RCTs are still required to confirm the effects of dietary interventions in GERD patients.

Management advice for patients with reflux-like symptoms: an evidence-based consensus

Patients with reflux-like symptoms (heartburn and regurgitation) are often not well advised on implementing individualised strategies to help control their symptoms using dietary changes, lifestyle modifications, behavioural changes or fast-acting rescue therapies. One reason for this may be the lack of emphasis in management guidelines owing to 'low-quality' evidence and a paucity of interventional studies. Thus, a panel of 11 gastroenterologists and primary care doctors used the Delphi method to develop consolidated advice for patients based on expert consensus. A steering committee selected topics for literature searches using the PubMed database, and a modified Delphi process including two online meetings and two rounds of voting was conducted to generate consensus statements based on prespecified criteria (67% voting 'strongly agree' or 'agree with minor reservation'). After expert discussion and two rounds of voting, 21 consensus statements were generated, and assigned strength of evidence and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) rating. Eleven statements achieved the strongest (100%) agreement: five are related to diet and include identification and avoidance of dietary triggers, limiting alcohol, coffee and carbonated beverages, and advising patients troubled by postprandial symptoms not to overeat; the remaining six statements concern advice around smoking cessation, weight loss, raising the head-of-the-bed, avoiding recumbency after meals, stress reduction and alginate use. The aim of developing the consensus statements is that they may serve as a foundation for tools and advice that can routinely help patients with reflux-like symptoms better understand the causes of their symptoms and manage their individual risk factors and triggers.

Good clinical practice recommendations for the diagnosis and treatment of gastroesophageal reflux disease. An expert review from the Asociación Mexicana de Gastroenterología

INTRODUCTION

Gastroesophageal reflux disease (GERD) is very prevalent in the general population, with a broad spectrum of clinical manifestations, requiring accurate diagnosis and treatment.

AIM

The aim of this expert review is to establish good clinical practice recommendations for the diagnosis and personalized treatment of GERD.

METHODS

The good clinical practice recommendations were produced by a group of experts in GERD, members of the Asociación Mexicana de Gastroenterología (AMG), after carrying out an extensive review of the published literature and discussing each recommendation at a face-to-face meeting. This document does not aim to be a clinical practice guideline with the methodology such a document requires.

RESULTS

Fifteen experts on GERD formulated 27 good clinical practice recommendations for recognizing the symptoms and complications of GERD, the rational use of diagnostic tests and medical treatment, the identification and management of refractory GERD, the overlap with functional disorders, endoscopic and surgical treatment, and GERD in the pregnant woman, older adult, and the obese patient.

CONCLUSIONS

An accurate diagnosis of GERD is currently possible, enabling the prescription of a personalized treatment in patients with this condition. The goal of the good clinical practice recommendations by the group of experts from the AMG presented in this document is to aid both the general practitioner and specialist in the process of accurate diagnosis and treatment, in the patient with GERD.

Functional Food in Relation to Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is a common esophageal disorder characterized by troublesome symptoms associated with increased esophageal acid exposure. The cornerstones of therapy in this regard include treatment with acid-suppressive agents, lifestyle modifications, and dietary therapy, although the latter has not been well defined. As concerns regarding long-term proton pump inhibitor (PPI) use continue to be explored, patients and healthcare providers are becoming increasingly interested in the role of diet in disease management. However, dietary interventions lack evidence of the synthesis effect of functional foods. The following is a review of dietary therapy for GERD, emphasizing food components' impact on GERD pathophysiology and management. Although the sequential dietary elimination of food groups is a common practice, the literature supports broader intervention, including reduced overall sugar intake, increased dietary fiber, and changes in overall eating practices. While the primary concern of food companies is to provide safe products, the caloric, nutritional, and functional composition of foods is also generating interest in the food industry due to consumers' concerns.

Prevalence and risk factors of upper gastrointestinal symptoms in community pharmacies in Spain: a cross-sectional study

Background: Frequently, the community pharmacies are the only points of consultation for upper-gastrointestinal symptomology. However, the heterogeneity of symptoms often limits the correct management of the patient. The study aim is to describe the epidemiological and clinical characteristics of patients with upper-gastrointestinal symptoms who ask for advice in community pharmacies. Methods: A cross-sectional study was performed in 134 Spanish pharmacies (June-October 2022) and we included 1,360 patients. We collected sociodemographic, clinical variables and current medication data. The pharmacist evaluated the gastrointestinal symptoms through the application of the GERD Impact Scale (GIS questionnaire). Patients were classified into three groups according to their symptoms: epigastric, retrosternal and overlapping symptoms. Results: Median age was 49 years (interquartile range 36-62 years) and 59.3% were women. Most patients reported overlapping symptoms (738%, 54.3%), 433 (31.8%) retrosternal and 189 (13.9%) epigastric symptoms. Patients with overlapping symptoms were more likely to associated consumption of foods and/or drinks and symptoms and showed lower scores on the GIS scale (median 26, IQR 20-30) than those with epigastric (median 32, IQR 29-33) and retrosternal (median 32, IQR 28-34) symptoms (p < 0.001). Patients in treatment with a combination of alginates and antiacids were more likely to think that it better alleviated their symptoms in all the patients included (p = 0.012). Conclusion: More than half of the patients showed overlapping symptoms and were more likely to associate their symptoms with dietary habits and having poorer scores in the GIS scale. Clinical awareness of such overlapping condition would help optimize the management of patients with upper gastrointestinal symptoms in practice.

Dietary and Nutritional Support in Gastrointestinal Diseases of the Upper Gastrointestinal Tract (I): Esophagus

The esophagus is the centerpiece of the digestive system of individuals and plays an essential role in transporting swallowed nutrients to the stomach. Diseases of the esophagus can alter this mechanism either by causing anatomical damage that obstructs the lumen of the organ (e.g., peptic, or eosinophilic stricture) or by generating severe motility disorders that impair the progression of the alimentary bolus (e.g., severe dysphagia of neurological origin or achalasia). In all cases, nutrient assimilation may be compromised. In some cases (e.g., ingestion of corrosive agents), a hypercatabolic state is generated, which increases resting energy expenditure. This manuscript reviews current clinical guidelines on the dietary and nutritional management of esophageal disorders such as severe oropharyngeal dysphagia, achalasia, eosinophilic esophagitis, lesions by caustics, and gastroesophageal reflux disease and its complications (Barrett's esophagus and adenocarcinoma). The importance of nutritional support in improving outcomes is also highlighted.