Response of the lower esophageal sphincter to gastric distention by carbonated beverages

Salivary pepsin as an independent predictor of treatment response for laryngopharyngeal reflux: prospective cohort study with multivariate analysis

To analyze the predictive value of salivary pepsin for treatment outcomes in laryngopharyngeal reflux (LPR) using multivariate analysis that includes various associated factors. This prospective cohort study was conducted between August 2020 and August 2022. Patients with LPR who had symptoms lasting more than 1 month and a reflux symptom index (RSI) of 14 or higher were enrolled. The participants received a 2-month regimen of proton pump inhibitors (PPIs) treatment and lifestyle modification. Salivary pepsin was checked using fasting saliva before treatment. Salivary pepsin was detected more frequently in the good treatment response group (61.1%), compared to 14.3% in the poor response group. Similarly, patients with higher compliance to lifestyle modifications (> 90%) had a higher chance of a good response (91.7%) compared to those with lower compliance, who had a 53.8% chance of a good response. Other clinical factors have no significant association with treatment response. In multivariate analysis, both pretreatment salivary pepsin and higher compliance with lifestyle modification were found to be independent factors for treatment response (OR 14.457, CI 1.075 ~ 194.37 for both). This study found that positive salivary pepsin and strict lifestyle modification are independent predictors of treatment outcomes in LPR.

Causal association between dietary factors and esophageal diseases: A Mendelian randomization study

BACKGROUND

Using Mendelian randomization (MR) approach, our objective was to determine whether there was a causal association between dietary factors and gastroesophageal reflux disease (GERD), Barrett's esophagus (BE), or esophageal cancer (EC).

METHODS

Genome-wide association study (GWAS) data for eighteen types of dietary intake were obtained from the UK Biobank. GWAS data for GERD, BE, and EC were sourced from the FinnGen consortium. We performed univariable and multivariable MR analysis to assess the cause effect between dietary factors and esophageal diseases. MR results were expressed as odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

Raw vegetable intake was associated with a lower risk of GERD (OR = 0.478; P = 0.011). On the contrary, cooked vegetable intake increased the risk of GERD (OR = 1.911; P = 0.024). Bread intake was associated with increased odds of BE (OR = 6.754; P = 0.007), while processed meat intake was associated with reduced risk of BE (OR = 0.210; P = 0.035). We also observed evidence that increased consumption of dried fruit (OR = 0.087; P = 0.022) and salt added to food (OR = 0.346; P = 0.045) could prevent EC. The results of multivariable MR showed that the protective effect of consumption of salt added to food on EC was no longer significant after adjusting for the consumption of dried fruit.

CONCLUSION

Vegetable consumption was associated with GERD, whereas consumption of bread and processed meat was associated with BE. Dried fruit intake was associated with a lower risk of EC, and the protective effect of consumption of salt added food on EC may also be mediated by consumption of dried fruit. Future research should be performed to investigate the mechanisms behind these cause-and-effect relationships to reduce the burden of disease caused by dietary habits.

Personalized Treatments Based on Laryngopharyngeal Reflux Patient Profiles: A Narrative Review

OBJECTIVE

To review the current findings of the literature on the existence of several profiles of laryngopharyngeal reflux (LPR) patients and to propose personalized diagnostic and therapeutic approaches.

METHODS

A state-of-the art review of the literature was conducted using the PubMED, Scopus, and Cochrane Library databases. The information related to epidemiology, demographics, clinical presentations, diagnostic approaches, and therapeutic responses were extracted to identify outcomes that may influence the clinical and therapeutic courses of LPR.

RESULTS

The clinical presentation and therapeutic courses of LPR may be influenced by gender, age, weight, comorbidities, dietary habits and culture, anxiety, stress, and saliva enzyme profile. The clinical expression of reflux, including laryngopharyngeal, respiratory, nasal, and eye symptoms, and the hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring profile of patients are important issues to improve in patient management. The use of more personalized therapeutic strategies appears to be associated with better symptom relief and cures over the long-term. The role of pepsin in LPR physiology is well-established but the lack of information about the role of other gastrointestinal enzymes in the development of LPR-related mucosa inflammation limits the development of future enzyme-based personalized diagnostic and therapeutic approaches.

CONCLUSION

Laryngopharyngeal reflux is a challenging ear, nose, and throat condition associated with poor therapeutic responses and a long-term burden in Western countries. Artificial intelligence should be used for developing personalized therapeutic strategies based on patient features.

Dietary factors involved in GERD management

Gastroesophageal reflux disease (GERD) is extremely common, and even modest weight gain has been associated with higher symptom burden as well as objective evidence of reflux on endoscopy and physiological measurement. Certain trigger foods, especially citrus, coffee, chocolate, fried food, spicy food and red sauces are frequently reported to worsen reflux symptoms, although hard evidence linking these items to objective GERD is lacking. There is better evidence that large meal volume and high calorie content can increase esophageal reflux burden. Conversely, sleeping with the head end of the bed raised, avoiding lying down close to meals, sleeping on the left side and weight loss can improve reflux symptoms and objective reflux evidence, especially when the esophagogastric junction 'reflux barrier' is compromised (e.g., in the presence of a hiatus hernia). Consequently, attention to diet and weight loss are both important elements of management of GERD, and need to be incorporated into management plans.

Diet and risk of Barrett's oesophagus: Melbourne collaborative cohort study

Barrett's oesophagus (BE) is the precursor of oesophageal adenocarcinoma, which has become the most common type of oesophageal cancer in many Western populations. Existing evidence on diet and risk of BE predominantly comes from case-control studies, which are subject to recall bias in measurement of diet. We aimed to investigate the potential effect of diet, including macronutrients, carotenoids, food groups, specific food items, beverages and dietary scores, on risk of BE in over 20 000 participants of the Melbourne Collaborative Cohort Study. Diet at baseline (1990-1994) was measured using a food frequency questionnaire. The outcome was BE diagnosed between baseline and follow-up (2007-2010). Logistic regression models were used to estimate OR and 95 % CI for diet in relation to risk of BE. Intakes of leafy vegetables and fruit were inversely associated with risk of BE (highest v. lowest quartile: OR = 0·59; CI: 0·38, 0·94; P-trend = 0·02 and OR = 0·58; CI: 0·37, 0·93; P-trend = 0·02 respectively), as were dietary fibre and carotenoids. Stronger associations were observed for food than the nutrients found in them. Positive associations were observed for discretionary food (OR = 1·54; CI: 0·97, 2·44; P-trend = 0·04) and total fat intake (OR per 10 g/d = 1·11; CI: 1·00, 1·23), the association for fat was less robust in sensitivity analyses. No association was observed for meat, protein, dairy products or diet scores. Diet is a potential modifiable risk factor for BE. Public health and clinical guidelines that incorporate dietary recommendations could contribute to reduction in risk of BE and, thereby, oesophageal adenocarcinoma.

Factors that Impact Day-to-Day Esophageal Acid Reflux Variability and Its Diagnostic Significance for Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on patient-reported symptoms, and the gold standard for diagnosis is ambulatory reflux monitoring, a tool particularly utilized in the common scenario of non-response to therapy or atypical features. Over the past 20 years, there has been a shift toward extending the duration of reflux monitoring, initially from 24 to 48 h and more recently to 96 h, primarily based on a demonstrated increase in diagnostic yield. Further, multiple studies demonstrate clinically relevant variability in day-to-day acid exposure levels in nearly 30% of ambulatory reflux monitoring studies. For these reasons, an ongoing clinical dilemma relates to the optimal activities patients should engage in during prolonged reflux monitoring. Thus, the aims of this review are to detail what is known about variability in daily acid exposure, discuss factors that are known to influence this day-to-day variability (i.e., sleep patterns, dietary/eating habits, stress, exercise, and medications), and finally provide suggestions for patient education and general GERD management to reduce variation in esophageal acid exposure levels.

Is Diet Sufficient as Laryngopharyngeal Reflux Treatment? A Cross-Over Observational Study

OBJECTIVES/HYPOTHESIS

To investigate the efficacy of low-fat, low-quick-release sugar, high-protein, alkaline, and plant-based diet as single treatment for patients with laryngopharyngeal reflux (LPR).

STUDY DESIGN

Cross-over observational study.

METHODS

Patients with LPR diagnosis at the hypopharyngeal-esophageal multichannel intraluminal impedance-pH-monitoring were prospectively recruited from the reflux clinic of three University Hospitals. Patients were instructed to follow low-fat, low-quick-release sugar, high-protein, alkaline, and plant-based diet for 6 to 12 weeks. Pre- to post-treatment symptom and finding changes were evaluated with reflux symptom score (RSS) and reflux sign assessment. Findings were compared to those of a control period where patients did not receive any treatment or diet. Diet was evaluated with refluxogenic diet score (REDS).

RESULTS

Fifty patients completed the study (19 males). Otolaryngological, digestive, and total RSS scores significantly improved from baseline to 6-week post-diet, while there were no significant changes during the control period. At 6-week post-diet, 37 (74%) patients reported significant symptom improvement or relief. Among them, symptoms continued to improve from 6 to 12 weeks in 27 cases, corresponding to a diet success rate of 54%. The REDS was predictive of the baseline RSS (P = .031).

CONCLUSION

Low-fat, low-quick-release sugar, high-protein, alkaline, and plant-based diet is an alternative cost-effective therapeutic approach for patients with LPR. Patients with higher REDS reported higher baseline symptom score.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

Diet and risk of gastro-oesophageal reflux disease in the Melbourne Collaborative Cohort Study

OBJECTIVE

To examine associations between diet and risk of developing gastro-oesophageal reflux disease (GERD).

DESIGN

Prospective cohort with a median follow-up of 15·8 years. Baseline diet was measured using a FFQ. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least 2 years after baseline. Sex-specific logistic regressions were performed to estimate OR for GERD associated with diet quality scores and intakes of nutrients, food groups and individual foods and beverages. The effect of substituting saturated fat for monounsaturated or polyunsaturated fat on GERD risk was examined.

SETTING

Melbourne, Australia.

PARTICIPANTS

A cohort of 20 926 participants (62 % women) aged 40-59 years at recruitment between 1990 and 1994.

RESULTS

For men, total fat intake was associated with increased risk of GERD (OR 1·05 per 5 g/d; 95 % CI 1·01, 1·09; P = 0·016), whereas total carbohydrate (OR 0·89 per 30 g/d; 95 % CI 0·82, 0·98; P = 0·010) and starch intakes (OR 0·84 per 30 g/d; 95 % CI 0·75, 0·94; P = 0·005) were associated with reduced risk. Nutrients were not associated with risk for women. For both sexes, substituting saturated fat for polyunsaturated or monounsaturated fat did not change risk. For both sexes, fish, chicken, cruciferous vegetables and carbonated beverages were associated with increased risk, whereas total fruit and citrus were associated with reduced risk. No association was observed with diet quality scores.

CONCLUSIONS

Diet is a possible risk factor for GERD, but food considered as triggers of GERD symptoms might not necessarily contribute to disease development. Potential differential associations for men and women warrant further investigation.

Development of scores assessing the refluxogenic potential of diet of patients with laryngopharyngeal reflux

OBJECTIVE

To develop clinical tools assessing the refluxogenic potential of foods and beverages (F&B) consumed by patients with laryngopharyngeal reflux (LPR).

METHODS

European experts of the LPR Study group of the Young-Otolaryngologists of the International Federation of Oto-rhino-laryngological societies were invited to identify the components of Western European F&B that would be associated with the development of LPR. Based on the list generated by experts, four authors conducted a systematic review to identify the F&B involved in the development of esophageal sphincter and motility dysfunctions, both mechanisms involved in the development of gastroesophageal reflux disease and LPR. Regarding the F&B components and the characteristics identified as important in the development of reflux, experts developed three rational scores for the assessment of the refluxogenic potential of F&B, a dish, or the overall diet of the patient.

RESULTS

Twenty-six European experts participated to the study and identified the following components of F&B as important in the development of LPR: pH; lipid, carbohydrate, protein composition; fiber composition of vegetables; alcohol degree; caffeine/theine composition; and high osmolality of beverage. A total of 72 relevant studies have contributed to identifying the Western European F&B that are highly susceptible to be involved in the development of reflux. The F&B characteristics were considered for developing a Refluxogenic Diet Score (REDS), allowing a categorization of F&B into five categories ranging from 1 (low refluxogenic F&B) to 5 (high refluxogenic F&B). From REDS, experts developed the Refluxogenic Score of a Dish (RESDI) and the Global Refluxogenic Diet Score (GRES), which allow the assessment of the refluxogenic potential of dish and the overall diet of the LPR patient, respectively.

CONCLUSION

REDS, RESDI and GRES are proposed as objective scores for assessing the refluxogenic potential of F&B composing a dish or the overall diet of LPR patients. Future studies are needed to study the correlation between these scores and the development of LPR according to impedance-pH study.

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.

Assessment of the Acute Effects of Carbonated Beverage Consumption on Symptoms and Objective Markers of Gastric Reflux

Previous studies have suggested that carbonated beverages may cause gastro-oesophageal reflux. Pepsin (the major enzyme secreted by the stomach) has been suggested to be an objective, acute marker of a reflux event. This pilot study aimed to investigate whether intake of carbonated beverages could affect pepsin concentration in saliva or reflux symptoms. This was assessed by a randomised, crossover trial where participants consumed 330 mL of beverage (carbonated cola, degassed cola or water) at separate visits. Saliva samples and symptom questionnaires were collected at baseline and over the 30 min postprandial period. Pepsin was detected in all saliva samples. No difference was found in the salivary pepsin concentrations between treatments at all time points. There were significantly higher scores (p > 0.05) for feelings of fullness, heartburn, urge to belch and frequency of belches after ingestion of carbonated cola than degassed cola and water. The ingestion of carbonated beverages did not appear to increase postprandial pepsin concentration in saliva compared to other beverages but did evoke higher levels of reflux-related symptoms such as fullness, heartburn and belching. This suggests carbonated beverages may cause symptoms associated with reflux but do not drive detectable levels of gastric juice to reach the oral cavity.

Prevalence and risk factors of gastro-esophageal reflux disease among undergraduate medical students from a southern Indian medical school: a cross-sectional study

Objective

Gastro-esophageal reflux disease (GERD) affects all age groups, and various lifestyle as well as psychological factors are recognized as risk factors for GERD. Undergraduate medical students are exposed to lifestyle changes and psychological stressors. We aimed to study the prevalence of GERD among undergraduate students of a medical school in southern India in a cross-sectional survey using a validated symptom score.

Results

A total of 358 undergraduate medical students participated in the study. There were 188 (52.5%) males and 170 (47.4%) females; the mean (SD) age of the participants was 20.3 (1.5) years. A total of 115 (31.2%) participants had at least one episode of heartburn per week, while 108 (30.1%) participants had at least one episode of regurgitation per week. Heartburn or regurgitation of at least mild severity was present in 115 (32.1%) and 108 (30.16%) of participants respectively. Based on the symptom score, a diagnosis of GERD was made in 18 (5.02%) students. Frequent consumption of carbonated drinks (OR = 3.63 [95% CI 1.39–9.5]; P = 0.008) and frequent consumption of tea or coffee (OR = 4.65 [95% CI 1.2–17.96]; P = 0.026) were significantly associated with a diagnosis of GERD.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3569-1) contains supplementary material, which is available to authorized users.

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.

Prevalence of dental erosion among people with gastroesophageal reflux disease in China

STATEMENT OF PROBLEM

Gastroesophageal reflux disease (GERD) is typically diagnosed based on symptoms of regurgitation and heartburn, although it may also manifest as asthma-like symptoms, laryngitis, or dental erosion.

PURPOSE

The purpose of this prospective, cross-sectional study was to assess the prevalence of dental erosion in people with GERD and to evaluate the association between GERD and dental erosion.

MATERIAL AND METHODS

The presence, severity, and pattern of dental erosion was assessed in 51 participants with GERD and 50 participants without GERD using the Smith and Knight tooth wear index. Medical, dietary, and dental histories were collected by questionnaire. Factors potentially related to dental erosion, including GERD, were evaluated by logistic regression.

RESULTS

Dental erosion was observed in 31 (60.8%) participants with GERD and 14 (28%) participants without GERD. Bivariate analysis revealed that participants with GERD were more likely to experience dental erosion (crude odds ratio [cOR]: 2.74; 95% CI: 1.19, 6.32) than participants without GERD. Multivariate analysis also revealed that participants with GERD had a higher risk of dental erosion (adjusted odds ratio [aOR]: 3.97; 95% CI: 1.45, 10.89). Consumption of grains and legumes, the most frequently consumed foods in China, did not correlate with dental erosion. However, carbonated beverage consumption was significantly associated with GERD and dental erosion (aOR: 3.34; 95% CI: 1.01, 11.04; P=.04).

CONCLUSIONS

GERD was positively correlated with dental erosion. Carbonated beverage consumption can increase the risk of both GERD and dental erosion.

Dietary guideline adherence for gastroesophageal reflux disease

Background

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disease, and the cost of health care and lost productivity due to GERD is extremely high. Recently described side effects of long-term acid suppression have increased the interest in nonpharmacologic methods for alleviating GERD symptoms. We aimed to examine whether GERD patients follow recommended dietary guidelines, and if adherence is associated with the severity and frequency of reflux symptoms.

Methods

We conducted a population-based cross-sectional study within the Kaiser Permanente Northern California population, comparing 317 GERD patients to 182 asymptomatic population controls. All analyses adjusted for smoking and education.

Results

GERD patients, even those with moderate to severe symptoms or frequent symptoms, were as likely to consume tomato products and large portion meals as GERD-free controls and were even more likely to consume soft drinks and tea [odds ratio (OR) = 2.01 95% confidence interval (CI) 1.12-3.61; OR = 2.63 95% CI 1.24-5.59, respectively] and eat fried foods and high fat diet. The only reflux-triggering foods GERD patients were less likely to consume were citrus and alcohol [OR = 0.59; 95% CI: 0.35-0.97 for citrus; OR = 0.41 95% CI 0.19-0.87 for 1 + drink/day of alcohol]. The associations were similar when we excluded users of proton pump inhibitors.

Conclusions

GERD patients consume many putative GERD causing foods as frequently or even more frequently than asymptomatic patients despite reporting symptoms. These findings suggest that, if dietary modification is effective in reducing GERD, substantial opportunities for nonpharmacologic interventions exist for many GERD patients.

Alcoholic beverages and carbonated soft drinks: consumption and gastrointestinal cancer risks

Alcoholic beverages (ABs) and carbonated soft drinks (CSDs) are widely consumed worldwide. Given the high consumption of these beverages, the scientific community has increased its focus on their health impact. There is epidemiological evidence of a causal association between AB intake and digestive cancer, but the role of alcohol in determining cancer is not fully defined. Experimental studies have so far identified multiple mechanisms involved in carcinogenesis; ethanol itself is not carcinogenic but available data suggest that acetaldehyde (AA) and reactive oxygen species-both products of ethanol metabolism-have a genotoxic effect promoting carcinogenesis. Other carcinogenetic mechanisms include nutritional deficits, changes in DNA methylation, and impaired immune surveillance. As CSDs are often suspected to cause certain gastrointestinal disorders, consequently, some researchers have hypothesized their involvement in gastrointestinal cancers. Of all the ingredients, carbon dioxide is prevalently involved in the alteration of gastrointestinal physiology by a direct mucosal effect and indirect effects mediated by the mechanical pressure determined by gas. The role of sugar or artificial sweeteners is also debated as factors involved in the carcinogenic processes. However, several surveys have failed to show any associations between CSDs and esophageal, gastric, or colon cancers. On the other hand, a slight correlation between risk of pancreatic cancer and CSD consumption has been found.

Ingestion of a carbonated beverage decreases lower esophageal sphincter pressure and increases frequency of transient lower esophageal sphincter relaxation in normal subjects

Transient lower esophageal sphincter relaxation (tLESR) and decreased basal lower esophageal sphincter (LES) pressure are postulated mechanisms of gastroesophageal reflux (GER). There is conflicting evidence on the effect of carbonated drinks on lower esophageal sphincter function. This study was conducted to assess the effect of a carbonated beverage on tLESR and LES pressure. High resolution manometry tracings (16 channel water-perfused, Trace 1.2, Hebbard, Australia) were obtained in 18 healthy volunteers (6 men) for 30 min each at baseline, and after 200 mL of chilled potable water and 200 mL of chilled carbonated cola drink (Pepsi [Pepsico India Ltd]). The sequence of administration of the drinks was determined by random number method generated by a computer. The analysis of tracings was done using TRACE 1.2 software by a physician who was unaware of the sequence of administration of fluids. The mean (SD) age of the participant was 37.3 (12.9) years. The median (range) frequency of tLESr was higher after the carbonated beverage (10.5 [0-26]) as compared to baseline (0 [0-3], p = 0.005) as well as after water (1 [0-14], p = 0.010). The LES pressure decreased after ingestion of the carbonated beverage (18.5 [11-37] mmHg) compared to baseline (40.5 [25-66] mmHg, p = 0.0001) and after water (34 [15-67] mmHg, p = 0.003). Gastric pressure was not different in the three groups. Ingestion of a carbonated beverage increases tLESr and lowers LES pressure in healthy subjects.

Relationship between gastroesophageal reflux symptoms and dietary factors in Korea

Background/Aims

The incidence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study was to evaluate the relationship between GERD symptoms and dietary factors in Korea.

Methods

From January 2007 to April 2008, 162 subjects were enrolled (81 in GERD group and 81 in control group). They were asked to complete the questionnaires about GERD symptoms and dietary habits. The symptom severity score was recorded by visual analogue scale.

Results

Subjects with overweight or obesity had an increased risk for GERD (OR, 2.52; 95% CI, 1.18-5.39). Irregular dietary intake was one of the risk factors for GERD (OR, 2.33; 95% CI, 1.11-4.89). Acid regurgitation was the most suffering (2.85 ± 2.95 by visual analogue scale) and frequent reflux-related symptom (57.5%) in GERD. Noodles (OR, 1.22; 95% CI, 1.12-1.34), spicy foods (OR, 1.09; 95% CI, 1.02-1.16), fatty meals (OR, 1.20; 95% CI, 1.09-1.33), sweets (OR, 1.42; 95% CI, 1.00-2.02), alcohol (OR, 1.16; 95% CI, 1.03-1.31), breads (OR, 1.17; 95% CI, 1.01-1.34), carbonated drinks (OR, 1.69; 95% CI, 1.04-2.74) and caffeinated drinks (OR,1.41; 95% CI, 1.15-1.73) were associated with symptom aggravation in GERD. Among the investigated noodles, ramen (instant noodle) caused reflux-related symptoms most frequently (52.4%).

Conclusions

We found that noodles, spicy foods, fatty meals, sweets, alcohol, breads, carbonated drinks and caffeinated drinks were associated with reflux-related symptoms.

Alterations confined to the gastro-oesophageal junction: the relationship between low LOSP, TLOSRs, hiatus hernia and acid pocket

The gastro-oesophageal junction is a specialised segment of the gut designed to prevent reflux of gastric contents into the oesophagus. This task is fulfilled by two structures, i.e. the lower oesophageal sphincter and the crural diaphragm, which generate a high pressure zone. Especially during low pressure at the junction, as in case of long-lasting transient lower oesophageal sphincter relaxations, reflux can occur but mainly if a positive pressure gradient exists between stomach and the oesphagogastric junction. Although patients with gastro-oesophageal reflux disease have increased oesophageal acid exposure compared to controls, the number of transient relaxations is not increased compared to healthy controls. Instead, the risk to have acid reflux is at least doubled in patients, especially in those with a hiatal hernia, most likely as a result of the supradiaphragmatic position of the acid pocket. In hiatal hernia patients, the acid pocket is indeed often trapped in the hernia above the diaphragm. Which factors exactly determine the physical composition (liquid or gas) and the proximal extent of the refluxate however requires further research.

Dietary factors and the risks of oesophageal adenocarcinoma and Barrett's oesophagus. Nutr Res Rev. 2010;23:230-246. [PMID: 20624335 DOI: 10.1017/s0954422410000132]

Incidence rates for oesophageal adenocarcinoma have increased by over 500% during the past few decades without clear reasons. Gastro-oesophageal reflux disease, obesity and smoking have been identified as risk factors, although the demographic distribution of these risk factors is not consistent with the demographic distribution of oesophageal adenocarcinoma, which is substantially more common among whites and males than any other demographic groups. Numerous epidemiological studies have suggested associations between dietary factors and the risks of oesophageal adenocarcinoma and its precursor, Barrett's oesophagus, though a comprehensive review is lacking. The main aim of the present review is to consider the evidence linking dietary factors with the risks of oesophageal adenocarcinoma, Barrett's oesophagus, and the progression from Barrett's oesophagus to oesophageal adenocarcinoma. The existing epidemiological evidence is strongest for an inverse relationship between intake of vitamin C, β-carotene, fruits and vegetables, particularly raw fruits and vegetables and dark green, leafy and cruciferous vegetables, carbohydrates, fibre and Fe and the risk of oesophageal adenocarcinoma and Barrett's oesophagus. Patients at higher risk for Barrett's oesophagus and oesophageal adenocarcinoma may benefit from increasing their consumption of fruits and vegetables and reducing their intake of red meat and other processed food items. Further research is needed to evaluate the relationship between diet and the progression of Barrett's oesophagus to oesophageal adenocarcinoma. Evidence from cohort studies will help determine whether randomised chemoprevention trials are warranted for the primary prevention of Barrett's oesophagus or its progression to cancer.

Systematic review: the effects of carbonated beverages on gastro-oesophageal reflux disease

BACKGROUND

Carbonated beverages have unique properties that may potentially exacerbate gastro-oesophageal reflux disease (GERD), such as high acidity and carbonation. Cessation of carbonated beverage consumption is commonly recommended as part of lifestyle modifications for patients with GERD.

AIMS

To evaluate the relationship of carbonated beverages with oesophageal pH, oesophageal motility, oesophageal damage, GERD symptoms and GERD complications.

METHODS

A systematic review.

RESULTS

Carbonated beverage consumption results in a very short decline in intra-oesophageal pH. In addition, carbonated beverages may lead to a transient reduction in lower oesophageal sphincter basal pressure. There is no evidence that carbonated beverages directly cause oesophageal damage. Carbonated beverages have not been consistently shown to cause GERD-related symptoms. Furthermore, there is no evidence that these popular drinks lead to GERD complications or oesophageal cancer.

CONCLUSIONS

Based on the currently available literature, it appears that there is no direct evidence that carbonated beverages promote or exacerbate GERD.

Carbonated beverages and gastrointestinal system: between myth and reality

A wealth of information has appeared on non-scientific publications, some suggesting a positive effect of carbonated beverages on gastrointestinal diseases or health, and others a negative one. The evaluation of the properties of carbonated beverages mainly involves the carbon dioxide with which they are charged. Scientific evidence suggests that the main interactions between carbon dioxide and the gastrointestinal system occur in the oral cavity, the esophagus and the stomach. The impact of carbonation determines modification in terms of the mouthfeel of beverages and has a minor role in tooth erosion. Some surveys showed a weak association between carbonated beverages and gastroesophageal reflux disease; however, the methodology employed was often inadequate and, on the overall, the evidence available on this topic is contradictory. Influence on stomach function appears related to both mechanical and chemical effects. Symptoms related to a gastric mechanical distress appear only when drinking more than 300 ml of a carbonated fluid. In conclusion there is now sufficient scientific evidence to understand the physiological impact of carbonated beverages on the gastrointestinal system, while providing a basis for further investigation on the related pathophysiological aspects. However, more studies are needed, particularly intervention trials, to support any claim on the possible beneficial effects of carbonated beverages on the gastrointestinal system, and clarify how they affect digestion. More epidemiological and mechanistic studies are also needed to evaluate the possible drawbacks of their consumption in terms of risk of tooth erosion and gastric distress.

Diet, lifestyle and gender in gastro-esophageal reflux disease

BACKGROUND

Studies indicate that gastro-esophageal reflux disease (GERD) is associated with obesity, smoking, esophagitis, diet, and lifestyle.

AIM

To identify risk factors associated with GERD among patients presenting to a tertiary GI clinic in Italy.

METHODS

Patients with a first diagnosis of GERD based on heartburn and/or regurgitation and/or esophagitis at the endoscopic examination were enrolled. A control group with neither GERD symptoms nor esophagitis was enrolled from the same hospital. Each subject completed a questionnaire including demographic information, lifestyle (e.g., exercise, alcohol, coffee, chocolate, and soda consumption, smoking, having large meals), and frequency of bowel movement. For each participant the body mass index (BMI) was calculated.

RESULTS

Five hundred subjects were enrolled including 300 GERD patients and 200 controls. Females had significantly higher prevalence of GERD than males (66 vs. 48%, P = 0.001, OR = 2.1, 95% CI = 1.5-3.1). There was an inverse relationship between the level of education and presence of GERD (76% of GERD patients has completed only elementary school (OR = 2.1, 95% CI = 1.7-4.9). Obesity (BMI of > or =95th percentile for their age/gender specific) was significantly related to GERD (OR = 1.8, P = 0.01). None of the other variables studied showed significant associations with GERD. Logistic regression analysis showed that BMI > or =95th percentile, gender, and low education level were significant risk factors for GERD.

CONCLUSIONS

Understanding the epidemiology and risk factors for GERD in a region is the first step in designing prevention and treatment strategies.

Sweetened carbonated drinks do not alter upper digestive tract physiology in healthy subjects

Sweetened carbonated beverages are widely consumed, which has fuelled several conflicting opinions about their effects on upper digestive tract functions. We aimed to evaluate the effect of sweetened carbonated drinks, consumed with a standard meal, on gastro-oesophageal reflux, gastric emptying and gallbladder contraction and postmeal sensations in healthy subjects. Thirteen healthy volunteers (seven women, six males; median age 22 years) were tested following the intake of 300 mL sweetened water containing increasing concentrations of carbon dioxide (seven subjects), and of 300 mL sweetened commercial flavoured drink with and without carbon dioxide (six subjects). Gastro-oesophageal reflux, gastric emptying and gallbladder contraction were studied by pH-impedance, octanoic acid breath test and ultrasound respectively. Gastro-oesophageal refluxes were significantly increased 1 h after meal with both water and commercial beverages; only sweetened water without carbon dioxide determined a persistently increasing number of refluxes 2 h postmeal. No differences were found for gastric emptying, gallbladder contraction or postmeal symptoms with any of the beverages tested. This study shows that 300 mL of sweetened carbonated beverage with different levels of carbonation or a commercial soft drink do not modify the physiology of the upper digestive tract.

Cancers of the esophagus and carbonated beverage consumption: a population-based case-control study

OBJECTIVE

Increased consumption of carbonated soft drinks has been hypothesized to be a risk factor for esophageal adenocarcinoma (EAC); however, previous studies have not found supportive evidence. We analyzed data from a population-based case-control study to measure the association between carbonated beverage intake and risk of adenocarcinomas and squamous cell carcinoma (SCC) of the esophagus.

METHODS

A food frequency questionnaire (FFQ) was used to collect data on carbonated soft drink and beer consumption; a self-administered questionnaire was used to collect information on demographic, socioeconomic, and lifestyle-related factors from 1,484 control subjects, 294 cases with EAC, 325 cases with adenocarcinoma of the esophagogastric junction (EGJAC), and 238 cases with SCC of the esophagus. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional multivariable logistic regression, adjusting for confounders.

RESULTS

High intake of soft drinks was not associated with risk of EAC (fully adjusted OR = 0.94, 95% CI 0.53-1.66, p for trend = 0.85) or EGJAC (fully adjusted OR = 1.07, 95% CI 0.67-1.73, p for trend = 0.89) but was inversely associated with SCC of the esophagus (fully adjusted model OR = 0.40, 95% CI 0.20-0.78, p for trend = 0.04). High intake of beer was inversely associated with risk of EGJAC (fully adjusted OR = 0.53, 95% CI 0.35-0.81) but positively associated with esophageal SCC (fully adjusted model OR = 1.86, 95% CI 1.17-2.95).

CONCLUSION

High levels of consumption of carbonated soft drinks do not appear to increase the risk of either adenocarcinomas or SCC of the esophagus.

Developments in pathogenesis and diagnosis of gastroesophageal reflux disease

PURPOSE OF REVIEW

Although gastroesophageal reflux is a common disorder, diagnosis is still imprecise. Moreover, its pathogenesis is incompletely understood. This review summarizes recent progress in diagnosis and our understanding of the pathogenesis of gastroesophageal reflux disease.

RECENT FINDINGS

Recent studies have focused on the pattern of reflux in the distal esophagus, just above the esophago-gastric junction, challenging its importance on the genesis of reflux symptoms. New techniques, such as impedance, could improve the diagnostic yield, especially in patients with nonacid reflux. Esophageal sensitivity and motility, transient lower esophageal sphincter relaxations, and hiatus hernia are important pathogenic mechanisms of reflux disease. Studies showed that obesity plays a role in the pathogenesis of reflux symptoms; a disruption of the esophago-gastric junction (leading to hiatus hernia) could allow reflux to occur. The association between reflux (particularly nonacid) and extraesophageal manifestations of gastroesophageal reflux disease has been further evaluated.

SUMMARY

Improvement of diagnostic techniques and better understanding of the pathogenesis of reflux may lead to new or better therapeutic modalities. Our understanding of some of the risk factors for reflux has been increased. Extra-esophageal manifestations and their association with gastroesophageal reflux are still a very controversial and promising area of research.

Physiology of reflux disease: role of the lower esophageal sphincter

The function of the lower esophageal sphincter (LES) has historically been elucidated by two major manometric methods: the one concentrating on static parameters including resting pressure, overall length, and intraabdominal length, and the other concentrating on the episodic loss of sphincter tone, termed "transient lower esophageal sphincter relaxations" (TLESRs). Both approaches yield valuable insights, but neither is all-encompassing. Both resting characteristics and the production of TLESRs are affected by many features in the typical western diet, including carbonated beverages. The authors hypothesize that repetitive distention resulting from such substances causes the LES to become transiently defective and reduces the threshold for the occurrence of TLESRs. Long-term defects of the resting parameters may reflect secondary damage to underlying muscle caused by increased reflux. The coexistence of hiatal hernia compounds the mechanical deficiency, and obesity also may contribute. Despite much research to reduce the frequency of TLESRs pharmacologically, restoration of the LES remains primarily within the realm of the surgeon.