Introduction
What are the nutrition/lifestyle recommendations for GERD and what is the strength of evidence behind these guidelines?
Task
Learning Objectives:
- Understand the pathophysiology, symptoms, prevalence, and risk factors for GERD.
- Understand the medical intervention for GERD
- Identify the lifestyle recommendations for managing GERD and the strength of evidence behind these recommendations.
- Identify the specific foods that are often recommended to avoid/eliminate fin GERD and evaluate the strength of evidence for these guidelines.
Process
Background (1)
What is GERD?
Gastroesophageal reflux disease: reflux of gastric/stomach contents into the esophagus due to lower esophageal sphincter (LES) dysfunction. This LES incompetence may be due to decreased intrinsic sphincter tone or from recurrent relaxations of the LES at inappropriate intervals.
Prevalence: 10-20% of adults (that's common!)
Risk factors: excess weight, smoking, certain drugs (nticholinergics, antihistamines, tricyclic antidepressants, calcium channel blockers, progesterone, and nitrates)
Other contributing factors? weight gain/excess weight, fatty foods, caffeinated/carbonated beverages, alcohol
Symptoms: burning pain after eating, heartburn, regurgitation of gastric contents; may have cough, hoarseness, or wheezing if chronic.
Complications: esophagitis, peptic esophageal ulcer, esophageal stricture, Barrett esophagus, and esophageal adenocarcinoma.
Medical treatment treatment: proton-pump inhibitor (PPI), H2 blockers; surgery only indicated in patients with serious complications, such as esophagitis, large hiatal hernias, hemorrhage, stricture, or ulcers.
Lifestyle Management (1)
-Head of bed elevation (~15 cm)/refrain from laying down after eating
-Avoid eating close to bedtime (>2-3 hours)
-weight loss in overweight/obese patients
- increase of BMI by > 3.5 kg/m2 associated with an increase risk of frequent symptoms of reflux according to Nurse's Health Study.
-studies have supported positive correlation between BMI and GERD/GERD symptoms. Central obesity plays a large role.
-obesity associated with greater complications (e.g. Barret esophagus, erosive esophagitis, esophageal adenocarcinoma)
-Mechanisms: increased prevalence of esophageal motor disorders, higher number of transient relaxations of the lower esophageal sphincter, and increased intra-abdominal pressure.
-for each 5-unit increase in BMI, the risk of BE increased by 35%
-gastric bypass surgery leads to substantial weight loss and the data has consistently shown a decrease in GERD symptoms
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920303/
-Avoid foods that promote acid secretion (e.g.
-Avoid other dietary triggers (e.g. chocolate, high-fat foods)
Credits
1. Lynch KL. Gastroesophageal Reflux Disease (GERD) page. Merck Manual Web site. http://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/gastroesophageal-reflux-disease-gerd. Last revised October 2016. Accessed August 1, 2017.