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Study 1: Obesity and gastroesophageal reflux disease (GERD)
A new analysis from the Nurses Health Study examines the relationship between body weight and GERD.
Subjects and methods: 10,545 nurses completed a questionnaire on symptoms of GERD. The data was compared with their body mass index (BMI) measured two years earlier.
Results: E 'was shown a sharp increase in the possibility of having symptoms of GERD in the entire spectrum of body weights, BMI from 22 to less obesity. This report has also occurred in relation to the severity of the symptoms of GERD - see chart.
Bibliography: N Engl J Med 2006 Jun 1; 354 \u200b\u200b(22) :2340-8.
Study 2: a meta-analysis confirms the relationship
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E 'was recently published a meta-analysis on the association between BMI and GERD, esophagitis, and other related gastrointestinal diseases.
Subjects and methods: A total of 9 observational studies (involving about 63,000 individuals, including 7372 cases), six studies have found an association between BMI and symptoms of GERD. The combined odds ratio in 8 studies was 1.43 (95% CI: 1.16-1.77) for overweight (BMI = 25-30) and 1.94 (1:47 to 2:57) for obesity (BMI> 30), overweight and obesity were also associated with a higher risk of esophageal cancer (OR = 1.52 and 2.78, respectively).
Bibliography: Ann Intern Med 2005 Aug 2; 143 (3) :199-211.
Study 3: The schedule of meals is important
Japanese researchers have examined whether the timing of meals might affect the risk of having symptoms of GERD.
Subjects and methods: case-control study on 147 patients with GERD and 294 controls without GERD.
Results: The interval between dinner and sleep was strongly associated with the possibility of having GERD. With a range <3 size="2"> Bibliography: Am J Gastroenterol. 2005 Dec; 100 (12) :2633-6
COMMENT
Symptoms of gastroesophageal reflux disease (GERD), such as heartburn and indigestion, are quite common and not just in Western countries (ref. 1, 2). A recent Swedish study reported a prevalence of GERD symptoms by 40% of a large adult population in 15% there was evidence of reflux, gastroscopy (ref. 1). Apart from the effect on quality of life (ref. 3), GERD may cause esophagitis and esophageal cancer to develop (ref. 4).
The possible causes of GERD are numerous, and some fall between these nutritional factors. Excess weight is always mentioned in the popular press (eg, ref. 5), but less frequently in medical texts (eg, ref. 6). As the new studies 1 and 2 show, should be mentioned more often. In fact, one study showed an increased risk of GERD by the weight of the lower limits under the severe obesity.
An interesting explanation for this association is reported in a new English study shows that a recent weight gain (> 5 kg over the previous 12 months) is associated with an increase of 50% of the risk of GERD symptoms compared to that period (ref. 7). While we can not overcome the lack of an RCT, these observations suggest a cause-effect relationship in the overweight-GERD.
The mechanisms responsible for such an association are not hard to imagine. Obesity increases the intra-abdominal pressure and obese patients can have gastro-intestinal motility disorders (ref. 8, 9). However, it is possible say that overweight is associated with all aspects and types of GERD. For example, one study showed that obesity was not associated with laryngeal reflux events (ref. 10).
On the other hand, some studies have shown that overweight patients with GERD have a higher risk than non-overweight to be hospitalized for complications of GERD and esophagitis present and / or Barrett's esophagus (ref. 11, 12) . It would be great news to find that weight loss may not only reduce the symptoms of GERD, like heartburn, but also reduce the risk of cancer of the gastrointestinal tract that are usually associated with this condition.
However this is only speculation. The fact is that, for the moment, the advice often given to patients with GERD to lose weight (if overweight) is not supported by evidence from RCTs (ref. 13).
Other dietary approaches, commonly recommended to patients with GERD include the avoidance of foods that can aggravate the symptoms: fatty foods, chocolate, spices, mint, coffee, alcohol and 'fatty foods' (ref. 13). The patients themselves seem to believe that these foods are associated with the onset of symptoms, and can also report food allergies (ref. 14).
Avoid fatty foods have a rational, because the fats slow gastric emptying and increase lower esophageal sphincter pressure (ref. 13). This can also be a confounder in the association, described by observational studies, between obesity and GERD.
However, some epidemiological data suggest that obesity is a risk factor for GERD, with or without fat (ref. 11). Some studies have shown that fat can increase the reflux, but an equally large number have refuted this association (ref. 15-17). In particular, in one study, the number of total calories consumed seems to be a more important factor in determining the GERD than total fat intake (ref. 18).
There is also evidence that chocolate reduces esophageal sphincter pressure and increases reflux (ref. 19-21). However, there are no RCTs showing that avoiding chocolate reduces the symptoms of GERD (ref. 21). Similar goes for alcohol (ref. 21-23).
The evidence suggests that coffee represents a risk factor for GERD is difficult to interpret with certainty. While some studies suggest that coffee represents a risk factor (ref. 24), unlike others support the idea that it represents a protective factor (ref. 25). Curiously these studies also show that regular use of salt increases the risk. The data on the impact of coffee intake on esophageal sphincter pressure have proved inconsistent (ref. 26). Have been published RCT showing that coffee increases the reflux, while others have not demonstrated this association. The coffee does not reduce the gastric pH (ref. 29) and also the effects of decaffeinated coffee on reflux are not clear (ref. 22, 27, 30).
Limited clinical evidence is available on the effect of spicy foods, in addition to demonstrating that the chili is that capsaicin (a substance found in chili) can influence the onset of heartburn (ref. 31, 32). In a study of Egyptian fiber intake has proven protective against GERD (ref. 33), but the addition of fibers improves reflux in patients fed by enteral (ref. 34). In a trial, the increase in fermentation in the colon through the intake of indigestible carbohydrates was shown to aggravate reflux (ref. 35). Intolerance to protein may have a material effect on reflux in children (ref. 36), but studies in adults showing a significant role of food intolerance on reflux are lacking, as there is no data on the assumption that changes in the flora bowel may be involved in GERD and that therefore the use of probiotics can be helpful (ref. 37).
Despite this lack of convincing evidence from clinical studies, experience teaches us not to ignore comments from patients about the factors that influence the symptoms. Therefore, together with regular drug therapy, an attempt to avoid certain foods may be especially appropriate when the patient notes that these can influence the symptoms. If overweight, lose weight may be worth. And finally, new observational data of study 3 suggest that increasing the interval between dinner and sleep may also represent a successful attempt to reduce the symptoms of GERD.
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