Gastroesophageal Reflux

Introduction

Gastroesophageal reflux disease (GERD) is a chronic disease of the gastrointestinal system that refers to the reflux of stomach contents primarily into the esophagus and secondarily into neighboring organs such as the lungs. The most important reason why the disease develops is the relaxation of the lower esophageal sphincter, which is a hollow muscular tube. In GERD, this sphincter relaxes, resulting in the esophageal mucosa being exposed to the acidic contents of the stomach. This prolonged exposure ultimately causes its erosion and is responsible for the appearance of symptoms.

The main symptoms of patients with GERD

• Heartburn and pain behind the sternum (retrosternal heartburn)
• Reflux of food and liquids
• Severe acid reflux and tooth erosion
• Chronic cough and shortness of breath, symptoms that affect the quality of sleep

The intensity of the symptoms varies depending on the severity of the disease, that is, depending on the degree of erosion of the esophagus. If the symptoms are not managed in a timely manner, the development of other chronic diseases such as asthma is possible, further affecting the quality of life of patients. In addition, the risk of developing complications increases. The main complications are esophageal strictures that can lead to eating disorders (dysphagia, dysphagia), esophageal bleeding and the development of Barrett’s esophagus. The disease is of great scientific interest since the number of patients worldwide is constantly increasing. It is estimated that in the last 30 years the number of people suffering from GERD worldwide has increased by 18.1%.

Risk Factors for the Development of the Disease

Genetic and environmental factors have been shown to cause the development of the disease. Genetic factors include family history, while environmental factors include:

• excess weight
• chronic exposure to substances that irritate the mucosa such as smoking and alcohol
• stress
• special situations such as pregnancy

The above factors, combined with increased age, have been directly associated with the development of GERD mainly due to increased pressure in the abdominal cavity (intra-abdominal pressure) which ultimately causes relaxation of the lower esophageal sphincter.

Dietary habits that are negatively associated with the development of the disease are specifically:

• the rapid consumption of a large amount of food
• lying down within 2 hours after eating
• the increased acidity and fat content of foods
• the addition of spices

Finally, an important risk factor is hiatal hernia, an acquired condition in which part of the stomach moves into the chest. The risk of developing this increases with age, just as is observed in GERD. In many cases, patients with hiatal hernia present GERD as a result of this, but this does not mean that all patients with hiatal hernia necessarily present GERD and vice versa.

Dietary Treatment of GERD

There are three axes for treating the disease:

1.Lifestyle changes

General lifestyle changes for patients with GERD are important and necessary in order to improve quality of life and reduce the risk of developing complications due to worsening of the disease. These changes include:

• Reducing body weight and avoiding the use of tight clothing and belts. These changes will lead to a decrease in intra-abdominal pressure and therefore to a decrease in the contact of the lower esophageal sphincter with stomach acids.
• Small and frequent meals. Eating every 3-4 hours helps to better regulate weight, which as mentioned is necessary in GERD, and does not cause stomach distension, which would cause increased relaxation of the lower esophageal sphincter.
• Avoid eating 2-3 hours before bedtime and avoid eating late at night. This will reduce the risk of reflux of gastric contents into the esophagus.
• Avoid intense physical activity immediately after eating
• Reduce smoking and alcohol

2. Dietary modification

Regarding dietary management, patients with gastroesophageal reflux disease are advised to have a satisfactory intake of:

• Proteins by increasing the intake of fish, poultry, eggs, meat, legumes and dairy products as they increase the pressure of the lower esophageal sphincter, thus preventing it from relaxing. In this way, the exposure of the esophageal mucosa to stomach acids is limited.
• Vegetable Fiber through increased intake of fruits, vegetables, legumes and whole grain products as, although the mechanism is unknown, they seem to be negatively associated with the risk of reflux.

In addition, it would be advisable for patients to limit or even exclude the consumption of specific foods, beverages and herbs that either increase the intensity of the symptoms of the disease or worsen it, due to the effect on the function of the lower esophageal sphincter.

Foods and herbs that worsen the symptoms of the disease:

• Sweets, especially syrupy ones (spoon sweets, donuts, whipped cream, honey or jam) and chocolate
• Coffee
• Alcohol
• Juices, especially those derived from citrus fruits (orange, lemon, grapefruit) and tomatoes
• Spices
• Foods with a high fat content (fried foods, cold cuts, baked goods, fatty meats and fish, cheeses and sauces such as mayonnaise)
• The carbonated drinks
• Chocolate
• Alcohol
• Spearmint and peppermint which require further investigation

On the other hand, there are studies that support that there are foods that can reduce the intensity of symptoms. These foods include:

1. Chios mastic: A variety of bioactive components contained in it provide it with antimicrobial and anti-inflammatory properties. The main components are polyphenols, phytosterols and terpenes. Chewing gum has been shown to cause an increase in saliva production and, on the other hand, increases the frequency of swallowing, resulting in limiting the exposure of the esophageal mucosa to the acidic contents of the stomach.
2. Probiotics:Their presence in the intestine facilitates the process of digestion and absorption of nutrients, resulting in reducing their residence time in the gastrointestinal system. In this way, the possibility of exposure of the esophageal mucosa to them is reduced.
3. Licorice:Increases the production of mucus by the esophageal mucosa, which causes it to heal and prevents its further erosion. In this way, the intensity of common symptoms of GERD, such as heartburn, is reduced.

3. Pharmacotherapy (antacids, H2 antagonists, prokinetic drugs or proton pump antagonists).

Medication is used in cases where, while changes in both lifestyle and dietary habits have been implemented, there have still been no results. If these symptoms improve, it is probably not necessary to continue treatment, but in any case, decisions are made by the gastroenterologist. He will decide which treatment is appropriate for each case, as well as the dosage and frequency of treatment.

In conclusion

In summary, gastroesophageal reflux disease is a chronic condition that impairs the quality of life of patients and requires immediate treatment. Changes in lifestyle and dietary habits are important and an integral part of the management of the disease and, in combination with the administration of specific medications, can lead to a remission of the intensity of symptoms, healing of the esophageal mucosa and slowing down its progression. Early diagnosis and eventual treatment of the disease can bring the best possible results and significantly improve the lifestyle of patients.