Nutrition. What is gastroesophageal reflux?

There are many preconceived notions about diet for gastroesophageal reflux disease (GERD). To better understand its implications, here are some concepts.

GERD, what is it?

Gastroesophageal reflux disease occurs when acidic stomach contents back up into the esophagus, causing symptoms and damaging the lining of the esophagus.

The anatomical area where the esophagus connects to the stomach is called the esophagogastric junction. Right here “lower esophageal sphincter” (LES), a circular muscle that regulates the passage of contents from the esophagus to the stomach. This “valve” blocks the movement of food from the stomach into the esophagus. When this sphincter does not function properly (eg, low tone), it can lead to problems such as gastroesophageal reflux disease.

Besides medications, certain health and dietary practices are important to treat GERD, such as waiting 2-3 hours after eating before going to bed.

Diet and weight play a role in the symptoms of GERD. Weight loss is effective in reducing reflux symptoms.

Indeed, obesity contributes to the development of GERD due to increased intra-abdominal pressure and stress on the esophagogastric junction, the border between the esophagus and the stomach.

What about high-calorie foods?

The caloric load of a meal (number of calories) and fat content influence GERD. Indeed, food intake reduces the tone of the lower esophageal sphincter (LES) and causes it to relax more often and for longer (“transient relaxation of the ESS”), thereby allowing reflux of esophageal contents into the stomach. esophagus.

This transient relaxation is normal, but it may be more frequent and longer lasting in people with GERD.

However, it has been shown that in the presence of dietary lipids, a neuropeptide (cholecystokinin) is released in the duodenum, which contributes to a decrease in the tone of the esophagogastric valve and an increase in the frequency of these transient relaxations.

All this contributes to increased acid reflux. Finally, lipids increase the perception of reflux (we talk about “lipid-induced reflux hypersensitivity”).

That’s why it’s important to consider the calories and lipids in your diet, which are often related.

In addition, high-calorie foods slow gastric emptying (the process of food moving from the stomach to the small intestine), which prolongs gastric distension, reduces the tone of the esophagogastric valve, and increases the occurrence of transient valve actuation.

Carbohydrates contribute to reflux

If the protein component of food has little effect on the physiology of the esophagus and stomach, then carbohydrates through their fermentation products (short-chain fatty acids) affect the motility of the esophagus/stomach.

The result: a flap with less tone, which relaxes more often and for a longer time. Studies of diets low in sugar and carbohydrates have shown beneficial effects on reflux symptoms.

So, taking this information into account, it is now certain that foods rich in calories, fat, and/or carbohydrates contribute to the occurrence of reflux episodes, as well as the sensation of them.

Therefore, experts advise that if you have GERD, you should follow a diet low in fats and carbohydrates.

Sources: Francophone Days of Hepatogastroenterology and Digestive Oncology (JFHOD; 14–17 March 2024, Paris); ACG Clinical Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease.