Source: Francophone Days of Hepato-Gastroenterology and Digestive Oncology (JFHOD; 14-17 March 2024, Paris); ACG Clinical Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease. American Journal of Gastroenterology 2022; 117: 27-56; Piche T et al Gastroenterology 2003;124:894-902; Eusebi L.H. et al. Global prevalence and risk factors for gastroesophageal reflux symptoms: a meta-analysis. Gut 2018;67:430-40.
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. Here is the lower esophageal sphincter (LES), a circular muscle that regulates the passage of contents from the esophagus into the stomach. This type of valve blocks the movement of food from the stomach into the esophagus. When this sphincter does not function properly (such as low tone), it can lead to problems such as gastroesophageal reflux, in which acid reflux flows back up, sometimes into the mouth.
Apart from medications, certain health and dietary guidelines 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. In fact, eating reduces the tone of the lower esophageal sphincter. It also relaxes more often and for longer (we talk about “transient relaxations of the LES”), and the contents of the stomach take the opportunity to rise into the esophagus. Although these temporary relaxations are normal, in cases of GERD they are more frequent and longer lasting.
However, it has been shown that in the presence of dietary lipids, a neuropeptide (cholecystokinin) is released, 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 are talking about hypersensitivity to lipid-induced reflux). This is why it is important to consider the calorie content as well as the amount of lipids in the diet, which are often related.
In addition, high-calorie foods slow down gastric emptying (the process of moving food from the stomach to the small intestine): gastric distension is prolonged, gastroesophageal valve tone is reduced, and there is more transient relaxation of the lower esophageal sphincter.
Carbohydrates contribute to reflux episodes and their perception.
If the protein component of food has little effect, then carbohydrates (especially fast carbohydrates, such as glucose, fructose, sucrose, etc. in fruit juices, sweet drinks, industrial products) through their fermentation products (short-chain fatty acids) reduce valve tone (lower esophageal sphincter). This releases more often and for a longer time. Moreover, studies of diets low in sugar (fast or slow carbohydrates such as legumes, etc.) have shown a beneficial effect on reflux symptoms.
Thus, foods high in calories, fat, and/or carbohydrates contribute to the occurrence and sensation of reflux episodes. Therefore, experts advise reducing the consumption of fats and carbohydrates.
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