2024-04-04 17:00:00
There are many preconceived ideas regarding diet in cases of gastroesophageal reflux disease (GERD). To better understand its effects, here are some concepts.
GERD, what is it?
Gastroesophageal reflux disease occurs when acidic contents from the stomach flow back into the esophagus, causing symptoms and damage to its lining.
The anatomical area where the esophagus connects to the stomach is called the esophagogastric junction. This is where the “lower esophageal sphincter” (LES) is located, a circular muscle that regulates the passage of contents from the esophagus into the stomach. This “valve” blocks the movement of food from the stomach to the esophagus. When this sphincter is not functioning properly (low tone, for example), it can lead to problems such as gastroesophageal reflux disease.
In addition to medications, certain health and diet rules are important for managing GERD, such as waiting 2 to 3 hours following a meal before going to bed.
Diet and weight play a role in the onset of GERD symptoms. Weight loss is effective in reducing reflux symptoms.
Indeed, obesity contributes to GERD due to increased abdominal pressure and stress placed on the esophagogastric junction, this border between the esophagus and the stomach.
What regarding a high-calorie meal?
The caloric load of a meal (the amount of calories) and fat content impact GERD. Indeed, eating a meal reduces the tone of the lower esophageal sphincter (LES) and causes it to relax more often and for longer (“transient relaxations of the ESS”), thus allowing the reflux of the contents of the esophagus. stomach into the esophagus.
These transient relaxations are normal, but in people with GERD they may be more frequent and prolonged.
However, it has been shown that in the presence of lipids provided by the meal, a neuropeptide (cholecystokinin) is released in the duodenum which contributes to lowering the tone of the esophagus-stomach valve, and to increasing the frequency of these transient relaxations.
All of this contributes to increasing acid reflux. Finally, lipids increase the perception of reflux (we speak of “hypersensitivity to reflux” induced by lipids).
This is why it is important to take into account the caloric value and the quantity of lipids in the diet, which are often linked.
In addition, a high-calorie meal slows gastric emptying (the process by which the meal passes from the stomach to the small intestine), which prolongs the distention of the stomach, reduces the tone of the esophagus-stomach valve and promotes increased occurrence of transient valve releases.
Carbohydrates promote reflux
If the protein component of a meal has little impact on esophagogastric physiology, carbohydrates, via the products resulting from their fermentation (short-chain fatty acids), produce effects on the motility of the esophagus/stomach.
Consequence: a flap with less tone, which relaxes more often and for a long time. Studies of low sugar/carbohydrate diets have shown a beneficial effect on reflux symptoms.
Thus, taking into account this information, it is now certain that meals rich in calories, fats and/or carbohydrates promote the appearance of reflux episodes as well as their sensations.
Therefore, experts advise a diet reduced in fats and carbohydrates in case of GERD.
Sources: French-speaking hepato-gastroenterology and digestive oncology days (JFHOD; March 14-17, 2024, Paris); ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease.
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