Relationship between postprandial esophageal acid exposure and meal volume and fat content

Third Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Digestive Diseases and Sciences (Impact Factor: 2.61). 05/1996; 41(5):926-30. DOI: 10.1007/BF02091532
Source: PubMed


The effect of meal volume and fat content on gastroesophageal reflux was investigated in 20 asymptomatic healthy subjects. In each subject, intraesophageal pH monitoring was performed during a 3-hr postprandial period (PP) in the same position (supine or upright) on two successive days. On day 1, 500-ml low- and high-fat meals were ingested and, on day 2, an 800-ml low-fat meal was ingested. The acid exposure time was assessed as the percentage of time with a pH < 4.0. The acid exposure time in subjects in the upright position was significantly longer in the 800-ml group than in the 500-ml group for the entire PP (2.7 +/- 1.5%; mean +/- SE, 0.7 +/- 0.4%; P < 0.05). Of subjects in the supine position, the high-fat group showed significantly longer acid exposure time than the low-fat group both for the entire PP (7.6 +/- 3.0%, 0.7 +/- 0.5%; p < 0.05) and for the second hour (P < 0.05). We have demonstrated that differences in the meal volume and fat content influence gastroesophageal reflux in healthy asymptomatic subjects and that this influence varies with the position.

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    • "However, the evidence to support such recommendations of lifestyle modification has not been well substantiated. In several studies investigating the effect of dietary habits on gastroesophageal reflux, the results have not been consistent.18-22 In our study, the odds ratio for relative risk of irregular dietary intake was 2.33, while other habits (large-volume meal, rapid food intake, eating between meals and late-evening meals) did not show statistical significance. "
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    ABSTRACT: The incidence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study was to evaluate the relationship between GERD symptoms and dietary factors in Korea. From January 2007 to April 2008, 162 subjects were enrolled (81 in GERD group and 81 in control group). They were asked to complete the questionnaires about GERD symptoms and dietary habits. The symptom severity score was recorded by visual analogue scale. Subjects with overweight or obesity had an increased risk for GERD (OR, 2.52; 95% CI, 1.18-5.39). Irregular dietary intake was one of the risk factors for GERD (OR, 2.33; 95% CI, 1.11-4.89). Acid regurgitation was the most suffering (2.85 ± 2.95 by visual analogue scale) and frequent reflux-related symptom (57.5%) in GERD. Noodles (OR, 1.22; 95% CI, 1.12-1.34), spicy foods (OR, 1.09; 95% CI, 1.02-1.16), fatty meals (OR, 1.20; 95% CI, 1.09-1.33), sweets (OR, 1.42; 95% CI, 1.00-2.02), alcohol (OR, 1.16; 95% CI, 1.03-1.31), breads (OR, 1.17; 95% CI, 1.01-1.34), carbonated drinks (OR, 1.69; 95% CI, 1.04-2.74) and caffeinated drinks (OR,1.41; 95% CI, 1.15-1.73) were associated with symptom aggravation in GERD. Among the investigated noodles, ramen (instant noodle) caused reflux-related symptoms most frequently (52.4%). We found that noodles, spicy foods, fatty meals, sweets, alcohol, breads, carbonated drinks and caffeinated drinks were associated with reflux-related symptoms.
    Journal of neurogastroenterology and motility 01/2011; 17(1):54-60. DOI:10.5056/jnm.2011.17.1.54 · 2.30 Impact Factor
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    • "This may be related to increased fat consumption in the diet, and the expanding proportion of obese individuals [7] [8]. "
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    ABSTRACT: Gastroesophageal reflux disease is a common condition with increasing prevalence worldwide. The disease encompasses a broad spectrum of clinical symptoms and disorders from simple heartburn without esophagitis to erosive esophagitis with severe complications, such as esophageal strictures and intestinal metaplasia. Diagnosis is based mainly on ambulatory esophageal pH testing and endoscopy. There has been a long-standing debate about the best treatment approach for this troublesome disease. Medical treatment with PPIs has an excellent efficacy in reversing the symptoms of GERD, but they should be taken for life, and long-term side effects do exist. However, patients who desire a permanent cure and have severe complications or cannot tolerate long-term treatment with PPIs are candidates for surgical treatment. Laparoscopic antireflux surgery achieves a significant symptom control, increased patient satisfaction, and complete withdrawal of antireflux medications, in the majority of patients. Surgical treatment should be reserved mainly for young patients seeking permanent results. However, the choice of the treatment schedule should be individualized for every patient. It is up to the patient, the physician and the surgeon to decide the best treatment option for individual cases.
    Gastroenterology Research and Practice 12/2009; 2009(1687-6121):371580. DOI:10.1155/2009/371580 · 1.75 Impact Factor
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    • "This relationship between BMI and esophageal acid exposure suggests that the same environmental influences are responsible for the epidemic of both diseases in contemporary Western society. There is evidence that the volume and fat content of the diet are associated with increased esophageal acid exposure.26 In addition, high caloric diets have been shown to increase esophageal acid exposure.27,28 "
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    ABSTRACT: Introduction Obesity and gastroesophageal reflux disease (GERD) are increasingly important health problems. Previous studies of the relationship between obesity and GERD focus on indirect manifestations of GERD. Little is known about the association between obesity and objectively measured esophageal acid exposure. The aim of this study is to quantify the relationship between body mass index (BMI) and 24-h esophageal pH measurements and the status of the lower esophageal sphincter (LES) in patients with reflux symptoms. Methods Data of 1,659 patients (50% male, mean age 51 ± 14) referred for assessment of GERD symptoms between 1998 and 2008 were analyzed. These subjects underwent 24-h pH monitoring off medication and esophageal manometry. The relationship of BMI to 24-h esophageal pH measurements and LES status was studied using linear regression and multiple regression analysis. The difference of each acid exposure component was also assessed among four BMI subgroups (underweight, normal weight, overweight, and obese) using analysis of variance and covariance. Results Increasing BMI was positively correlated with increasing esophageal acid exposure (adjusted R2 = 0.13 for the composite pH score). The prevalence of a defective LES was higher in patients with higher BMI (p < 0.0001). Compared to patients with normal weight, obese patients are more than twice as likely to have a mechanically defective LES [OR = 2.12(1.63–2.75)]. Conclusion An increase in body mass index is associated with an increase in esophageal acid exposure, whether BMI was examined as a continuous or as a categorical variable; 13% of the variation in esophageal acid exposure may be attributable to variation in BMI.
    Journal of Gastrointestinal Surgery 08/2009; 13(8):1440-1447. DOI:10.1007/s11605-009-0930-7 · 2.80 Impact Factor
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