ArticlePDF Available

The Role of the Nutrition in the Pathogenesis of Gastroesophageal Reflux Disease, Barrett’s Oesophagus and Oesophageal Adenocarcinoma

Authors:

Abstract and Figures

This paper aims at evaluating the role of improper nutrition in the pathogenesis of gastroesophageal reflux disease (GERD), Barrett's oesophagus (BE), and oesophageal adenocarcinoma (EADC). It also tries to examine the influence of the alcohol, nicotine and coffee consumption in the development of the mentioned diseases. There were 180 subjects included in the trial, 109 males and 71 females, which were divided in the four groups (70 patients with GERD, 20 patients with BE, 20 patients with EADC, and 70 healthy examinees composing a control group). Their dietary habits were investigated by the usage of the dietary questionnaires. The results show that the fast eating and the insufficient mastication were present in 64.3-85.0% patients with GERD, BE, and EADC in comparison with only 15% of the examinees from the control group. Furthermore, very hot was preferred by 25.0-42.9% of the mentioned patients in comparison with only 12.9% from the control group. Similarly, 60.0-75.0% of them preferred strongly spiced food on contrary with 17.1% of the healthy examinees. Moreover, strong alcoholic beverages were consumed three or more times per week by 55.0-75.0% of the mentioned patients in comparison with only 15.7% from the control group. Finally, there were 15.7-55.0% heavy smokers among the patients with GERD, BE, and EADC contrary to 1.4% in the control group.
Content may be subject to copyright.
Coll. Antropol. 34 (2010) 3: 905–909
Original scientific paper
The Role of the Nutrition in the Pathogenesis
of Gastroesophageal Reflux Disease, Barrett’s
Oesophagus and Oesophageal Adenocarcinoma
Marko Luki}1, Ana [egec2, Igor [egec3, Ljerka Pinoti}4, Kre{imir Pinoti}5, Bruno Atali}6,
Kre{imir [oli}7and Aleksandar V~ev8
1Department of Nutrition, Osijek University Hospital Center, Osijek, Croatia
2Department for Pathologic Anatomy and Forensic Medicine, Osijek University Hospital Center, Osijek, Croatia
3Clinic for Otorhinolaryngology and Maxillofacial Surgery, Osijek University Hospital Center, Osijek, Croatia
4Clinic for Paediatrics, Osijek University Hospital Center, Osijek, Croatia
5Clinic for Surgery, Osijek University Hospital Center, Osijek, Croatia
6Department of Physiology and Immunology, School of Medicine, »Josip Juraj Strossmayer« University, Osijek, Croatia
7Department of Biophysics, Medical Statistics and Medical Informatics, School of Medicine, »Josip Juraj Strossmayer« University,
Osijek, Croatia
8Clinic for Internal Medicine, Osijek University Hospital Centar, Osijek, Croatia
ABSTRACT
This paper aims at evaluating the role of improper nutrition in the pathogenesis of gastroesophageal reflux disease
(GERD), Barrett’s oesophagus (BE), and oesophageal adenocarcinoma (EADC). It also tries to examine the influence of
the alcohol, nicotine and coffee consumption in the development of the mentioned diseases. There were 180 subjects in-
cluded in the trial, 109 males and 71 females, which were divided in the four groups (70 patients with GERD, 20 patients
with BE, 20 patients with EADC, and 70 healthy examinees composing a control group). Their dietary habits were inves-
tigated by the usage of the dietary questionnaires. The results show that the fast eating and the insufficient mastication
were present in 64.3–85.0% patients with GERD, BE, and EADC in comparison with only 15% of the examinees from the
control group. Furthermore, very hot was preferred by 25.0–42.9% of the mentioned patients in comparison with only
12.9% from the control group. Similarly, 60.0–75.0% of them preferred strongly spiced food on contrary with 17.1% of the
healthy examinees. Moreover, strong alcoholic beverages were consumed three or more times per week by 55.0–75.0% of
the mentioned patients in comparison with only 15.7% from the control group. Finally, there were 15.7–55.0% heavy
smokers among the patients with GERD, BE, and EADC contrary to 1.4% in the control group.
Key words: nutrition, dietary questionnaire, gastroesophageal reflux disease, Barrett’s oesophagus, oesophageal
adenocarcinoma
Introduction
Improper nutrition has a significant place among the
factors in the pathogenesis of different diseases. In this
respect gastrointestinal diseases are the most represen-
ted ones. One of them is gastroesophageal reflux disease
(GERD) as the most frequent oesophageal disease, which
can be defined as any clinical symptomatic condition or
histopathological change of oesophagus, which is a conse-
quence of repeated episodes of gastroesophageal reflux1.
Its frequency rises with the age and it is more frequent in
men than women2. GERD begins to appear when aggres-
sive factors such as the stomach acid overcome defending
factors such as the mucous membrane3. The appearance
of the already mentioned stomach acid in the oesophagus
is the major event in its pathogenesis4. The mentioned
acid may end up in the larynx, the mouth and the lungs
as well5.
The complications of the reflux could be divided in
intraoesophageal and extraoesophageal ones. The pro-
905
Received for publication July 12, 2010
longed reflux can cause erosions and ulcers of the oe-
sophageal mucosa. It can even lead to the narrowing of
the oesophageal lumen, which can result in the obstruc-
tion of food passage. The next stage would be the devel-
opment of the Barrett’s oesophagus (BE), which is a
precarcinomatous condition characterised with the me-
taplasia of the typical squamous epithel into the atypical
cylindrical epithel6. The final stage is the development of
the oesophageal adenocarcinoma (EADC) in the area of
the metaplastic epithel7. The reflux of stomach acid can
cause the complications in the other organs as well8–10,
such as coughing, laryngitis11, teeth diseases, pneumo-
nia12, and asthma13.
The conditions that help the reflux of the stomach
acid are obesity, full stomach, lying after eating, body
ante flexion, hard objects elevating, pregnancy, and un-
treated obstructive lung diseases14. Some drugs are also
important in this respect like the muscle relaxators such
as diazepam, the oral bronhodilatators such as teophilin,
and the blockers of calcium channels15. The composition
of food and the way of eating can have their effect as
well16. Regarding the composition of food, chocolate,
menthol and spicy food, as well as the consumption of
tea, coffee and alcohol play significant role17. Nicotine es-
pecially causes the weakening of the lower oesophageal
sphincter18. Taking into the consideration the way of eat-
ing, too hot food can be damaging as well19.
The majority of scientific papers were looking at the
constitutional factors as the necessary causes of the re-
flux conditions20. Springer et al were quantitatively as-
sessing visceral adipose tissue (VAT) in order to deter-
mine whether GERD and lower oesophageal sphincter
pressure (LESP) are related to the volume of visceral fat
masses. 25 morbidly obese patients (nine male, 16 fe-
male) were examined by the combination of a multi-slice
MRI for VAT, a standardized questionnaire for GERD,
and an oesophageal manometry for LESP. Endoscopy of
the upper gastrointestinal tract was performed to reveal
pathologies of the gastroesophageal junction. The results
have shown that waist-to-hip ratio and VAT were signifi-
cantly higher (p = 0.0021) in males (X=1.05+/–0.05;
X=8.89+/–2.33 l) than in females (X=0.86+/–0.07;
X=6.04+/–1.28 l). Despite its obvious gender connec-
tion, VAT in the end was not correlated with either
GERD, BMI or LESP, so they have concluded that nei-
ther GERD, BMI nor LESP were significantly influenced
by the stage of morbid obesity21. Healy et al. were exam-
ining the connection between GERD, BE and EADC in
order to determine the role of the obesity. 118 BE pa-
tients and 113 age- and sex-matched GERD controls
were studied by metabolic syndrome screening, anthro-
pometry studies including segmental body composition
analysis, and laboratory tests including fasting lipids, in-
sulin, and C-reactive protein. They have observed that
the central obesity and the metabolic syndrome are com-
mon in both Barrett’s and GERD cohorts, but not signifi-
cantly different, suggesting that the central obesity and
the metabolic syndrome does not by itself impact on the
development of BE in a reflux population22.
Basseri et al have evaluated the role of lymphocytes in
the eosinophilic esophagitis, lymphocytic esophagitis and
GERD, and have concluded that it blurs the line between
these already clinically and histologically overlapping
entities23. A number of scientific papers has examined
GERD in children. Teitelbaum et al have analysed the
body mass index of pediatric patients with gastrointesti-
nal complaints and have observed a greater percentage of
obese patients with constipation, gastroesophageal re-
flux, irritable bowel syndrome, encopresis, and func-
tional abdominal pain compared with the healthy con-
trols24. Wijk et al. have investigated the threshold amount
of constantly infused feed needed to trigger lower oe-
sophageal sphincter relaxation, and concluded that GERD
is triggered at volumes unlikely to induce gastric disten-
sion, and more in the right lateral position and left lat-
eral position25.
Only a small number of authors were looking at di-
etary habits as either causes or cures of reflux condi-
tions, but primarily by qualitative approach26,27. This
was the main reason why this paper will try to examine
the role of the nutrition in the pathogenesis of GERD, BE
and EADC by semi-quantitative approach. It will also try
to evaluate the influence of alcohol, nicotine and coffee
consumption.
Examinees and Methods
The study lasted from September 2000 until June
2002. There were 180 subjects in the research, 71 women
and 109 men, who were chosen randomly and divided
into four groups (70 patients GERD, 20 patients with BE,
20 patients with EADC, and 70 healthy examinees as a
control group). They ranged from youths to elders
(=53.04±14.41 years, range=17–83 years). The subjects
all lived in the region of Eastern Croatia. They under-
went oesophagogastroduodenoscopy in the Department
for Endoscopy at the Clinic for Internal Medicine of the
Osijek University Hospital Centre, and an endoscopic di-
agnosis was made for each patient.
Dietetic research was conducted through the individ-
ual interview based on the dietary questionnaire. Its aim
was to establish the possible influence of dietary habits
in the development of the reflux conditions. It was organ-
ised as a semiquantitive questionnaire containing the
questions on a type and quantity of food, the way of pre-
paring food, the speed of consuming food, the warmth of
consumed food, the quantity of spices in the food, the
smoked food, as well as alcohol, nicotine and coffee con-
sumption.
Statistical analysis
Data are presented as absolute and relative frequen-
cies. Differences in categories (GERD, BE, EADC) were
tested with Fisher’s exact test. Statistical analyses were
conducted using SAS software (version 8.02, SAS Insti-
tute Inc., Cary, NC, USA) with significance level set at
p<0.05.
M. Luki} et al.: Nutrition and GERD, Coll. Antropol. 34 (2010) 3: 905–909
906
Results
The research on dietary habits was conducted in or-
der to determine the role of the nutrition in the patho-
genesis of GERD, BE and EADC (Table 1). Number of
meals per day, food consumption speed, the most con-
sumed food type, consumed food warmth, spiced food
consumption, fat food consumption, barbecue food con-
sumption, and smoked food consumption were analysed.
The patients with GERD, BE or EADC tended to prefer
irregular meals, fast food consumption speed, roasted
food, very hot or cold food, very spiced food, very fat food,
barbecue food consumption one to four times per month,
and smoked food consumption three times and more per
week. On contrary, the healthy examinees preferred three
to four meals per day, normal food consumption speed,
boiled food, medium warm food, medium spiced food,
temperate fat food, and finally barbecue and smoked food
consumption one to four times per month. The Fischer’s
exact test has showed that all the mentioned results were
statistically significant with p<0.001. The only exception
was barbecue food consumption with p=0.065.
M. Luki} et al.: Nutrition and GERD, Coll. Antropol. 34 (2010) 3: 905–909
907
TABLE 1
DISTRIBUTION OF ALL EXAMINEES REGARDING THEIR NUTTRITION HABBITS
Gastroesophageal re-
flux disease / No (%) Barrett’s oesopha-
gus / No (%) Oesophageal
adenocarcinoma / No (%) Control group /
No (%) p*
Number of meals per day
One to two times 25 (35.72) 7 (35.00) 5 (25.00) 7 (10.00)
Three to four times 21 (30.00) 2 (10.00) 4 (20.00) 61 (87.14)
Irregular 24 (34.28) 11 (55.00) 11 (55.00) 2 (2.86) <0.001
Food consumption speed
Fast 45 (64.29) 17 (85.00) 14 (70.00) 11 (15.71)
Normal 16 (22.85) 2 (10.00) 1 (5.00) 38 (54.21)
Slow 9 (12.86) 1 (5.00) 5 (25.00) 21 (30.00) <0.001
The most consumed food type
Boiled 16 (22.85) 3 (15.00) 2 (10.00) 40 (57.14)
Roasted 36 (51.43) 10 (50.00) 11 (55.00 ) 5 (7.14)
Industrial 6 (8.57) 1 (5.00) 1 (5.00) 0 (0)
Mixed 12 (17.15) 6 (30.00) 6 (30.00) 25 (35.72) <0.001
Consumed food warmth
Very hot 30 (42.85) 8 (40.00) 5 (25.00) 9 (12.85)
Medium warm 19 (27.15) 2 (10.00) 4 (20.00) 58 (82.85)
Cold 21 (30.00) 10 (50.00) 11 (55.00) 3 (4.30) <0.001
Spiced food consumption
Very spiced 48 (68.57) 15 (75.00) 12 (60.00) 12 (17.14)
Medium spiced 17 (24.28) 4 (20.00) 6 (30.00) 40 (57.14)
Weakly spiced 5 (7.15) 1 (5.00) 2 (10.00) 18 (25.72) <0.001
Fat food consumption
Very fat food 38 (54.28) 10 (50.00) 9 (45.00) 9 (12.85)
Temperate 25 (35.72) 9 (45.00) 11 (55.00) 36 (51.42)
No fat food 7 (10.00) 1 (5.00) 0 (0.00) 25 (35.73) <0.001
Barbecue food consumption
3 times and more per week 6 (8.57) 0 (0.00) 5 (25.00) 2 (2.86)
1–4 times per month 52 (74.28) 16 (80.00) 11 (55.00) 51 (72.86)
No 12 (17.15) 4 (20.00) 4 (20.00) 17 (24.28) =0.065
Smoked food consumption
3 times and more per week 48 (68.57) 11 (55.00) 15 (75.00) 11 (15.71)
1–4 times per month 20 (28.57) 8 (40.00) 5 (25.00) 53 (75.71)
No 2 (2.86) 1 (5.00) 0 (0.00) 6 (8.58) <0.001
Total 70 (100) 20 (100) 20 (100) 70 (100)
*Fisher’s Exact test
The consummation of alcohol, nicotine and coffee was
taken into consideration as well (Table 2). The patients
with GERD, BE or EADC consumed alcohol, nicotine and
coffee more often than the healthy examinees. All the re-
sults were statistically significant according to the Fis-
cher exact test with p<0.001.
Disscussion and Conclusion
This study represents a continuation of the half a cen-
tury old tradition of nutritional studies in Croatia. Like
the similar previous studies it is also composed as a
multidisciplinary approach28–30. The results show that
the unhealthy dietary habits were more represented
among the patients with the reflux conditions, in com-
parison with the healthy examines from the control
group. Both the irregular eating and the fast eating were
more represented among the mentioned patients than
among the healthy examines. The very hot food and the
much spiced food were again equally highly consumed by
the patients from all the three groups. Fat, barbecue and
smoked food were as well more often consumed by the
mentioned patients than by the healthy examines. While
the patients with the reflux conditions tended to prefer
roasted food, the healthy examinees preferred boiled
food.
While alcoholic drinks were consumed mainly by the
patients with the reflux conditions, soft drinks were con-
sumed mainly by the healthy examinees. The greatest
number of heavy smokers was among the patients with
EADC (50%), while the greatest number of non-smokers
was among the healthy examiners, which is in accor-
dance with the studies on the carcinogenic effect of the
cigarette smoking31–33. Coffee drinking was represented
among the examinees from all the four groups, but it
could be observed that it was represented with more
than five cups per day among the patients with reflux
conditions, and with less than four cups per day among
the healthy examiners from the control group. In this re-
spect this study could be used as a basis for a comparison
of eating habits between Croatian and other popula-
tions34,35.
M. Luki} et al.: Nutrition and GERD, Coll. Antropol. 34 (2010) 3: 905–909
908
TABLE 2
DISTRIBUTION OF ALL EXAMINEES REGARDING ADDICTIVES CONSUMPTION
Gastroesophageal
reflux disease / No
(%)
Barrett’s oesopha-
gus / No (%) Adenocarcinoma
oesophagus / No (%) Control group /
No (%) p*
Alcoholic drinks consumption
No 34 (48.57) 6 (30.00) 5 (25.00) 61 (87.14)
0.3 dL per week 8 (11.42) 4 (20.00) 2 (10.00) 7 (10.00)
0.5 dL per day 20 (28.57) 5 (25.00) 9 (45.00) 1 (1.43)
More than 1 dL per day 8 (11.44) 5 (25.00) 4 (20.00) 1 (1.43) <0.001
Wine or beer consumption
No 23 (32.85) 1 (5.00) 6 (30.00) 53 (75.71)
2–3 dL per week 16 (22.85) 8 (40.00) 4 (20.00) 16 (22.86)
2–5 dL per day 21 (30.00) 11 (55.00) 7 (35.00) 1 (1.43)
>6 dL per day 10 (14.30) 0 (0.00) 3 (15.00) 0 (0.00) <0.001
Soft drinks consumption
No 15 (21.42) 6 (30.00) 6 (30.00) 34 (48.57)
5dLper week 23 (32.85) 5 (25.00) 3 (15.00) 29 (41.43)
5dLper day 20 (28.57) 5 (25.00) 8 (40.00) 5 (7.14)
>6 dL per day 12 (17.16) 4 (20.00) 3 (15.00) 2 (2.86) <0.001
Cigarettes Smoking
No 29 (41.43) 4 (20.00) 3 (15.00) 47 (67.14)
Up to 10 cigarettes per day 9 (12.85) 1 (5.00) 0 (0.00) 15 (21.43)
10–20 cigarettes per day 21 (30.00) 4 (20.00) 10 (50.00) 7 (10.00)
More than 21 cigarettes per day 11 (15.72) 11 (55.00 ) 7 (35.00) 1 (1.43) <0.001
Coffee Drinking
No 7 (10.00) 0 (0.00) 0 (0.00) 19 (27.14)
Less than 4 cups per day 26 (37.14) 5 (25.00) 7 (35.00) 47 (67.14)
More than 5 cups per day 37 (52.86) 15 (75.00 ) 13 (65.00) 4 (5.72) <0.001
Total 70 (100) 20 (100) 20 (100) 70 (100)
*Fisher’s Exact test
All the results were statistically significant with
p<0.001. The only exception was barbecue food con-
sumption with p=0.065, which in context with all the
other results, could be broadly interpreted as statistically
significant as well. Although, the results have showed
the differences in the dietary habits between the patients
with GERD, BE and EADC on one hand, and the healthy
examinees on the other hand, which could be interpreted
as an evidence of their role in the pathogenesis of the
mentioned diseases, they have not reflected the differ-
ences between the three mentioned diseases as the re-
sults of the various stages of the gastric acid reflux.
Proper nutrition could have a prophylactic effect against
the development of the reflux conditions, which should
be more thoroughly, investigated in the future resear-
ches. On this track, a well chosen dietary therapy could
effectively improve the life quality of the patients with
GERD, BE and EADC, which should also be further re-
searched.
REFERENCES
1. SONTAG S, Defining GERD. In: MODLIN I (Ed) GERD: the last
word? (Gastric pathobiology research group, 1998). — 2. SONNEBER A,
EL-SERAG A, Epidemiology of gastroesophageal reflux disease. In: MO-
DLIN I (Ed) GERD: the last word? (Gastric pathobiology research group,
1998). — 3. MACDOUGAL N, JOHANSTON B, KEE F, COLLINS J, MC-
FARLAND R, LOVE A, Gut, 38 (1996) 481. — 4. HIRSCHOWITZ B, Pep-
sin and the oesophagus. In: MODLIN I (Ed) GERD: the last word? (Gas-
tric pathobiology research group, 1998). — 5. PULJAK L, Gastroezofa-
gealna refluksan bolest, accessed 18.04.2010. Available from: URL:
http://www.medicina.hr/clanci/gastroezofagealna_refluksna_bolest.htm.
— 6. KOOP H, Endoscopy, 36 (2004) 103. — 7. SAMPLINER A, Ann Int
Med, 130 (1999) 67. — 8. RICHTER JE, Gastroenterol Clin North Am, 25
(1996) 75. — 9. NAPIERKOWSKI J, WONG RK, Am J Med Sci, 326
(2003) 285. — 10. MALAGELADA JR, Aliment Pharmacol Ther, 19 Suppl
1 (2004) 43. — 11.VAEZI MF, HICKS DM, ABELSON TI, RICHTER JE,
Clin Gastroenterol Hepatol, 1 (2003) 333. — 12. SPECHLER SJ, Am J
Med Sci, 326 (2003) 279. — 13. THAKKAR K, BOATRIGHT RO,
GILGER MA, EL-SERAG HB, Paediatrics, 125 (2010) 925. — 14. OR-
LANDO RC, Am J Med Sci, 326 (2003) 274. — 15. O’MALLEY P, Clin
Nurse Spec, 17 (2003) 286. — 16. @IVKOVI] R, Prakti~na gastroentero-
logija ([kolska knjiga, Zagreb, 1993). — 17. SHAHEEN N, PROVENZA-
LE D, Am J Med Sci, 326 (2003) 264. — 18. LEPOGLAVEC @, Gastro-
ezofagealna refluksne bolest, accessed 18.04.2010. Available from: URL:
http://www.plivazdravlje.hr/aktualno/clanak/16054/Gastroezofagealna-re
fluksna-bolest-GERB.html. — 19. JEREB B, TODOROVI] J (Eds) Ga-
stroenterologija ([kolska knjiga, Zagreb, 1987). — 20. KINOSHITA Y,
FURUTA K, Nippon Shokakibyo Gakkai Zashi, 107 (2010) 531. — 21.
SPRINGER F, SCHWARTZ M, MACHANN J, FRITSCHE A, CLAUSSEN
CD, SCHICK F, SCHNEIDER JH, Obes Surg, 20 (2010) 749. — 22.
HEALY LA, RYAN AM, PIDGEON G, RAVI N, REYNOLDS JV, Dis Eso-
phagus, 23 (2010) 386. — 23. BASSERI B, LEVY M, WANG HL, SHAYE
OA, PIMENTEL M, SOFFER EE, CONKLIN JL, Dis Esophagus, 23
(2010) 368. — 24. TEITELBAUM JE, SINHA P, MICALE M, YEUNG S,
JAEGER J, J Pediatr, 154 (2009) 444. — 25. WIJK MP, BENNINGA MA,
DAVIDSON GP, HASLAM R, OMARI TI, J Pediatr, 156 (2010) 744. — 26.
PENAGINI R, MANGANO M, BIANCKI P, Gut, 42 (1998) 330-333. — 27.
PANAGINI R, BARTESAGHI B, CONTE D, BIANCKI P, Eur J Gastro-
enterol Hepatol, 4 (1992) 35. — 28. MISSONI S, Coll Antropol, 30 (2006)
673. — 29. PARZIKOVA J, Coll. Antropol, 11 (1987) 45. — 30. KERN J,
JURE[A V, VULETI] S, IVANKOVI] D, Coll. Antropol, 10 (1986) 21. —
31. ZHANG Z, PATCHETT S, PERRET D, DOMIZIO P, FARTHING M,
Eur J Gastroenterol and Hepatol, 12 (2000) 497. — 32. JI B, CHOW W,
ZANG G, MCLAUGHLIN J, Int J Cancer, 76 (1998) 659. — 33. TERRY P,
LAGERGREN J, YE W, NYREN O, WOLK A, Int J Cancer, 87 (2000) 750.
— 34. DRAPER HH, Coll Antropol, 10 (1986) 221. — 35. ZELJKO H,
[KARI]-JURI] T, SMOLEJ-NARAN^I] N, PERI^I]-SALIHOVI] M,
MARTINOVI]-KLARI] I, BARBALI] M, BARA]-LAUC L, JANI]IJE-
VI] B, Coll Antropol, 32 (2008) 315.
M. Luki}
Department of Nutrition, Osijek University Hospital Centre, J. Hüttlera 4, 31000 Osijek, Croatia
e-mail: lukic.marko@kbo.hr
ULOGA PREHRANE U PATOGENEZI GASTROEZOFAGEALNE REFLUKSNE BOLESTI,
BARRETTOVOGA EZOFAGUSA I EZOFAGEALNOGA ADENOCARCINOMA
SA@ETAK
Cilj rada je evaluirati ulogu nepravilne prehrane u patogenezi gastroezofagealne refluksne bolesti (GERB), Bar-
rettovoga ezofagusa (BE) i ezofagealnoga adenokarcinoma (EADC). Nadalje nastoji se istra`iti utjecaj konzumacije
alkohola, nikotina i kave na nastanak spomenutih boesti. Studija je obuhvatila 180 sudionika, 109 mu{kih i 71 `enskih,
koji su bili podijeljeni u ~etiri skupine (70 pacijenata s GERB-om, 20 pacijenata s BE-om, 20 s EADC-om, te 70 zdravih
ispitanika iz kontrolne skupine).Rezulti su pokazali da su brzo jedenje i nedovoljno `vakanje zastupljeni u 64,3–85%
bolesnika s GERB-om, BE-om i EADC-om nasuprot samo 15% zdravih ispitanika iz kontrolne skupine. Nadalje, vrlo
topla hrana je preferirana od 25,0–42,9% spomenutih bolesnika u usporedbi sa samo 12,9% zdravih ispitanika. U skladu
s time, 60,0–75,0% spomenutih bolesnika preferiralo je jako za~injenu hranu nasuprot 17,1% zdravih ispitanika. Na-
dalje, `estoka alkoholna pi}a su konzumirana tri ili vi{e puta tjedno od 55,0–75,0% spomenutih bolesnika u usporedbi
sa samo 15,7% zdravih ispitanika. Kona~no, 15,7–55,0% bolesnika s GERB-om, BE-om i EADC-om su bili okorjeli
pu{a~i nasuprot 1,4% iz kontrolne skupine.
M. Luki} et al.: Nutrition and GERD, Coll. Antropol. 34 (2010) 3: 905–909
909
... Among the 182 articles, 31 full-texts were assessed for eligibility after removing 151 articles (reviews, case reports and overlapped articles). Subsequently 2 articles were duplicated reports from previous data and 15 ones in which the data not in usable format were excluding from the inclusion and in final, a total of 14 studies were included for the quantitative synthesis [11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Figure 1 demonstrated the selection of studies. ...
Article
Full-text available
Purpose In the developed countries, the incidence of esophageal adenocarcinoma (EAC) is increasing over recent decades. The purpose of this meta-analysis was to arrive at quantitative conclusions about the contribution of alcohol intakes and the progression of Barrett's esophagus. Methods A comprehensive, systematic bibliographic search of medical literature published up to Oct 2013 was conducted to identify relevant studies. A meta-analysis was conducted for alcohol consumption on the Barrett's esophagus progression. Results A total of 882 cases in 6,867 individuals from 14 observational studies were indemnified in this meta-analysis. The result of this current meta-analysis, including 10 case-control and 4 cohort studies, indicated that alcohol consumption was not associated with the neoplastic progression in Barrett's esophagus (RR, 1.17; 95% CI, 0.93–1.48). When stratified by the study designs, no significant association was detected in either high vs low group or ever vs never group. Conclusions Alcohol drinking is not associated with risk of neoplastic progression in Barrett's esophagus. Further well designed studies are needed in this area.
Article
Background: Beverage-drinking behavior could be a potential risk factor for gastroesophageal reflux disease (GERD) in young populations. However, GERD prevalence in this population has not been investigated, and beverage consumption's association with GERD remains inconclusive. This study aimed to evaluate the prevalence and beverage-related risk factors of GERD among Chinese college freshmen and in youth around the world. Methods: A cross-sectional survey was conducted in Chinese college freshmen in September 2019 using random cluster sampling method. Participants completed questionnaires on demographic information, food intake frequency, and GER symptoms. Multivariate logistic regression models were applied to assess the association between beverages and GERD. Studies were retrieved from multiple databases for systemic review. The prevalence of GERD in young populations and beverage-related risk factors were pooled using random-effect models. Key results: Based on the 3345 individuals who completed the questionnaires, GERD prevalence in Chinese college freshmen is 5.1%. Multivariate analysis showed students who drink green tea daily, and those who drink coffee regularly were more likely to develop GERD compared with those who never drink tea or coffee. The pooled prevalence of GERD in young populations is 18.0%, and frequent alcohol consumption is positively associated with GERD in general population. Conclusions and inferences: The prevalence of GERD in Chinese college freshmen is significantly lower than that in worldwide youth populations. Alcohol, green tea, and coffee consumption could be potential risk factors for GERD. Future large-scale epidemiological studies are warranted for reliable identification of beverage-related risk factors for GERD in young populations.
Article
Background & aims: Patients are frequently advised to eliminate coffee, tea, and/or soda to reduce symptoms of gastroesophageal reflux (GER), such as heartburn or regurgitation. However, there are no data from prospective studies to support these recommendations. Methods: We collected data from the prospective Nurses' Health Study II from 48,308 women, 42-62 years old, who were free of regular GER symptoms, without cancer, and not taking proton pump inhibitors or H2 receptor agonists. Multivariate Cox proportional hazards models were used to assess associations between beverage intake and risk for GER symptoms. Results: During 262,641 person-years of follow up, we identified 7961 women who reported symptoms of GER once or more per week. After multivariable adjustment, hazard ratios (HRs) for women with the highest intake of each beverage (more than 6 servings/day) compared to women with the lowest intake (0 servings/day) were 1.34 for coffee (95% CI, 1.13-1.59; Ptrend<.0001), 1.26 for tea (95% CI, 1.03-1.55; Ptrend<.001), and 1.29 for soda (95% CI, 1.05-1.58; Ptrend<.0001). We obtained similar results when we stratified patients according to caffeine status. No association was observed between milk, water, or juice consumption and risk for GER symptoms. In a substitution analysis, replacement of 2 servings/day of coffee, tea, or soda with 2 servings of water was associated with reduced risk of GERD symptoms: coffee HR, 0.96 (95% CI, 0.92-1.00); tea HR, 0.96 (95% CI, 0.92-1.00); and soda HR, 0.92 (95% CI, 0.89- 0.96). Conclusions: In an analysis of data from the prospective Nurses' Health Study II, intake of coffee, tea, or soda was associated with an increased risk of GER symptoms. In contrast, consumption of water, juice, or milk were not associated with GER symptoms. Drinking water instead of coffee, tea, or soda reduced the risk of GER symptoms.
Chapter
Full-text available
Dental health insurance coverage in the United States is either nonexistent (Medicare and the uninsured), spotty (Medicaid) and limited (most employer-based private benefit plans). Perhaps as a result, dental health in the United States is not good. What public policy makers may not appreciate is that this may well be impacting medical care costs in a way that improved dental benefits would produce a substantial return to investment in expanded dental insurance coverage.
Article
Injuries caused by animal bites are common in general practice. In most cases, injury are caused by domestic animals, injury from wild animals are rare. As therapeutic measures next to local wound management vaccinations might be necessary. This article presents the case report of a patient who was attacked by a common buzzard. The bird clung to the patients arm and could only be removed by surgery. After surgical wound revision and tetanus booster the patient presented at the general practitioners surgery to continue the rabies vaccination. Antibiotic prophylaxis was prescribed. In the further course a rabies infection could be ruled out by the veterinary examination. The significance and current recommendations for antibiotic prophylaxis in animal bites in the conflict between available evidence and individual perceptions of security are discussed.
Article
Gastroesophageal reflux (GER) is very common in children and in many cases a physiological event. However, if GER results in symptoms or pathological findings such as esophagitis, it is called gastroesophageal reflux disease (GERD). Besides anatomical reasons there are certain nutritional factors favouring a pathological gastroesophageal reflux in children. Furthermore during the last years an increasing incidence of diseases similar in symptoms, but with an assumed allergic pathogenesis has been described. In eosinophilic esophagitis (EoE) corticosteroid therapy leads only to a temporary improvement. In contrast allergen elimination results in a complete disappearance of symptoms and histopathological findings in almost all patients. It is possible to try an identification of a relevant food antigen by skin prick and patch tests and the determination of specific IgE, but often this is not successful. By the elimination of the six most common food antigens (milk, egg, wheat, soy, peanuts and fish) it is possible to improve symptoms in three-quarters of patients. Using allergen- free formula food, the success rates are rising up to 98%. A particular entity is the cow's milk protein allergy of infancy. There is a clear association with gastroesophageal reflux disease and due to the often completely non-specific symptoms in this age group the diagnosis is not always easy. Under cow's milk protein-free formula-food, most of the affected children show a very good response. In contrast to EoE the majority of infants with cow's milk protein allergy are expected to develop tolerance within the first few years of life.
Article
Gastroesophageal reflux disease (GERD) is one of the most common diseases affecting patients worldwide, but its risk factors and causes are not clearly known. The aim of this study was to investigate the effect of coffee intake on GERD by a meta-analysis. We searched online published research databases such as PubMed, EMBASE, and Cochrane Library for studies that were published up to December 2012. These publications were reviewed by two independent authors, and studies that fulfilled the criteria were selected. Whenever there was a disagreement between the authors, a consensus was reached by discussion. Fifteen case-control studies were included in the final analysis. A meta-analysis showed that there was no significant association between coffee intake and GERD. The odds ratio was 1.06 (95% confidence interval, 0.94-1.19). In subgroup analyses in which the groups were subdivided based on the definition of GERD (diagnosed by endoscopy or by symptoms alone), only the endoscopy group showed a significantly higher odds ratio. In subgroup analyses in which the groups were subdivided based on the amount of coffee intake, quality of study, and assessment of exposure, there was no significant association between coffee intake and GERD.
Article
Full-text available
The aim of this research was to investigate the prevalence of obesity and high blood pressure and to prove which of three anthropometric indicators of obesity - waist circumference, body mass index (BMI) waist-to-hip ratio - is better predictor for the development of hypertension in women population of the island of Cres. We approached separately groups of women with measured high blood pressure and with previously diagnosed. The research was preformed within the research project "Genetic and biomedical characteristics of the population of the island of Cres". This was the cross sectional study and data were obtained on the sample of 247 females over 18 years old that voluntarily participated in this study. In our study group the prevalence of overweight was 39.0%, obesity 27.5%, increased waist circumference was present in 69.4% while increased blood pressure was found in 53.0% examinees. Our results indicate that age, BMI, impaired glucose concentration and serum cholesterol could be considered as predictors for the development of arterial hypertension, whether measured or previously diagnosed.
Article
Full-text available
Although oesophagitis is the most common diagnosis made at upper gastrointestinal endoscopy, data on the longterm outcome of affected patients are sparse. This study assessed the level of reflux symptoms, quality of life, drug consumption, and complications in patients at least 10 years after diagnosis of oesophagitis at one centre. One hundred and fifty two patients with typical reflux symptoms and a first time diagnosis by endoscopy of grade I-III oesophagitis between 1981 and 1984, were followed up using a postal questionnaire and telephone interview. Eighteen of 152 patients had died, 33 failed to respond, and 101 replied (mean follow up 11 years, range 121-160 months). Over 70% of patients still had heartburn at least daily (32%) or weekly (19%) or required daily acid suppression treatment (20%). Two patients (2%) had developed oesophageal strictures and one had Barrett's oesophagus. Two of eight quality of life scores (physical function and social function) measured by the Short Form-36 were significantly lower than Northern Ireland population scores. Nearly three quarters of patients previously diagnosed as having oesophagitis still had significant morbidity related to gastro-oesophageal reflux disease more than 10 years after diagnosis. Some quality of life scores were significantly lower than those of the general population.
Article
Objective: To assess the time course of the rate (n/30 min) of transient lower oesophageal sphincter relaxations (TLOSRs) after a meal and to compare results with the fasting rate in healthy subjects. Design: Oesophageal motility was recorded in eight healthy volunteers for 30 min before and 2h after a 700kcal homogenized mixed nutrient meal. Methods: An assembly of polyvinyl tubes incorporating a sleeve sensor was used. The observation period was made up of five 30-min epochs: fasting and 0-30, 30-60, 60-90 and 90-120 min after eating. Differences among epochs were assessed by non-parametric analysis of variance followed by Newman-Keuls test for multiple comparisons. Results: Ingestion of the meal significantly (P<0.01) increased the rate of TLOSRs from 1.0; 0-2.5 (median; interquartile range) in fasting to 4.5; 3.0-5.0 in the 0-30 min epoch. However, the increase was not sustained, the rate declining progressively to 3.5; 2.5-5.0 in the 30-60 min epoch, 3.5; 2.0-5.0 in the 60-90 min epoch and 1.5; 1.0-2.0 in the 90-120 min epoch (respectively, P<0.05, P<0.05 and P = NS versus fasting). Conclusions: In healthy man, eating a meal is an effective stimulus to increase the rate of TLOSRs. However, the stimulation may be short-lived suggesting that, in research protocols using a meal as stimulus for TLOSRs, only one experimental condition should be tested on each study day.
Article
The effects of Helicobacter pylori infection and its associated gastric histology on alpha-tocopherol and beta-carotene concentrations in serum, gastric juice and antral mucosa were investigated in patients undergoing routine gastroscopy for investigation of dyspepsia. Eighty-six patients were studied. High-performance liquid chromatography was used to measure alpha-tocopherol and beta-carotene concentrations. H. pylori infection was assessed by histology, bacterial culture, rapid urease test and serology. No obvious association was found between age, sex, smoking or endoscopic diagnosis and alpha-tocopherol or beta-carotene concentrations in serum, gastric juice and antral mucosa. However, alcohol drinkers had significantly lower antral mucosal and gastric juice beta-carotene concentrations compared to non-drinkers. Gastric juice beta-carotene concentration was markedly lower in patients infected with H. pylori than uninfected controls (2.9 nmol/l (interquartile range 0.3-4.3) versus 4.6 nmol/l (interquartile range 3.5-7.6), P = 0.01), but there was no significant difference in serum or gastric mucosal beta-carotene concentrations between the two patient groups. The presence of gastric atrophy and intestinal metaplasia was significantly associated with reduced mucosal alpha-tocopherol and beta-carotene concentrations. Furthermore, antral mucosal alpha-tocopherol concentrations decreased progressively as antral mucosal histology changed from normal to chronic gastritis alone and finally to atrophy and intestinal metaplasia. Gastric alpha-tocopherol and beta-carotene concentrations are affected by H. pylori-associated gastric histological changes, and these findings suggest that H. pylori infection may not only impair the protective role of vitamin C, but also of alpha-tocopherol and beta-carotene in the stomach.
Article
The aim of this study was to quantitatively assess visceral adipose tissue (VAT) by means of a wide-bore MR scanner in a cohort of morbidly obese patients referred for bariatric surgery. Furthermore, it was investigated whether gastroesophageal reflux disease (GERD) and lower esophageal sphincter pressure (LESP) are related to the volume of visceral fat masses. Twenty-five morbidly obese patients (nine male, 16 female) were prospectively enrolled. In addition to common anthropometric measures of obesity, VAT was determined quantitatively by multi-slice MRI. Symptoms of GERD were evaluated using a standardized questionnaire, while endoscopy of the upper gastrointestinal tract was performed to reveal pathologies of the gastroesophageal junction. LESP was evaluated by esophageal manometry. Study population showed a body mass index (BMI) between 35.2 and 59.1 kg/m(2). Waist-to-hip ratio and VAT were significantly higher (p < 0.0001; p = 0.0021) in males (1.05 +/- 0.05; 8.89 +/- 2.33 l) than in females (0.86 +/- 0.07; 6.04 +/- 1.28 l). VAT was not correlated to BMI. LESP values and GERD-related symptoms were neither dependent on anthropometric measures nor on VAT in our cohort. VAT did not show a positive correlation with BMI in our cohort of extremely obese subjects, indicating a pronounced fat deposition in subcutaneous tissue compartment. Moreover, this indicates that VAT is limited to a gender-dependent maximum volume for each individual and seems to be no further increasing in extremely obese subjects. This might be the reason that neither symptoms nor endoscopic findings of GERD nor LESP were significantly influenced by the stage of morbid obesity.
Article
Eosinophilic esophagitis (EoE) and reflux esophagitis (RE) overlap clinically and histologically. RE is characterized by epithelial infiltration with small numbers of neutrophils and eosinophils, EoE by a prominent eosinophilic infiltrate. Lymphocytic esophagitis (LE), a new entity characterized by peripapillary lymphocytosis, questions the role lymphocytes play in esophageal inflammation. We test the hypothesis that lymphocyte infiltration in RE differs from EoE. One blinded pathologist read esophageal biopsies from 39 RE and 39 EoE patients. Both groups demonstrated significant numbers of lymphocytes (RE 22.7 +/- 2.2/HPF, EoE 19.8 +/- 1.8/HPF). Eosinophils/HPF in RE and EoE were 2.8 +/- 0.7 and 74.9 +/- 8.2, respectively (P < 0.001). Neutrophils were uncommon in RE (0.26 +/- 0.16/HPF) and EoE (0.09 +/- 0.04; P = 0.07). Eight of the 39 RE specimens had >or=50 lymphocytes in >or=1 HPF. Two were consistent with LE. There was an inverse correlation between numbers of eosinophils and lymphocytes in EoE (R = -0.47; P = 0.002), and no correlation between them in RE (R = 0.18; P = 0.36). The patients with EoE who used antireflux medications had fewer lymphocytes (16.3 +/- 1.3 vs 22.2 +/- 2.3/HPF; P = 0.030) and eosinophils (55.6 +/- 5.2 vs 76.0 +/- 8.7/HPF; P = 0.042) than those who did not. The pathological role of lymphocytes in RE and EoE may be underestimated. Our observation that 5% of the RE specimens meet histopathological criteria for LE potentially blurs the line between these entities. The observation that eosinophil counts are lower in EoE when antireflux meds are used supports the notion that reflux plays a role in the clinical expression of EoE.
Article
Obesity is an established risk factor for esophageal adenocarcinoma, although the mechanism is unclear. A pathway from reflux to inflammation through metaplasia is the dominant hypothesis, and an added role relating to visceral adiposity and the metabolic syndrome has been mooted in Barrett's esophagus (BE) patients. Whether BE differs from gastroesophageal reflux disease (GERD) in obesity and metabolic syndrome profiles is unclear, and this was the focus of this study. Patients with proven BE or GERD were randomly selected from the unit data registry and invited to attend for metabolic syndrome screening, anthropometry studies including segmental body composition analysis, and laboratory tests including fasting lipids, insulin, and C-reactive protein. Metabolic syndrome was defined using the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) criteria. One hundred and eighteen BE patients and 113 age- and sex-matched GERD controls were studied. The incidence of obesity (body mass index >30 kg/m(2)) was 36% and 38%, respectively, with the pattern of fat deposition predominantly central and an estimated trunk fat mass of 13 and 14 kg, respectively. Using the NCEP criteria, metabolic syndrome was significantly more common in the BE cohort (30% vs 20%, P < 0.05), but there was no significant difference using IDF criteria (42% vs 37%, P= 0.340). Central obesity and the metabolic syndrome are common in both Barrett's and GERD cohorts, but not significantly different, suggesting that central obesity and the metabolic syndrome does not per se impact on the development of BE in a reflux population. In BE, the importance of obesity and the metabolic syndrome in disease progression merits further study.
Article
To investigate the threshold amount of constantly infused feed needed to trigger lower esophageal sphincter relaxation (TLESR) in the right lateral position (RLP) and left lateral position (LLP). Eight healthy infants (3 male; gestational age: 32.9 +/- 2.4 weeks; corrected age: 36.1 +/- 1.3 weeks) were studied using an esophageal impedance-manometry catheter incorporating an intragastric infusion port. After tube placement, infants were randomly positioned in RLP or LLP. They were then tube-fed their normal feed (62.5 [40 to 75] mL) at an infusion rate of 160 mL/h. Recordings were made during the feed and 15 minutes thereafter. The study was repeated with the infant in the opposite position. More TLESRs were triggered in the RLP compared with LLP (4.0 [3.0 to 6.0] vs 2.5 [1.0 to 3.0], P = .027). First TLESR occurred at a significantly lower infused volume in RLP compared with LLP (10.6 +/- 9.4 vs 21.0 +/- 4.9 mL, P = .006). The percentage of feed infused at time of first TLESR was significantly lower in RLP compared with LLP (17.6% +/- 15.5% vs 35.4% +/- 8.02%, P = .005). In the RLP, TLESRs and gastroesophageal reflux are triggered at volumes unlikely to induce gastric distension.
Article
Although fatty foods are commonly considered detrimental in patients with reflux disease, no objective data exist that substantiate this belief. To investigate the effect of fat on gastro-oesophageal reflux and lower oesophageal sphincter (LOS) motor activity. Thirteen healthy subjects and 14 patients with reflux disease. Oesophageal pH, LOS, and oesophageal pressures were recorded for 180 minutes after a high fat (52% fat) and a balanced (24% fat) meal (both 3.18 MJ) on two different occasions. Eight controls and seven patients were studied in the recumbent position and the others in the sitting position. The percentage of time at pH less than 4 and the rate of reflux episodes were higher (p < 0.01) in the patients than in the healthy subjects (mean 14.1% versus 1.7% and 4.4/h versus 0.8/h respectively), as was the percentage of transient LOS relaxations associated with reflux (62% versus 32%, p < 0.01). The high fat meal did not increase the rate of reflux episodes nor exposure to oesophageal acid in either group regardless of body posture. The rate of transient LOS relaxations, their association with reflux, and basal LOS pressure were also unaffected. Increasing fat intake does not affect gastro-oesophageal reflux or oesophagogastric competence for at least three hours after a meal.
Article
The association between gastroesophageal reflux disease (GERD) and extraesophageal disease is often referred to as extraesophageal reflux (EER). This article reviews EER, discussing epidemiology, pathogenesis, diagnosis, and treatment with a focus on the most studied and convincing EER disorders-asthma, cough, and laryngitis. Although EER comprises a heterogeneous group of disorders, some general characterizations can be made, as follows. First, although GERD's association with extraesophageal diseases is well-established, definitive evidence of causation has been more elusive, rendering epidemiological data scarce. Secondly, regarding the pathogenesis of EER, 2 basic models have been proposed: direct injury to extraesophageal tissue by acid and pepsin exposure or injury mediated through an esophageal reflex mechanism. Third, because heartburn and regurgitation are often absent in patients with EER, GERD may not be suspected. Even when GERD is suspected, the diagnosis may be difficult to confirm. Although endoscopy and barium esophagram remain important tools for detecting esophageal complications, they may fail to establish the presence of GERD. Even when GERD is diagnosed by endoscopy or barium esophagram, causation between GERD and extraesophageal symptoms cannot be determined. Esophageal pH is the most sensitive tool for detecting GERD, and it plays an important role in EER. However, even pH testing cannot establish GERD's causative relationship to extraesophageal symptoms. In this regard, effective treatment of GERD resulting in significant improvement or remission of the extraesophageal symptoms provides the best evidence for GERD's pathogenic role. Finally, EER generally requires more prolonged and aggressive antisecretory therapy than typical GERD requires.