25% of the world’s population suffers from it, and in Italy we are at 23-26%. In practice, one of the most widespread diseases. But now, on how to deal with it at the table, the certainties we have acquired are faltering. Let’s talk about gastroesophageal reflux disease, the foods that should not be eaten and those that can be eaten to keep it at bay. That is, the diet that until yesterday was thought to be in harmony with this disorder, but which now risks not being so. “False myths”, say the experts, gathered at the national congress of digestive diseases, in Rome from 11 to 13 April.
Warning signs about reflux
When we talk about gastroesophageal reflux we mean a condition characterized by retrosternal burning or heartburn, regurgitation and perception of retrosternal pain. What do these symptoms come from? From the retrograde passage of gastric contents into the esophagus, or as the Anglo-Saxons say, “too acid in the wrong place”.
“People who suffer from it are not hypersecretors of acid, but have a loss of the physiological mechanisms that prevent the passage of gastric contents into the esophagus – he explains Nicola De Bortoli, professor of Gastroenterology at the University of Pisa – . We all have a minimum amount of reflux during the day, which is physiological and as such not perceived. When symptoms develop, they must be investigated to obtain a diagnosis that is as precise and correct as possible.” Risk factors include overweight, obesity and tobacco smoking.
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The false myths of the diet
One of the fundamental things that reflux sufferers have heard from their doctor until yesterday is what not to eat: foods that are highly discouraged because they would only make things worse. Key points from which not to deviate to avoid spending sleepless nights, between pain and endless regurgitation. But those rules are changing, and so is the diet that comes with them.
“From a nutritional point of view, over the years the elimination of foods defined as triggers has been recommended in a rather questionable way – underlines the professor Edoardo Savarino, of the University of Padua – . In the past it has been suggested not to eat citrus fruits and tomatoes, not to consume coffee, mint, chocolate, onion, garlic, etc. Today we can say that all this has never been supported by scientific evidence. The recent US guidelines from the American College of Gastroenterology say that there are no trigger foods by definition. Rather, the person must identify the foods in their diet that most easily evoke symptoms and then eliminate them or reduce their consumption”. “Let me explain better – continues Savarino -. It is true that some foods give a greater risk of developing reflux and pain, because they are acidic, but it is also true that there is a tolerance threshold that differs from person to person: it is called visceral sensitivity. Consequently, it is advisable to avoid saying “eliminate tomatoes, chocolate and coffee or carbonated drinks”. Much more practical is an approach with an evaluation that is not daily, but weekly or bi-weekly, in which the patient writes down on a sheet of paper which foods he experiences that cause reflux, and whether by eliminating them the problem decreases or no longer exists. With this objective we gave patients a list of foods to evaluate, explaining to them to test them and see if they found positive effects if they eliminated them, or if they were less symptomatic. Thus it was discovered that even foods with a high calorie content and concentration of lipids, such as red meat and sausages, can be well tolerated by those with gastroesophageal reflux problems. In other words: the rule is not the same for everyone.”
Green light for these foods
So here’s how we should behave at the table to avoid getting acid reflux. According to experts, the first point of reference is the Mediterranean diet: if we followed it to the letter, as well as the WHO dietary guidelines on the consumption of fruit and vegetables, the prevalence rates of the disease could be lower. A few examples: Fermented foods, like kimchi (alkaline), can be incredibly beneficial to your digestive system. According to some studies, consuming a spoonful of mustard during the onset of acid reflux symptoms and heartburn balances acidity levels. As for fruit, both bananas and apples contain natural antacids that can help relieve or prevent the onset of acid reflux. While chewing licorice also helps stimulate the production of enzymes, allowing for easier and faster digestion. Finally, blueberry and papaya, consumed in the right doses, also represent excellent allies for the treatment of acid reflux.
But there is also more. With science coming to our aid, it can be said that it is better to opt for a reduced intake of animal proteins in our diet, without distinguishing between red and white meat. While a moderate use of wine (125 ml per meal) has no contraindications. “Certainly an important element is body weight – highlights De Bortoli -. If a person is overweight, as a first approach they must necessarily reduce body weight, even by just 10% in six months, to gain better control of symptoms and reduction in the need for drug consumption”.
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How to reach the diagnosis
At the Rome congress, the most recent guidelines of the Lyon Consensus (now in version 2.0) are illustrated, which involves De Bortoli and Savarino as Italian co-authors. Guidelines that invite an objective diagnosis of gastroesophageal reflux disease and medical therapy with proton pump inhibitors only for patients who are actually affected. For this reason, the Guidelines themselves speak of Actionable GERD, that is, carrying out a correct diagnosis of the disease, based on objective parameters, and therefore tailoring the therapy in the best possible way for each individual patient.
What do they say? They underline that people with heartburn, regurgitation and chest pain can be classified as potentially suffering from reflux disease, where however it is crucial that the chest pain is not of cardiac origin, excluding cardiovascular pathologies. The general practitioner can already suggest a first level therapy: proton pump inhibitors at a standard dose for 4-8 weeks, if there is heartburn, regurgitation and chest pain. Therapy which however must be reduced within a couple of months with a slow and progressive tapering, i.e. reduction of the dose of drug administered or lengthening of treatment intervals.
What to do if the reflux returns
What if the reflux returns despite treatment? De Bortoli speaks again: “In case of recurrence it is necessary to make an objective diagnosis which involves the prescription, after a gastroenterological examination, of an upper digestive endoscopy to be performed after the suspension of proton pump inhibitor drugs for at least 3-4 weeks In case of a negative endoscopy, we must investigate the picture with esophageal pathophysiology tests. However, if the patient, after the endoscopy, presents a diagnosis of medium-severe esophagitis (Los Angeles Classification of grade B, grade C and D) then the diagnosis can be confirmed. Alternatively, an esophageal manometry and a 24-hour pH-impedance test should be performed, in order to highlight the presence of pathological exposure to acid”.
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There is also surgery
But there is more, there is another possibility: surgical therapy, which has an important role, above all thanks to two types of surgery which have confirmed their effectiveness more than five years later.
“To date, surgery is certainly the first option in patients affected by refractory reflux disease, i.e. those who present both the symptoms and pathological exposure to acid, despite optimal anti-reflux medical therapy”, explain the experts .
Furthermore, over the years some studies have demonstrated, through the use of symptom questionnaires, and then seen in reality, the overlap of gastroesophageal reflux disease with irritable bowel syndrome or with dyspepsia. “Finally, another thing – concludes De Bortoli -. When patients present extra-esophageal symptoms (cough, hoarseness, pharyngeal globus, sore throat, etc.) we will first have to exclude other causes, and only then investigate the possible presence of reflux disease”.
#Reflux #coffee #bad
– 2024-04-12 14:23:36
