Definition

Gastroesophageal reflux disease (GERD) is a digestive tract disorder that affects the esophagus. The esophagus connects the throat to the stomach, separated by a muscle called the lower esophageal sphincter (LES). When this muscle does not function properly, stomach contents can flow back into the esophagus and damage its lining, which is not designed to tolerate the acidity of gastric fluid. GERD can be erosive or non-erosive. Erosive GERD presents inflammation, erosions, or ulcers in the esophagus. Non-erosive GERD is more common and does not show inflammation, erosions, or ulcers.

Symptoms

GERD symptoms may include dental erosion, a burning sensation starting from the stomach and rising to the mouth (heartburn) after meals or when lying down, regurgitation (bitter taste in the mouth), difficulty swallowing (dysphagia), painful swallowing (odynophagia), sore throat, cough, and chest pain unrelated to the heart.

Treatment

GERD treatment may include a medical approach (e.g., medications to reduce stomach acidity), a nutritional approach, and behavioral modifications. In some cases, surgery called fundoplication may be necessary.

Nutritional Approach

The nutritional approach includes five key points:

1. Increase the pressure of the lower esophageal sphincter (LES)

The lower esophageal sphincter is the muscle that separates the base of the esophagus and the stomach. When the pressure is adequate, it prevents acidic stomach contents from flowing back into the esophagus. Some foods help increase LES pressure. This is notably the case for protein-rich foods, such as lean meat and low-fat dairy products. Conversely, some substances decrease LES tension and should be avoided. These include excess fat, alcohol, certain medications, tobacco, mint, and methylxanthines, compounds naturally found in chocolate, tea, and coffee.

2. Prevent irritation of the esophageal lining

Irritation of the esophageal lining can be worsened by consuming certain foods. These include tomatoes and their juice, citrus fruits and their juices, caffeine, strong spices, alcohol, and carbonated beverages.

3. Facilitate emptying of the esophagus and stomach

Emptying of the esophagus and stomach can be promoted through some behavioral changes. These include engaging in light physical activities and avoiding bending forward or backward after meals. It is also recommended to avoid eating 2 to 3 hours before going to bed and to elevate the head of the bed by 15 to 20 cm, for example, by using an extra pillow.

4. Avoid excessive pressure on the stomach or avoid excessive intra-abdominal pressureSeveral strategies can be implemented to limit pressure on the stomach. These strategies include maintaining an ideal weight, avoiding tight clothing, and preventing constipation (see the article

Constipation in Adults). Weight loss may be necessary in cases of overweight.Avoid excessive pressure in the stomach or avoid gastric hyperpressure

5. There are various recommendations to limit pressure in the stomach. These recommendations may include:Eating small, frequent meals and

snacks

• throughout the day.Eating and drinking slowly, taking time to chew food well.Avoid swallowing air while eating and drinking (e.g., chewing gum, carbonated drinks, etc.).
• Avoid drinking liquids 30 minutes before and after meals.
• Nutritional treatment of GERD includes dietary recommendations (e.g., avoiding irritating foods, etc.) as well as behavioral modifications (e.g., elevating the head of the bed, losing weight, etc.). As with all nutritional recommendations, those for GERD should always be personalized according to the diet and specific needs of each individual to provide appropriate treatment. Do not hesitate to consult a healthcare professional who can support you and best meet your specific needs with treatment adapted to your personal situation.
• References

Bouthillier, Lise. January 2019. "Digestive Tract Diseases." NUT 2047 – Clinical Nutrition 2. Montreal: University of Montreal.

D’Aoust, Louise. January 2019. "Pathophysiology of the Digestive System." NUT 2047 – Clinical Nutrition 2. Montreal: University of Montreal.

1. https://www.merckmanuals.com/fr-ca/accueil/troubles-digestifs/maladies-de-l%E2%80%99%C5%93sophage-et-de-la-d%C3%A9glutition/reflux-gastro-%C5%93sophagien-rgo#
2. https://www.merckmanuals.com/fr-ca/professional/troubles-gastro-intestinaux/troubles-%C5%93sophagiens-et-de-la-d%C3%A9glutition/gastroesophageal-reflux-disease-gerd?query=Reflux%20gastro-%C5%93sophagien%20(RGO)
3. https://www.merckmanuals.com/fr-ca/accueil/les-faits-en-bref-troubles-digestifs/maladies-de-l-%C5%93sophage-et-de-la-d%C3%A9glutition/reflux-gastro-%C5%93sophagien-rgo
4. Article written by:
5. Marie-Noël Marsan, written in 2021.

Article written by:

Marie-Noël Marsan, written in 2021.