Definition

Gastroesophageal reflux disease (GERD) is a disease of the digestive tract that affects the esophagus. The esophagus connects the throat with the stomach, from which it is separated by a muscle called the lower esophageal sphincter (LES). When this muscle is not functioning properly, stomach contents can travel up into the esophagus and damage its lining, which is not made to tolerate the acidity of stomach fluid. GERD can be erosive or non-erosive. Erosive GERD has inflammation, erosions, or ulcers in the esophagus. Non-erosive GERD is the most common and does not present with inflammation, erosions or ulcers.

Symptoms

Symptoms of GERD may include tooth corrosion, a burning sensation starting in the stomach and moving up to the mouth (heartburn) after meals or when lying down, regurgitation (bitter taste in the mouth), difficulty swallowing (dysphagia), pain when swallowing (odynophagia), sore throat, cough, and chest pain unrelated to the heart.

Treatment

Treatment for GERD may include a medical approach (eg, drugs to reduce stomach acid), a nutritional approach, as well as behavioral modifications. In some cases, surgery, called a fundoplication, may be necessary.

Nutritional approach

The nutritional approach includes five key points:

1. Increase lower esophageal sphincter (LES) pressure

The lower esophageal sphincter is the muscle that separates the base of the esophagus and the stomach. When the pressure is right, it prevents the acidic contents of the stomach from moving up into the esophagus. Certain foods contribute to increasing the pressure of the SOI. This is especially the case for foods high in protein, such as lean meat and low-fat dairy products. On the other hand, certain substances decrease the tension of the SOI and are to be avoided. This is the case with fat (in excess), alcohol, certain medications, tobacco, mint and methylxanthines, compounds naturally present in chocolate, tea and coffee.

2. Prevent irritation of the esophageal mucosa

Irritation of the esophageal lining may be made worse by eating certain foods. These foods include tomatoes and their juices, citrus fruits and their juices, caffeine, hot spices, alcohol and soft drinks.

3. Facilitate emptying of the esophagus and stomach

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

4. Avoid putting too much pressure on the stomach or feelingavoid having too much intra-abdominal pressure

There are several strategies that can be used to limit the pressure on the stomach. These strategies include achieving an ideal weight, avoiding wearing tight clothes, and avoiding constipation (see the article hereConstipation in adults). Weight loss may be necessary if you are overweight.

5. Avoid having too much pressure in the stomach oravoid gastric hyperpressure

There are different recommendations for reducing the pressure in the stomach. These recommendations may include:

• Eat small, frequent meals andsnacks throughout the day.
• Eat and drink slowly, taking the time to chew the food well.
• Avoid swallowing air when eating and drinking (eg chewing gum, soft drinks, etc.).
• Avoid drinking liquids 30 minutes before and after meals.

Nutritional treatment for GERD includes dietary recommendations (eg: avoiding irritating foods, etc.) as well as behavioral changes (eg: raising the head of the bed, losing weight, etc.). As with all nutritional recommendations, those for GERD should also always be personalized according to the diet and specific needs of each individual in order to provide adequate treatment. Do not hesitate to consult a health professional who will be able to support you and best meet your specific needs through treatment adapted to your personal situation.

References

1. Bouthillier, Lise. January 2019. Diseases of the digestive tract. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.al.
2. D’Aoust, Louise. January 2019. Pathophysiology of the digestive system. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.al.
3. 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% 93esophageal-rgo #
4. https://www.merckmanuals.com/fr-ca/professional/troubles-gastro-intestinaux/troubles-%C5%93sophagiens-et-de-la-d%C3%A9glutition/gastroesophageal-reflux-disease-gerdquery=Reflux % 20gastro-% C5% 93esophageal% 20 (GERD))
5. https://www.merckmanuals.com/fr-ca/accueil/les-faits-en-bref-troubles-digestifs/maladies-de-l-%C5%93sophage-et-de-la-d%C3%A9glutition / gastro-reflux% C5% 93sophageal-rgo

Article written by:

Marie-Noël Marsan, Nutritionist