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Barrett’s Esophagus

What is Barrett’s Esophagus (BE)?

Barrett’s Esophagus (BE) is a complication of chronic gastroesophageal reflux disease (GERD). The normal valve between the esophagus and stomach is incompetent and stomach fluid causes changes in the type of cells in the esophagus. The normal squamous epithelial cells of the esophagus become metaplastic and look like intestinal cells under the microscope. The appearance of the esophageal lining on upper endoscopy can be suggestive of BE, but the actual diagnosis of BE is made after looking at the esophageal cells under a microscope in the pathology lab.

Treatment of Barrett’s Esophagus requires an interdisciplinary approach that draws on various medical specialties. At BMC, physicians in our Center for Minimally Invasive Esophageal Therapies provide comprehensive, quality care including medical oncology, radiation oncology, thoracic surgery, gastroenterology, pathology, pulmonary medicine and radiology.

Virginia Litle, MD, Director, Barrett’s Esophageal Program
BE is estimated to occur in 2 – 5.6 % of people in the United States. BE is a known risk factor for precancerous dysplasia, which can then progress to esophageal adenocarcinoma (EAC). EAC develops in about 0.5% of people with BE annually. BE increase the risk of esophageal adenocarcinoma by 11-40 times when compared to patients without BE. When patients are diagnosed with BE, they are advised to enter a surveillance program of repeat endoscopies on a regular schedule to look for precancerous dysplastic changes or early esophageal cancer. The survival rate of all patients presenting with EAC is 15% at five years, but when EAC is diagnosed early, then cure is possible.

What are the Symptoms?

Typical symptoms of GERD include heartburn and regurgitation. BE occurs in about 10% of U.S. adults with heartburn. GERD however can be silent that is without heartburn or regurgitation, and BE can result in the absence of symptoms. In addition a loss of typical GERD symptoms like heartburn can be suggestive of the development of BE.

Barrett’s esophagus patients may have symptoms of:

  • Heartburn and regurgitation
  • Unexplained weight loss or loss of appetite

What are the Causes?

Barrett’s esophagus is thought to be caused mainly by gastroesophageal reflux disease (GERD), which is persistent reflux occurring at least twice a week. Patients generally experience a feeling of heartburn or acid indigestion, and they may taste food or fluid in the back of the mouth. The use of over-the-counter or prescription acid-reducing drugs may decrease the risk of Barrett’s esophagus.

How is Barrett’s Esophagus Diagnosed?

Diagnosis is often difficult, because symptoms may be limited. The main diagnostic tool is upper endoscopy:

Endoscopy

You will receive an intravenous sedative and pain medication. Once comfortable, the physician will then examine the area using an endoscope—a lighted tube with a small camera at the end. The physician will be able to view any abnormalities and take a tissue samples (biopsies) if necessary.

How is Barrett’s Esophagus Treated?

Barrett’s esophagus may be treated in a number of ways. These include:

  • Surveillance. Your physician may opt for watchful waiting to see if and how your cells change.
  • Mucosal Ablation

    For this procedure, a physician uses a special probe to apply heat energy to diseased cells to destroy them and encourage healthy cells to replace them.

  • Radiofrequency Ablation with Barx ablation

    Heat energy is applied to any areas of intestinal metaplasia to destroy the cells and allow replacement with normal appearing esophagus cells.

  • Cryoablation

    Cryoablation, sometimes called cryotherapy, is a minimally invasive treatment used to destroy diseased cells in the esophagus caused by esophageal cancer and/or Barrett’s esophagus. For cryoablation, a physician inserts a small tube (endoscope) through your mouth and into your esophagus. Once the endoscope is in place, liquid nitrogen is sprayed through the endoscope into the esophagus. The liquid nitrogen freezes the lining of your esophagus. The frozen cells die and are replaced by healthy cells. Cryoablation is used to treat Barrett’s esophagus with high-grade dysplasia, and some early stage esophageal cancers. It can also be used to improve symptoms of advanced cancers. These symptoms include difficulty swallowing and bleeding.

  • Endoscopic Mucosal Resection

    Endoscopic mucosal resection, or EMR, is one of the newer, more minimally invasive techniques we offer for our esophageal cancer patients who have small tumors that have not spread outside of the esophagus. It may also be beneficial for patients with Barrett’s esophagus. In this simple procedure, we are able to locate, remove, and examine cancerous or precancerous lesions of the esophagus. The mucosa is the innermost lining of the esophagus, and it extends down into your gastrointestinal tract. Cancers in this tract often originate in the mucosa, thus making visualization and access to it essential for diagnosis and treatment.

The following lifestyle changes may be helpful in controlling reflux:

  • Eating smaller, more frequent meals
  • Controlling your weight and avoiding obesity
  • Raising the head of your bed 30 degrees
  • Avoiding lying down 3-4 hours after eating
  • Quitting smoking

Occasional heartburn is often treatable with over-the-counter medication and/or lifestyle modification.

Ask yourself these questions to see if your heartburn may be caused by a more serious condition, such as gastroesophageal reflux disease, also called GERD:

  • Have you been having symptoms of GERD and treating with over-the-counter medicines for more than 2 weeks?
  • Has the pattern of your heartburn changed? Is it worse than it used to be?
  • Do your symptoms include regurgitation — bringing up gas and small amounts of food from your stomach to your mouth?
  • Do you wake up at night with heartburn?
  • Have you been having any difficulty swallowing?
  • Do you continue to have heartburn symptoms even after taking non-prescription medication?
  • Do you experience hoarseness or worsening of asthma after meals, lying down, or exercise, or asthma that occurs mainly at night?
  • Are you experiencing unexplained weight loss or loss of appetite?
  • Do your heartburn symptoms interfere with your lifestyle or daily activity?
  • Are you in need of increasing doses of nonprescription medicine to control heartburn?

If you answered yes to any of these questions, your heartburn warrants attention from a medical professional. People with long-standing chronic heartburn are at greater risk for serious complications including stricture (narrowing) of the esophagus or a potentially precancerous condition called Barrett’s esophagus.

A 30-Pound Weight Loss and Portion Control Tamed My Heartburn

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At first I barely noticed I had gastroesophageal reflux disease, a condition in which stomach acid backs up into the esophagus. I had problems with acid reflux only if I ate a really big meal. It was a little weird—it felt like I couldn’t keep food down—but it would go away; when I ate a normal meal, I didn’t have any problems at all. Then it started to get worse. Eventually it got to a point where drinking a glass of water would trigger acid reflux. On a vacation with my then-fiance—now my wife—I was in pain the entire time we walked back to our hotel after dinner. That was the last straw. My fiance told me I had to see a doctor; this was a serious problem.
Heartburn-Easing Foods That Fight GERD

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I had never heard of GERD before my doctor told me I had it, and I didn’t really know anything about acid reflux. The doctor prescribed omeprazole (Prilosec), one of many medications called proton-pump inhibitors that reduce the amount of acid in the stomach. Prilosec works great for some people, but in my case it only reduced the acid reflux, it didn’t stop it completely. I had less pain, but I still had acid reflux—it was still unpleasant.

What’s scarier than daily pain? No coffee
Even worse was the doctor’s next recommendation—he told me I could have two servings of caffeine a day, at most. That was a shocker: I wanted to say to him, “I already don’t drink, smoke, or do drugs, and now I can’t have my coffee?” I work in public relations, a high-pressure job with long hours—how was I supposed to function without coffee? But somehow I got in the habit of having only two cups of coffee a day, as opposed to five or six servings of caffeine. I gave up Indian food too. Luckily, I didn’t have GERD to the point that I couldn’t sleep at night. And if I had acid reflux at work, as impolite as this sounds, I was able to turn away for a few minutes, swallow, and get myself back under control. Some people are constantly vomiting; I was lucky my GERD wasn’t that bad.

Since the heartburn medication wasn’t completely curing my acid reflux, my doctor performed endoscopies—a procedure in which a lighted scope is used to examine the stomach—a couple of times over the years. Untreated GERD can cause damage to the esophagus, which over time might lead to esophageal cancer. Luckily, he didn’t find much damage.

Because there wasn’t a lot of damage, my doctor said he was hesitant to perform surgery to correct the GERD. In addition, GERD surgery doesn’t always work that well. He said it could be used to tighten the valve that connects the stomach to the esophagus, but said I didn’t really need it.

Next Page: As the extra pounds disappeared, so did GERD

As the extra pounds disappeared, so did GERD
I switched from Prilosec to Nexium when my insurance changed. I tried the over-the-counter Prilosec, but that wasn’t as effective.

I was resigned to the fact that I just had to live with my less painful—but still present—acid reflux. Then I decided to join Jenny Craig in December of 2008.

I cut down from 1,700 calories to 1,500 calories a day, and then to 1,200 calories a day. I lost 30 pounds, dropping from 180 pounds to 150 pounds. I noticed that I was having acid reflux less and less often, and eventually the reflux completely stopped.

There were so many foods I wasn’t supposed to eat, but I realized that they didn’t seem to trigger acid reflux anymore. Now I drink coffee whenever I want, I ate a ton of chocolate at Easter, and I can order spicy food at a Chinese restaurant—none of my old triggers bothers me anymore. As long as I keep the portions under control, I never have any GERD symptoms.

I still take Nexium as a precaution, but I actually forgot to take it this morning and haven’t really noticed. Some days are harder than others to stick to my diet, but it’s worth it to me not to be overweight. And the acid reflux cure—well, that was just a pleasant surprise!

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disorder in the United States occurring monthly, weekly and daily in 45%, 25% and 7% of the population, respectively. Gastroesophageal reflux occurs when the contents of the stomach back up into the esophagus and throat. GERD occurs when individuals with reflux (when stomach contents rise up into the esophagus) develop symptoms or injury to the esophagus.

SYMPTOMS

Common symptoms of GERD include heartburn and regurgitation of food into the esophagus and throat. Less common symptoms include upper abdominal pain, chronic cough, hoarseness, chest pain, sensation of a “ball” in the throat, asthma, sore throat, chronic sinus infections, vomiting and difficulty or painful swallowing. Worrisome signs and symptoms include unexplained weight loss, anemia, loss of appetite and bleeding (vomiting blood or tarry stools).

DIAGNOSING

GERD is usually diagnosed based on symptoms and response to treatment. A trial of lifestyle changes and a short course of over-the-counter (OTC) medication is often recommended for individuals with mild symptoms of acid reflux with no evidence of complications. Further testing may be indicated when symptoms fail to improve, if the diagnosis is uncertain or if an individual develops worrisome signs and symptoms.

Endoscopy is commonly used to evaluate patients with GERD symptoms. After sedation is administered, a small flexible tube with a camera known as an endoscope is passed into the mouth, tubular esophagus, stomach and the first part of the small intestine. The image is projected onto a monitor permitting detailed visualization of the gastrointestinal tract’s surface. During the procedure, specimens of the lining of the intestinal tract can be obtained to determine the extent of damage and to establish the diagnosis of certain diseases such as infections or tumors. Specialized instruments passed through the endoscope during the procedure allow diagnostic evaluation and therapeutic intervention. Dedicated endoscopes, such as the endoscopic ultrasound, permit the physician to determine the extent of tumor involvement and, in the case of early detection, perform complete endoscopic removal.

A 48-hour esophageal pH study is the most direct way to confirm the diagnosis of acid reflux. The test involves placement of a small capsule in the esophagus at the time of endoscopy. This capsule contains a pH-sensor which measures esophageal acid exposure during a 48-hour period that can be analyzed to confirm or exclude the diagnosis of acid reflux when the diagnosis of acid reflux is unclear.

Esophageal manometry involves swallowing a small tube that measures esophageal muscle contractions. This procedure can identify abnormal motility patterns of the esophagus and determine if the lower esophageal sphincter, which acts as a barrier to acid reflux, is functioning properly. In a similar manner, esophageal impedance is a procedure that can help determine if non-acid reflux may be responsible for the patient’s symptoms.

Complications of acid reflux include ulcers, strictures, lung disease, throat problems, and the precancerous condition know as Barrett’s esophagus. Barrett’s esophagus is found in 10% of patients with GERD. Periodic endoscopy is performed to monitor patients with Barrett’s esophagus. The most feared complication of GERD is the development of esophageal cancer, often seen in patients with underlying Barrett’s esophagus.

TREATMENTS

Treatment consists of lifestyle modifications such as weight loss, elevating the head of the bed, cessation of smoking, replacing tight clothing, eliminating foods which induce reflux, and also avoiding large, fatty and late meals. Many patients may require over-the-counter antacids such as Maalox, Mylanta and Tums, while others may obtain relief with drugs which decrease acid production known as histamine-2 receptor antagonists such as ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) and cimetidine (Tagamet). The more effective acid decreasing medications know as Proton Pump inhibitors (PPI) include omeprazole (Prilosec, Zegerid), lanzoprazole (Prevacid), rabeprazole (Aciphex), pantaprazole (Protonix), esomeprazole (Nexium) and dexlanzoprazole (Dexilant). Some of the PPI formulations are available over-the-counter and are most effective if taken 30-60 minutes before breakfast.

Surgery is reserved for the rare patient who may not be able to take medications or has developed significant regurgitation despite lifestyle modifications. The most commonly performed procedure is the Nissen fundoplication. Although effective in a select group of patients, this procedure is associated with troublesome and often non-reversible post-operative symptoms such as abdominal bloating and gas, early satiety, diarrhea as well as surgical complications. In some studies, up to 65% of patients continue to require further acid reducing therapy despite successful surgery. Newer endoscopic approaches to the management of GERD are being developed for this group of patients.

After ringing in the New Year, Americans from all walks of life have started dieting. For the 10% to 20% of Americans who experience gastric reflux, such weight loss may be the key to reducing associated symptoms.
That’s the message from a study published on December 17, 2014, ahead of print in Diseases of the Esophagus. The authors designed it based on evidence linking obesity to a significant increase in the risk for gastroesophageal reflux disease (GERD) symptoms and its complications. Now, they have indicated that losing weight can reduce reflux symptoms in overweight/obese patients with proven GERD.
The researchers enrolled 102 overweight or obese adults with typical GERD symptoms and erosive esophagitis. After evaluating reflux symptoms and gathering anthropometric measurements, the researchers designated 2 treatment groups.
Group A received proton pump inhibitor (PPI) therapy and a personalized, low-fat, high-carbohydrate, hypocaloric diet and aerobic exercise. In this group, the goal was to achieve weight loss of at least 10% within 6 months. Group B received PPI treatment and a standard diet prescribed for GERD patients that advised about the types of foods to avoid, but there was no change in caloric intake.
Subjects in group A increased their exercise, walking an average of 11,342.8 steps per day as measured by a pedometer. They lost an average of 5.3 points of mean body mass index (BMI) and 12.2 kg of weight. In contrast, subjects in group B maintained both their BMI and weight.
Although patients in both groups perceived fewer symptoms during PPI therapy, subjects in group A reported significantly greater improvements, and more than half of them completely discontinued PPI treatment. An additional one-quarter of group A patients halved their PPI doses.
In group B, 43% of subjects halved their PPI therapy, and 57% maintained full-dose PPIs. However, none of them discontinued PPI therapy.
The authors recommended weight loss of at least 10% in all patients with GERD to boost the effect of PPI on reflux symptom relief and reduce chronic medication use.

Diet Tips for Gastroesophageal Reflux Disease (GERD)

Diet Tips for Gastroesophageal Reflux Disease (GERD)

What is GERD?

Normally, there is a strong muscle that keeps stomach acid in your stomach where it belongs. In GERD (gastroesophageal reflux disease), this muscle is weak. This allows stomach acid to flow upward into the tube that carries food from your mouth to your stomach, called the esophagus. This can cause a burning feeling in the chest often referred to as “heartburn.” People who have GERD may also have other symptoms like trouble swallowing, chest pain, and coughing.

Can I control it with diet?

There are some diets and lifestyle changes that may ease the symptoms of GERD. However, there are no strong scientific data to support any specific diet therapy. Success with dietary changes varies from person to person – what works for one person may not work for another. So, you should adjust your diet and lifestyle based on what best helps your symptoms.

The only recommendation that does apply to all individuals is “IF A FOOD BOTHERS YOU, DON’T EAT IT!”

There are some foods that doctors and Registered Dietitians usually suggest you limit or avoid altogether. Some people with GERD may find that skipping these foods helps their GERD symptoms. But if you stop eating these foods and your symptoms do not get better, then there is no need to keep avoiding them.

Common Trouble Foods for GERD

Spicy foods

Chocolate or brownies

Raw onion, garlic, black pepper

Caffeine (sodas, coffee, tea, etc.)

Citrus products and juices (orange, grapefruit, or cranberry juice)

Fatty or greasy foods (fast food, salad dressing, potato chips, donuts, pastries, ice cream, etc.)

Tomato products

Peppermint

Other dietary changes that may help:

  • Eat smaller meals more often instead of 3 big meals.
  • Try to eat more slowly. Aim for 30 minutes per meal.
  • Avoid eating on the run. Sit down and enjoy your food.
  • Avoid large, high fat meals.
  • Avoid late evening snacks or eating before bed.
  • Avoid lying flat after eating. Try sitting up for at least an hour after finishing a meal.
  • Try keeping a food journal for at least a week to keep track of what foods trigger your symptoms.

What about lifestyle changes?

Changing some of your habits might help your GERD. Remember to avoid CATS: Caffeine, Alcohol, Tobacco, and Stress.

  • Try limiting or stopping caffeine altogether to see if your symptoms improve. Caffeine is found mainly in sodas, coffee, and tea.
  • Do not drink alcohol.
  • Stop smoking.
  • Limit or reduce stress in your life. Try participating in an exercise, yoga, or meditation program.
  • Avoid tight fitting clothing around the abdomen, including underwire bras.
  • If you are overweight, lose weight. Even a small weight loss can help.
  • Try light walking for 15-30 minutes following a meal.
  • Try chewing non-mint gum for 30 minutes following a meal.
  • Sleep on your left side. Remember, “right is wrong.”
  • Elevate the head of your bed 6 to 8 inches to prevent reflux when you are sleeping. Extra pillows may only elevate your head. Instead:
    • Try putting pillows between the mattress and box springs near the head of the bed.
    • Or, use a special wedge. One option is the Mattress Genie® Adjustable Bed Wedge, but many are available

Additional resources:

  • International Foundation for Functional Gastrointestinal Disorders: www.aboutgerd.org
  • The University of Virginia Health System, Digestive Health Center, GI Nutrition website: www.GInutrition.virginia.edu

Stomach Acid Levels and Weight-Loss

A lack of stomach acid production is one of the main reasons why so many people find weight-loss to be such an arduous task. When someone lacks stomach acid, they’re likely to suffer from a sub-optimal metabolism, struggle with blood sugar regulation issues, experience cravings, energy lows and sleep problems, and encounter a variety of other issues. All of these responses make it extremely difficult for someone with a lack of stomach acid to make the lifestyle shifts necessary to lose weight. Furthermore, while poor stomach acid production is a very common problem, it’s often overlooked by many healthcare practitioners. Addressing low levels of stomach acid can make a world of difference when it comes to facilitating weight-loss and cultivating a powerful and healthy body.

1 – What is stomach acid?

The stomach produces stomach acid to help break down and absorb the food we consume. Stomach acid activates important enzymes required for the digestive process and ensures optimal absorption of any nutrients, including proteins, vitamins, minerals and antioxidants. By helping everything get broken down properly, stomach acid also helps fight against the proliferation of bacteria in the stomach and gut – keeping us further balanced. An appropriate level of stomach acid is critical to a properly-functioning physiology and absolutely essential to regulating our body weight and promoting fat-loss.

2 – Symptoms potentially indicative of low stomach acid levels

  • Indigestion
  • Gas
  • Bloating
  • Stomach aches and pains
  • Pulmonary/esophageal/nasal/sinus mucous formation
  • Vertical lines on the nails
  • Manifestation of multiple allergies and intolerances

All of these symptoms are good indicators that the body lacks stomach acid. Although many of these symptoms may be considered “normal” because they’re experienced so often by so many people, their prevalence should by no means suggest they’re normal. These responses are messages from your body telling you something is wrong. Specifically, all of these symptoms are a sign of global inflammation. Inflammation equals breakdown. To restore order to the body, we have to stop this process by examining and treating the digestive system.

3 – Why do we need stomach acid, and how does a lack of it limit us? You are what you absorb!

Without proper stomach acid levels, nutrient absorption is hindered. Although some say we are what we eat, we are really only what we manage to break down and absorb. When our daily nutritional regimen lacks key nutrients, vitamins and minerals, these deficiencies begin to impact bodily functions, further perpetuating the physiological cycle of stress. Our digestive system further down-regulates, leading to a vicious cycle of less and less nutrient absorption and, in turn, greater and greater deficiencies. If we are looking to optimize our health, restore order to our body and lose weight, we must make it our top priority to regulate our stomach acid production.

4 – What causes low stomach acid levels?

It’s not surprising that most people tested end up scoring very low on their stomach acid evaluation. Psychological, emotional and environmental stressors (i.e.: poor food quality, harmful substances, lack of sleep, etc.) put our body into a state of chronic stress. The body essentially enters a “fight-or-flight” mode, in which we become sympathetic nervous system dominant. While this innate response to stress may be useful in a situation where we have to run from a lion, as a daily response, it contributes to the breakdown of our bodies. In a “fight-or-flight” state, the body does not prioritize digestion. Instead, it promotes the inhibition of stomach and intestinal operations, slowing down or halting the digestive process. Such a state also triggers fewer bowel movements, meaning toxins remain in the body for longer, which in turn results in the over activation of the immune system. All of these negative physiological consequences ultimately lead to continuous global inflammation in the body. This keeps the body in a chronic state of breakdown. The digestive symptoms outlined earlier are just the beginning of this dramatic downward spiral.

5 – Stomach acid and weight-loss

To optimize our metabolism, we must ensure that our body is secreting normal levels of digestive juices. Why? Stomach acid facilitates the breakdown and absorption of key nutrients essential to the elimination and detoxification of stored fat tissue. Any deficiencies will down-regulate the overall functioning of our bodies, decreasing our metabolic rate, triggering cravings and causing energy issues and problems with blood sugar regulation. All of these negative consequences impair weight-loss efforts. Luckily, stomach acid levels can be tested and assessed. By diagnosing low stomach acid, the healing process can be initiated to rebalance your body and restore physiological and biochemical order.

6 – How to fix low stomach acid levels

Fixing stomach acid levels is a multifaceted process. While stress is the primary and most important cause of poor stomach acid production, the existence of stress is itself a result of numerous lifestyle factors.

Stress is anything that burdens the body at a cellular level. For example, stress can include:

  • Psychological and emotional stress, brought on by your relationships, career, pursuit of success, etc.
  • Environmental stress (water, air etc.)
  • Poor quality food and beverages
  • Strenuous physical activities

To start the healing process, we have to reduce the stressors inflicting harm on us. Some practical ways to do this include:

  1. Eating a healthy and well-balanced diet
  2. Consuming lots of water to hydrate and detoxify the body
  3. Rotating our food sources for a variety of nutrients, vitamins, minerals and antioxidants
  4. Relaxing our bodies before bed by turning off electronics (computers, televisions, cellphone) 30-60 minutes before sleeping and engaging in a relaxation routine (hot bath, reading, meditation, etc.)
  5. Finding time for ourselves in general to relax and unwind
  6. Taking action to deal with the stressors of our lives head-on (changing careers and following our passions, addressing stressful relationships, etc.)
  7. Implementing supplement protocols to reduce inflammation in the body and promote the healing and functioning of the digestive system (for example, good quality, absorbable probiotics, glutamine supplementation, etc.)

* Always consult with a qualified healthcare practitioner before engaging in any type of supplement protocol

Conclusion

The body is made up of many interconnected systems. We cannot look at any one symptom in isolation — we have to look at the body as a whole. Just like the abdominal region is the physical core of the body, bridging the upper and lower body, the digestive system is the core of our physiology. It’s the bridge between the food we consume and the nutrients we absorb for daily functioning. Any deficiency in this physiological core will result in deficiencies in the rest of our bodies. By addressing digestive problems, you’ll sleep better, have more energy, experience less cravings, improve focus, boost your metabolic rate and expedite weight-loss. Stomach acid is truly the weakest link in the chain of health for many people. If you’ve never had your stomach acid levels tested, booking an evaluation could be the first step towards restoring balance to your body and getting those weight-loss results you’ve always wanted. For more information, please contact us.

Obesity & Heartburn: What is the Link?

by Nancy Kushner, MSN, RN, and Robert Kushner, MD

Winter 2013

To view a PDF version of this article, click here.

New research points to an association between obesity and heartburn. Studies have shown that weight gain and an increase in the size of one’s belly may either cause or worsen this condition.

Heartburn, also called GERD (gastroesophagael reflux disease), occurs when stomach acid flows back into the esophagus, which is the food pipe that connects the throat and stomach. Heartburn symptoms often occur shortly after eating and can last for a few minutes or even hours. People may complain of a burning sensation in the chest or throat, a sour or bitter taste in their mouth or even cough symptoms.

This association seems to be stronger in women and in the white population as compared to men and other ethnic groups. The increased risk of GERD is thought to be due to excess belly fat causing pressure on the stomach, the development of a hiatal hernia that causes the backflow of acid or hormonal changes like an increase in estrogen exposure that can occur in individuals who are affected by obesity.

Why is this important?
As acid flows back into the esophagus, it can cause irritation and inflammation. Throughout time, complications can develop. The esophagus can narrow, leading to a stricture and swallowing problems. A sore or ulcer can develop which can bleed, be painful and make swallowing difficult. Additionally, precancerous changes can occur to the esophagus, called Barrett’s esophagus, which is the main risk factor for developing esophageal cancer.

It turns out that obesity is associated with three related esophageal disorders: GERD, Barrett’s esophagus, and esophageal adenocarcinoma. The risk for these disorders seems to progressively increase with increasing weight. The goal of treating GERD is not only to decrease bothersome GERD symptoms but also to decrease one’s risks of developing these other, more serious esophageal conditions.

What can you do?
The most effective lifestyle interventions to reduce GERD symptoms are losing weight and, if symptoms occur during sleep, elevation of the head of the bed.
New research shows that weight-loss can improve GERD symptoms. In a recent study published in the journal Obesity in 2012, the majority of individuals who were overweight or affected by obesity who enrolled in a structured weight-loss program including dietary, physical activity and behavioral changes, experienced complete resolution of their GERD symptoms. The relationship between weight-loss and resolution of symptoms was dependent on the amount of weight lost, such that the more weight subjects lost, the greater improvement they saw in symptoms. Whereas women saw improvement in GERD symptoms after losing 5 to 10 percent of their weight, men experienced improvement after losing 10 percent of their weight.

In another study published in the journal Gastroenterology in 2010, weight-loss through restriction of calories and increased physical activity also demonstrated a significant improvement in participants’ symptoms of GERD. Most importantly, follow-up at 6, 12 and 18 months showed decreases in abdominal fatness and symptoms of heartburn and acid reflux. Reduced GERD symptoms means lower acid levels in the esophagus. Thus, another benefit to losing weight is that patients may be able to eliminate or reduce their over-the-counter (OTC) or prescription GERD medications.

Though improved GERD symptoms has also been shown in patients who undergo bariatric surgery, it is difficult to know if improvement is due to the anti-reflux nature of the surgical procedure or to the weight-loss itself.

There have also been studies on the effectiveness of elevating the head of the bed to decrease GERD symptoms. Compared with patients who slept flat, patients who elevated the head of the bed did have less esophageal acid exposure and fewer reflux symptoms. Studies show that this can be an effective strategy for some patients. You can elevate the head of the bed using wood or cement blocks under the legs of your bed or using wedges between your mattress and box spring.

Effectiveness of Other Life-style Modification Measures
The list of foods, drinks and other factors thought to worsen GERD symptoms is quite long and includes:

      • Tobacco
      • Alcohol
      • Carbonated beverages
      • Caffeine
      • Chocolate
      • Onions
      • Garlic
      • Spicy foods
      • Cooked tomato sauce
      • Mint
      • High-fat meals

The data studying these items is conflicting. More research is needed to determine the effectiveness that stopping smoking or eliminating the listed foods and drinks will have on GERD symptoms. It is recommended to pay attention to see if any of the listed items seem to worsen your condition. If so, you can decrease or eliminate them and see if symptoms improve.
Other Helpful Lifestyle Measures

      • Eat smaller meals.
      • Wear clothes that are looser around the waist.
      • Don’t lie down for at least three hours after eating a meal.

Medication Therapy
OTC and prescription medications are available to treat GERD. Ask your healthcare provider for guidance when seeking a medication treatment plan to control your symptoms. OTC medication options include antacids (Mylanta or Tums) that neutralize stomach acid; H2 blockers (Tagamet or Pepcid) that reduce stomach acid; and proton pump inhibitors (Prevacid or Prilosec) that also block stomach acid and allow the esophagus to heal. Prescription strength H2 blockers and proton pump inhibitors are also available. Combining medications can sometimes increase effectiveness.

Like all medications, GERD medications can have side effects and can interact with other drugs, so it’s important to discuss this with your healthcare provider. Be sure to talk about what and how much medication you are taking, the effects on your GERD symptoms and any side effects you are experiencing. The goal of medication therapy is to relieve GERD symptoms, allow the esophagus to heal and prevent GERD complications.

Conclusion
If you think you are experiencing heartburn (GERD) symptoms, it is important to discuss these symptoms with your primary care provider. Together, you will be able to identify an effective treatment plan.

About the Authors:
Nancy Kushner, MSN, RN, is a nurse practitioner, health writer and co-author of Dr. Kushner’s Personality Type Diet and Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit.
Robert Kushner, MD, is Clinical Director of the Northwestern Comprehensive Center on Obesity in Chicago, Professor of Medicine, Northwestern University Feinberg School of Medicine, Past President of The Obesity Society, author of more than 160 scientific articles on obesity and nutrition, author of Dr. Kushner’s Personality Type Diet, Counseling Overweight Adults: The Lifestyle Patterns Approach and Toolkit and Fitness Unleashed: A Dog and Owner’s Guide to Losing Weight and Gaining Health Together.

What can I do?

1) Don’t exercise immediately after eating

Make sure you leave around two hours between your last meal and a period of exercise.

2) Avoid high-carbohydrate sports drinks

Because of the acidic nature of these drinks, they can be a causative factor for heartburn symptoms. Drinking water will mean you are much less likely to induce heartburn.

3) Avoid common food triggers

There are certain foods which can trigger heartburn, especially spicy, or rich and fatty foods like curries and acidic based sauces. Most frequent sufferers will know their triggers, so it’s best to avoid these all together, especially before taking exercise.

4) Re-evaluate your heartburn treatment

Many OTC treatments, such as antacids and alginates, only provide short-term relief, meaning heartburn symptoms can come back; frequent sufferers report having to treat an average of more than four times per day to find relief. For some people, re-evaluating their treatment choice can help them achieve longer-term protection against the symptoms. Nexium Control® can provide 24- hour protection from the symptoms of heartburn with just one tablet per day for up to 14 consecutive days.

5) Don’t give up

In the long term, exercise and the resulting weight loss will help decrease your likelihood of experiencing heartburn. Carrying extra weight puts more pressure on the valve between the food pipe and the stomach, which causes acid to leak upwards from the stomach, triggering symptoms.

When everything is flowing smoothly, life is good. And we’re not just talking good hair days or a flawless presentation at work. Your digestive tract counts too. But when it’s out of whack, it could affect — you guessed it — the scale.

“Gastrointestinal and digestive issues can definitely have a large effect on the way we eat and how our bodies absorb and digest foods, causing us to gain or lose weight,” says Kenneth Brown, M.D., a board-certified gastroenterologist. “Most digestive problems tend to cause weight loss from poor absorption of food, but there are a few situations in which our intestinal health can contribute to weight gain.”

If the number on the scale is changing and you really aren’t sure why, one of these common digestive issues could be the culprit.

1. Acid Reflux Disease

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Also known as gastroesophageal reflux disease (GERD), this causes a painful burning sensation, or heartburn, in the lower chest when stomach acid rises back up into your esophagus. And for people who suffer from it, the term “comfort food” takes on a whole new meaning because the act of eating can actually help reduce pain. “Eating provides temporary relief because both the food you’re eating, and the saliva from actually chewing that food, neutralizes acid,” explains Brown. The only problem? Once the food’s been digested, all the symptoms — bloating, nausea, and hiccups that won’t disappear — tend to come back, and they’re usually more aggressive because of rebound acid production. But because people want help, Brown says it’s easy to get sucked into a dangerous cycle of overeating that leads to weight gain.

The fix: While plenty of online sources say home remedies like apple cider vinegar or aloe vera can help, Brown says there’s no scientific evidence to support those notions. Instead, he recommends taking an over-the-counter medication, such as Prilosec or Zantac (your doctor can help you choose which is best for you), which don’t have weight gain as a common side effect. And if you still find yourself overeating, try these fixes to help break the cycle.

2. Ulcers

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These uncomfortable sores — also known as duodenal ulcers — usually develop in the lining of the stomach or small intestine, and it’s usually because of too much acid production. And just like with GERD, eating food can improve the painful symptoms — including bloat and constant nausea — because it temporarily coats the ulcer with a protective lining and neutralizes the stomach acid, explains Su Sachar, M.D., a board-certified gastroenterologist who specializes in bariatrics, wellness, and optimal health. And, to re-state the obvious, if you’re eating more frequently, those excess calories can lead to weight gain.

The fix: To banish ulcers, see your doctor about the best remedy for you, which might involve an acid-blocking medication — aka an anti-acid — like Prilosec or Zantec, says Sachar. And stop taking nonsteroidal anti-inflammatory drugs or NSAID pain relievers like ibuprofen or aspirin, as they could cause internal bleeding and be life-threatening to those with ulcers. Instead, opt for acetaminophen, or Tylenol, when you need help with pain management.

3. Constipation

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When you’re stopped up, that weighed-down feeling you get could be weight gain. But there’s good news: your body isn’t actually absorbing more calories, says Brown, so it’s not true weight gain so much as it is extra fecal matter, which is what could be adding a few pounds to the scale. Not to mention that constipation itself doesn’t exactly give us the motivation to hit the gym and crush a workout. Rather, it’s way more likely that you’re feeling sluggish and heavy… and the couch is calling your name.

The fix: To stay, err, regular, Brown suggests sticking to a balanced diet of whole foods that have at least 25 to 30 grams of fiber per day, staying well-hydrated (try to drink one to two liters of water per day), and exercise regularly. If something doesn’t seem quite right, look at these signs for what it could mean, and consider talking with your physician.

4. Bacteria Overgrowth

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Bear with us — this one isn’t quite as gross as it sounds. Basically, your bowel contains both good and bad bacteria, and research shows that the good kind plays a crucial role in your overall health by reducing inflammation and keeping your weight in check. The problem occurs when the amount of bacteria increases, or when the type of bacteria gets thrown off-balance. (For optimal health, it’s best to think of it like a seesaw — best when the good and bad is totally balanced.) When that happens, what’s known as small intestinal bacterial overgrowth (SIBO) can occur, and it can cause weight gain in two ways, says Brown.

First, the bacteria could produce methane gas, which “slows down the overall function of the small intestine, allowing the intestinal villi — small, finger-like projections in the lining of your intestine — to absorb more calories per bite,” he explains. In other words, the exact opposite of what you want to happen. Second, SIBO can slow down metabolism and affect your insulin and leptin resistance, both of which help regulate hunger and satiety. As a result, you’re likely to crave carbs and probably won’t feel full after eating, even if it’s a fully satisfying meal, says Sachar.

The fix: To avoid SIBO, Brown suggests avoiding antibiotics unless absolutely needed (as the name suggests, these medications kill off bacteria, which you only really want if you’re sick to get the seesaw back in balance). If bacteria overgrowth is already happening, though, your doctor may suggest a digestive herbal supplement like Atrantil to help you get back on track.

5. Irritable Bowel Syndrome (IBS)

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The term IBS gets tossed around a lot these days, as “it’s the most commonly diagnosed GI condition, and it often overlaps with other digestive problems like food sensitivities, a leaky gut, and an imbalance of good and bad bacteria,” says Sachar. And like constipation (a symptom of IBS), it can cause bloat and chronic inflammation, which, once again, could lead to weight gain.

The fix: For people who are diagnosed with IBS, it’s about getting to the root of the problem. Your doctor can work with you to build up the good bacteria you need with probiotics, and add digestive enzymes to help break down food so it’s not just sitting around in your gut causing inflammation, explains Sachar. Brown says it could be helpful to try a gluten-free or low gas-producing diet, like FODMAP, as it can help reduce bloating and help get any unnecessary weight gain under control.

6. Crohn’s Disease

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While a smaller appetite and excessive weight loss are common symptoms of Crohn’s disease — an incurable chronic inflammatory conditions — the exact opposite can happen as soon as someone gets put on a treatment that involves steroids, which is usually the first step in trying to find a medication that works for you, says Sachar.

“Steroids tend to increase your cravings for carbs and cause you to hold on to more water and feel bloated,” says Sachar.

Fortunately, it’s usually not too tough to lose the weight once you’re off steroids. That usually happens as soon as a flare-up — or the reappearance of symptoms like diarrhea, constipation, rectal bleeding, and fever — subside and symptoms are better under control.

The fix: First of all, your overall health is more important than a few pounds on the scale, so following your doctor’s orders is imperative. But some doctors do shy away from steroid use, like Brown, as he knows the side effects can be less than desirable. Every patient responds differently to medication, though, so talk with your own physician to see what works best for you.

7. Gastroparesis

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Often associated with those who have type 1 or type 2 diabetes, gastroparesis — also known as delayed gastric emptying — is a disorder that “slows or stops the movement of food from the stomach to the small intestine,” according to the National Institute of Diabetes and Digestive and Kidney Diseases. Because normal digestion isn’t able to occur, it’s common to feel like you’re gaining weight due to fullness and bloating in the stomach area, but the disorder most commonly leads to weight loss in the end.

The fix: According to the American College of Gastroenterology, diet is one of the most important factors in treating gastroparesis. Because fatty and fiber-filled foods take longer to digest, it’s recommended that anyone with the disorder limits or avoids those foods altogether. But since this is a serious condition, it’s best to speak with your doctor to see what the best treatment options are for you.

8. Food Intolerance

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If you’ve noticed your body is easily irritated by certain foods, there’s a good chance you have a food intolerance. Different from a food allergy, which is an immune system response, food intolerance affects the digestive system, making it hard to digest and break down certain foods (the most common being dairy), says the Cleveland Clinic. Those with a food intolerance often experience gas, cramps, and bloating, making it feel like they’re gaining weight. Depending on how severe the food intolerance is, they might also experience diarrhea.

The fix: While you might feel super bloated and uncomfortable throughout the day because of your diet, you might not actually be gaining weight. The Cleveland Clinic recommends avoiding or reducing the foods you think are giving you issues, and if you do end up eating something that bothers your stomach, take an antacid.

9. Ulcerative Colitis

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Although Crohn’s disease can pop up anywhere between the mouth and the anus, UCLA Health says ulcerative colitis stays in the colon, resulting in a constantly inflamed digestive tract that can initially lead to weight loss. Like Crohn’s, though, the treatment for the inflammatory bowel disease — steroids — could make your body gain weight.

“An oral steroid like Prednisone can also cause your body fat to redistribute itself, so instead of it being in your stomach or glutes, it could move to the face or neck,” says Sachar.

Even though you may notice a difference in your weight during treatment, everything should go back down to normal as soon as you’re able to get off the steroids.

The fix: After speaking to your doctor, find a treatment plan that’s right for you and the severity of your ulcerative colitis — one that may or may not involve steroids. While more moderate to severe forms might be treated with steroids, 5-aminosalicylates and immunosuppressant drugs are also options. Whatever you end up using, know your wellbeing is top priority. If that involves gaining a few pounds to better your health, it’s worth it.

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“The sooner we start an acid reflux diet and healthier lifestyle, the better,” recommends Danine Fruge, MD, Associate Medical Director at the Pritikin Longevity Center in Miami, Florida.

GERD

That’s because acid reflux can become a serious, chronic condition called gastroesophageal reflux disease or GERD. GERD can have several unpleasant symptoms that include difficulty swallowing, hoarseness, dry sore throat, and coughing, as well as heartburn. Depending on their severity, these symptoms can significantly impair daily quality of life. Worse yet, GERD can lead to life-threatening conditions, including esophageal ulcers and cancer.

Acid reflux, the flow of stomach acid back into the esophagus, can become a serious condition called gastroesophageal reflux disease, or GERD.

The problem with pills

So why not just take the medications that neutralize stomach acid or restrict its production? The problem is, except for the most serious cases of GERD, these drugs are not meant for long-term or continual use. Over time, they can have negative side effects. Antacids can eventually upset the digestive tract and lead to diarrhea or constipation. Proton pump inhibitors like Prevacid and Prilosec, which are used to reduce the production of stomach acid, have been linked to increased risk of osteoporosis (brittle bone disease), pneumonia, and negative drug interactions.

And unfortunately, the many pills now available to treat acid reflux have done little to curtail its incidence. Approximately 40% of adult Americans now suffer from acid reflux. And shockingly, rates of esophageal cancer in the U.S. have increased 500% since the 1970s. Research, particularly a recent study from Denmark following more than 9, 800 GERD sufferers, has linked proton pump inhibitors with increase risk of esophageal cancer.

Have a conversation with your physician

“So, begin by talking with your doctor about the risks and benefits of extended use of drugs to treat your acid reflux,” advises Dr. Fruge.

Know the cause to know the solution

Secondly, keep in mind that, as with many things in life, the solution to a problem can often be found by examining its causes.

Following an acid reflux diet and other lifestyle solutions can help you reduce and maybe even eliminate acid reflux.

For the vast majority of people, acid reflux and GERD are brought on by lifestyle-related factors, including:

  • Smoking
  • Excessive alcohol use
  • Obesity
  • Diets high in fat
  • Diets high in acid
  • Diets high in spices
  • Diets high in sugar
  • Diets high in caffeine
  • Large, late-night meals, especially just before bedtime
  • Stress

Acid Reflux Diet and Lifestyle – Pritikin Program

From this list, readers of our Pritikin Perspective newsletter can probably already discern the solution: Pritikin living. Eating healthy, exercising regularly, and reducing stress can prevent and treat more than just cardiovascular-related diseases. They are the solution to a whole host of health problems, including acid reflux and GERD.

Observes Dr. Fruge, MD, “Our guests at the Pritikin Longevity Center are amazed that not only do problems like high blood pressure and high cholesterol disappear with healthy Pritikin living, their acid reflux disappears, too.”

Pritikin Diet for Acid Reflux

Enjoy a superabundance of healthy delicious foods, and kiss acid reflux goodbye! Learn more about the healthiest diet on earth.

13 Key Lifestyle Solutions For Acid Reflux

To prevent or reduce acid reflux, start an acid reflux diet and lifestyle like the Pritikin Program. Here are 13 key lifestyle-based solutions:

  1. Exercise regularly.
  2. Employ stress-reducing skills like meditation and yoga. Even something as simple as 10 minutes daily of deep breathing can be hugely beneficial.

    A recliner set at a 45-degree angle or higher can help prevent reflux in the evening after dinner (image courtesy of Northwestern University).

  3. Enjoy a full night’s sleep, every night.
  4. Eat plenty of whole foods naturally low in fat and sugar, such as fruits, vegetables, whole grains, nonfat dairy, and fish.
  5. Steer clear of fatty meat, sugary drinks (especially carbonated drinks), processed foods, and fatty, sugary desserts.
  6. Drink little or no alcohol and caffeine.
  7. If spicy foods or acidic fruits like oranges, lemons, and tomatoes seem to lead to symptoms of acid reflux, avoid them.
  8. Play detective. Keep a diary of eating and activities to see what exacerbates acid reflux symptoms; then eliminate the culprits.
  9. Eat dinner earlier in the evening, preferably before 7 PM.

    Before falling asleep at night, raise your body so that your esophagus is more upright, at a 45-degree angle, using a wedge or bed. (image courtesy of Buzzle).

  10. Don’t lie down or go to sleep after eating. “Sit upright for at least three hours after a meal,” recommends Dr. Fruge. “A recliner set at a 45-degree angle or higher is a good option for preventing reflux in the evening after dinner. Even better, take an after-dinner walk before reclining.”
  11. Before falling asleep for the night, try raising your head, shoulders, and torso so that your esophagus is more upright, at a 45-degree angle, using a wedge or bed. “Just propping the head with a pillow does not work,” clarifies Dr. Fruge.
  12. Quit smoking.
  13. If you’re overweight, follow a healthy diet and exercise program like Pritikin to help shed the excess weight, and keep it off.

A Happier, Healthier Life

Following these acid reflux diet and lifestyle-related modifications can greatly increase your chances of living without the unpleasant symptoms of acid reflux, and, in the long run, avoiding the possibility of serious health consequences.

And certainly, by following a healthy lifestyle like Pritikin, “you will improve your overall health and well being,” concludes Dr. Fruge.

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A little weight gain, how much gastroesophageal reflux disease?

Obesity has been speculated to cause GERD symptoms due to multiple factors including increased gastroesophageal sphincter gradient (J Med 1987;18:135–146), incidence of hiatal hernia (Scand J Gastroenterol 1988;23:427–432; Am J Gastroenterol 1999;94:2840–2844; Obes Rev 2002;3:9–15), intra-abdominal pressure (Neurology 1997;49:507–511), output of bile and pancreatic enzymes (Metabolism 1988;37:436–441), and possibly hormonal factors that are not well-understood related to adiposity. Prior small case-control studies have suggested an increased frequency of GERD in morbidly obese patients (Obes Surg 2004;14:1095–1102; Surg Endosc 2003;17:1766–1768). Other large population-based studies have demonstrated that BMI appears to be a risk for GERD symptoms. In a telephone survey of 2500 subjects in Spain, of whom 32% reported GERD, reflux symptoms were associated with BMI 25.0–29.9 kg/m2 (OR, 1.53; 95% CI, 1.23–1.92) and obesity, defined as BMI ≥ 30 kg/m2 (OR, 1.74; 95% CI, 1.3–2.32; Aliment Pharmacol Ther 2004;19:95–105). In another large population case-control study in Sweden (JAMA 2003;290:66–72), 3113 individuals reporting severe GERD symptoms during the past 12 months were compared with 39,872 persons without reflux. The authors found that compared with patients with a BMI < 25 kg/m2, the risk of reflux increased significantly with increasing weight: for BMI 25–30 kg/m2, the OR was 2.2 for men (95% CI, 2.0–2.6) and 2.0 for women (95% CI, 1.7–2.4); among the severely obese, with a BMI > 35 kg/m2, the OR was 3.3 for men (95% CI, 2.4–4.7) and 6.3 for women (95% CI, 4.9–8.0). In another large population study that was part of a randomized controlled trial of Helicobacter pylori eradication in the UK, 10,537 subjects were evaluated for BMI, GERD severity, and frequency (Int J Epidemiol 2003;32:645–650). Compared with subjects of normal weight with a BMI < 25 kg/m2, subjects with BMI 25–30 kg/m2 had an adjusted OR for frequency of heartburn and acid regurgitation of 1.82 (95% CI, 1.33–2.5) and 1.5 (95% CI, 1.13–1.99), respectively. Patients with BMI > 30 kg/m2 had ORs for heartburn and regurgitation of 2.91 (95% CI, 2.07–4.08) and 2.23 (95% CI, 1.44–3.45), respectively. Both of these studies enrolled a large number of male patients and demonstrated ORs similar to those obtained in the Nurses’ Health Study; therefore, there appears to be sufficient evidence that the relationship between increased BMI and increase in reflux symptoms is equally important for men and women.

The current study also illustrated that weight loss equating to a BMI of ≥ 3.5 kg/m2 was associated with a significant decrease in GERD symptoms. The prior literature has shown that bariatric surgery has been associated with improved GERD parameters (Obes Surg 1999;9:527–531; Obes Surg 1999;9:396–398; Obes Surg 2002;12:652–660; Obes Surg 2004;14:216–223; South Med J 1998;91:1143–1148). Given that the surgical procedure has inherent antireflux properties, it is difficult to evaluate whether there is an independent effect of weight loss on GERD. Three studies have evaluated the independent effect of weight loss on GERD parameters. Fraser-Moodie et al (Scand J Gastroenterol 1999;34:337–340) showed a significant correlation between weight loss and esophageal pH (OR, 0.55; P < .001) in an uncontrolled study of 34 obese GERD patients. Mathus-Vliegen et al (Scand J Gastroenterol 2002;37:1246–1252) demonstrated a similar correlation with decreased upright pH < 4 (8.0% vs 5.5%; P < .05) and postprandial reflux episodes (49.0 vs 32.1; P < .05) in patients with a mean weight loss of 12.4 kg over a 13-week period. However, in another study randomizing 20 obese patients with reflux esophagitis to either a 430 kcal/day diet or an unrestricted diet, there was no significant difference in reflux symptoms between controls and patients with a 10% body weight loss after 6 months (Scand J Gastroenterol 1996;31:1047–1051).

How, therefore, does the Jacobson study contribute to the prior literature on the relationship between GERD and obesity? Whereas prior studies examined subjects of normal weight compared with patients who were overweight (BMI 25–30 kg/m2) and obese (BMI > 30 kg/m2), the Jacobson study provides stepwise odds ratio for BMIs ranging between < 20–35 kg/m2 and demonstrates that even in subjects with normal weight, an increase in BMI of ≥ 3.5 kg/m2 (translating to an increase of approximately 20 pounds) can lead to GERD symptoms. Therefore, physicians evaluating GERD patients should inquire about recent weight gain, quantify the amount of weight change, and encourage weight loss as a means for symptom reduction. This recommendation is important given that a recent evidence-based approach examining lifestyle measures for GERD demonstrated that there is little to no evidence of support lifestyle measures for GERD except for weight loss and head of bed elevation (Arch Intern Med 2006;166:965–971).

The potential weaknesses of the current study include the fact that data on BMI were obtained from questionnaire and therefore subject self-assessment rather than actual physician measurement. There may be a tendency for participants to underestimate their actual weight. However, the fact that these results have been demonstrated in several other large population studies supports the overall conclusions linking obesity to GERD.

The presence of obesity has also been linked to complications of GERD, including erosive esophagitis (Scand J Gastroenterol 2002;37:899–904), Barrett esophagus (BE; Aliment Pharmacol Ther 2005;22:1005–1010; Am J Gastroenterol 2006;100:2151–2156), and esophageal adenocarcinoma (Ann Intern Med 1999;130:883–890). A recent meta-analysis (Ann Intern Med 2005;143:199–211) included studies published between 1966 and 2004 that examined links between obesity and complications of GERD. The authors found that 9 studies examined an association between BMI with GERD symptoms, with 6 studies showing statistically significant associations. In 6 of 7 studies, there were significant associations of BMI with erosive esophagitis and/or esophageal adenocarcinoma. In data from 8 studies, there was a trend towards a dose–response relationship between GERD symptoms and increasing BMI.

Two studies to date have shown a relationship between BE and obesity. In a retrospective case-control study of patients with BE who had an abdominal computed tomography scan within 1 year of upper endoscopy at a single large Veteran’s Affairs Medical Center, mean BMI was significantly greater in patients with BE compared with controls, and the mean visceral adipose tissue (VAT) was approximately 1.5-fold greater in cases compared with controls. The authors estimated that each 10-cm2 increase in VAT was associated with a 9% increase in risk of BE (Am J Gastroenterol 2005;100:2151–2156). In a subsequent case-control retrospective study (Aliment Pharmacol Ther 2005;22:1005–1010), the presence of obesity was shown to be risk factor for the presence of BE when compared with a control population of patients undergoing endoscopy for any indication. In the multivariable logistic regression model adjusting for race and age, when compared with BMI < 25 kg/m2, the odds ratio for BE was 2.43 (95% CI, 1.12–5.31) for BMI 25–30 kg/m2 and 2.46 (1.11–5.44) for BMI ≥ 30 kg/m2. When examined as a continuous variable, the adjusted OR for each 5-point increase in BMI was 1.35 (95% CI, 1.06–1.71; P = .01). The association between weight and BE was also statistically significant (adjusted OR for each 10-pound increase, 1.10; 95% CI, 1.03–1.17; P = .002). Among the 65 cases of BE, there was no correlation between the length of BE at the time of diagnosis and the BMI (correlation coefficient = 0.03; P = .79).

In summary, the current study and prior literature support a dose-dependent relationship between BMI and GERD symptoms and a relationship between obesity and GERD-related complications. The time has arrived for gastroenterologists to perform counseling for all GERD patients about weight loss programs while they are prescribing proton pump inhibitor therapy for chronic heartburn symptoms.

GERD Diet

This diet is used to help reduce discomfort in the esophagus caused by Gastroesophageal Reflux Disease (GERD). Symptoms such as heartburn, and chest discomfort and a bitter taste in the mouth often occur, due to acid washing up from the stomach. Coughing, hoarseness, or shortness of breath can occur if the fluid washes into the breathing passages. You can find more information about GERD in the Gastroesophageal Reflux Disease page.

The esophagus is a tube that connects the throat and the stomach. At the bottom of the esophagus, there is a valve that usually prevents acid from washing up from the stomach. A muscle keeps usually the valve tightly closed.

Some foods cause the muscle at the bottom of the esophagus to relax. Other foods cause the stomach to create more acid. This diet is designed to avoid these foods. Choose your foods according to the Food Guide Pyramid to meet your needs.

Treatment may include medications, but the following guidelines should be followed:

GERD Diet – General Guidelines

  • Stop smoking and chewing tobacco.
  • Discuss your weight with your doctor. Lose weight if you are overweight.
  • Do not overeat. Eat small portions at meals and snacks.
  • Avoid tight clothing, tight-fitting belts. Do not lie down or bend over within the first 15-30 minutes after eating.
  • Do not chew gum or suck on hard candy. Swallowing air with chewing gum and sucking on hard candy can cause belching and reflux.
  • Use bricks or wood blocks to raise the head of your bed 6-8 inches.
  • Do not eat/drink: Chocolate, tomatoes, tomato sauces, oranges, pineapple and grapefruit, mint, coffee, alcohol, carbonated beverages, and black pepper.
  • Eat a low-fat diet. Fatty, greasy foods cause your stomach to produce more acid.

GERD-Friendly Diet Recommendations

Choose these foods / beverages Do not eat these foods / beverages
Fruits/juices Most fruits and fruit juices such as apple, grape, cranberry, banana, pears, etc. Citrus fruits: oranges, grapefruit
Soups Low-fat and fat-free soups such as clear broth based soups*. Regular cream soups, other high fat soups*.
Beverages Decaffeinated tea, herbal tea (not mint), Kool-Aid, water, juices (except orange, grapefruit and pineapple). Coffee (regular and decaffeinated), alcohol, carbonated beverages.
Sweets and deserts Fruit ices, gelatin, popsicles, ice milks and frozen low-fat yogurt, low fat cookies and cakes (less than 3 g fat per serving). Chocolate and high fat deserts.
Vegetables All steamed, roasted, stir-fried (with little oil) vegetables. Fried, creamed vegetables.
Milk and dairy products Skim or 1% milk, lowfat yogurt, or cheeses (<3 g fat per oz). Whole and 2% milk, whole milk yogurt and cheeses. Chocolate milk and hot chocolate.
Bread, cereals and grain products Low-fat Made with whole milk or cream.
Meat, Chicken, Fish, and meat substitutes (nuts, tofu, etc) Low-fat meats with the fat trimmed before cooking, skinless poultry. Baked, broiled, poached roasted, without added fat. Sausage, bacon, fried meats and chicken, salami, bologna and other high fat meats (> 3 g per ounce). Chicken skin and meats with visible fat left on.
Oils, butter, margarine None, or small amounts. Animal or vegetable fats.

* Fat can be skimmed from the top of soups and stews when they are hot or cold.

Credits for this dietary information go to Maureen Murtaugh, PhD.

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