Role of Dietary Factors in Gastroesophageal Reflux Disease, continued. The speed with which food is consumed is another risk factor for the development of GERD symptoms. Wildi et al. compared individuals who consumed a specified amount of food over 5 minutes with those who consumed it over 30 minutes; they detected that the median number of reflux episodes observed during a 2-hour, post-prandial period was significantly higher in those individuals who ate more rapidly (14 vs. 10, p=0.02) (17). Acknowledgement This manuscript was derived from the Turkish GERD consensus group data. Recommendations • There is insufficient evidence in studies to confirm which foods can trigger reflux. • There are data to suggest an association between the development of reflux and the consumption of salt and salted foods, chocolate, fatty foods and carbonated soft drinks. • Eating small amounts, frequently and slowly, should be recommended • The consumption of fiber-rich foods should be recommended. • There are inter-individual differences in the effects of various foods on the development of GERD symptoms. Therefore, large-scale, randomized trials are necessary to show whether reflux symptoms improve after the removal of dietary factors that could pose a risk for an individual. References 1. DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005;100:190-200. 2. Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976;21:953-956. 3. Ruhl CE, Everhart JE. Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Follow-up Study. First National Health and Nutrition Examination Survey. Ann Epidemiol 1999;9:424-435. 4. Shapiro M, Green C, Bautista JM, Dekel R, Risner-Adler S, Whitacre R, Graver E, Fass R. Assessment of dietary nutrients that influence perception of intra-oesophageal acid reflux events in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2007;25:93-101. 5. El-Serag HB, Satia JA, Rabeneck L. Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut 2005;54:11-17. 6. Zheng Z, Nordenstedt H, Pedersen NL, Lagergren J, Ye W. Lifestyle factors and risk for symptomatic gastroesophageal reflux in monozygotic twins. Gastroenterology 2007;132:87-95. 7. Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux. Gut 2004;53:1730-5. 8. Dennish GW, Castell DO. Inhibitory effect of smoking on the lower esophageal sphincter. N Engl J Med 1971;284:1136-7. 9. Stanciu C, Bennett JR. Smoking and gastro-oesophageal reflux. Br Med J 1972;3(5830):793-5. 10. Nocon M, Labenz J, Willich SN. Lifestyle factors and symptoms of gastro-oesophageal reflux -- a population-based study. Aliment Pharmacol Ther 2006;23:169-74. 11. Watanabe Y, Fujiwara Y, Shiba Met al. Cigarette smoking and alcohol consumption associated with gastro-oesophageal reflux disease in Japanese men. Scand J Gastroenterol 2003;38:807-11. 12. Schindlbeck NE, Heinrich C, Dendorfer A, Pace F, Müller- Lissner SA. Influence of smoking and esophageal intubation on esophageal pH-metry. Gastroenterology 1987;92:1994-7. 13. Boekema PJ, Samsom M, Smout AJ. Effect of coffee on gastrooesophageal reflux in patients with reflux disease and healthy controls. Eur J Gastroenterol Hepatol 1999;11:1271-6. 14. Lagergren J , Bergstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825–31. 15. Murphy DW, Castell DO. Chocolate and heartburn: evidence of increased esophageal acid exposure after chocolate ingestion. Am J Gastroenterol 1988;83:633-6. 16. Fass R, Quan SF, O’Connor GT, Ervin A, Iber C. Predictors of heartburn during sleep in a large prospective cohort study. Chest 2005;127:1658-66. 17. Wildi SM, Tutuian R, Castell DO. The influence of rapid food intake on postprandial reflux: studies in healthy volunteers. Am J Gastroenterol 2004;99:1645-51. World Digestive Health Day WDHD May 29, 2015 WGO HANDBOOK HEARTBURN: A GLOBAL PERSPECTIVE 20
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