Tuesday, 26 November 2013

Gastro-esophageal reflux disease (GERD)- The GERD Diet

The prevalence of upper gastrointestinal (GI) diseases is increasing in subjects aged 65 years and over. Pathophysiological changes in esophageal functions that occur with aging may, at least in part, be responsible for the high prevalence of
1. Gastro-esophageal reflux disease (GERD) in old age.
2. The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations worldwide.
3.  H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis
4.  Almost 40% of GU and 25% of DU in the elderly patients are associated with the use of NSAID(1) and/or aspirin(2).(a)
I.  Gastro-esophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD), also known as gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease, is defined as a chronic condition of liquid stomach acid refluxing back up from the stomach into the esophagus, causing heartburn. According to the study of “Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.” by DeVault KR, Castell DO; American College of Gastroenterology, GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.
A. GERD Diet
According to the The GERD Diet (Gastroesophageal Reflux Disease) in McKinley Health Center of The university of Illinois at Urbana-Champaign
Dietary modifications are recommended to lessen the likelihood of reflux and to avoid irritation of sensitive or inflamed esophageal tissue. Listed below are several recommendations that may help to manage GERD:
1. Decrease total fat intake – High fat meals and fried foods tend to decrease LES pressure and delay
2. Avoid large meals – Large meals increase the likelihood of increased gastric (stomach) pressure and reflux.
3. Decrease total caloric intake if weight loss is desired – Since obesity may promote reflux, weight loss
may be suggested by your healthcare provider to control reflux. Reducing both total fat and caloric intake will aid in weight loss.
4. Avoid chocolate – Chocolate contains methylxanthine, which has been shown to reduce LES pressure by causing relaxation of smooth muscle.
5. Avoid coffee depending on individual tolerance – Coffee, with or without caffeine, may promote gastroesophageal reflux. Coffee may be consumed if it is well tolerated.
6. Avoid other known irritants – Alcohol, mint, carbonated beverages, citrus juices, and tomato products all may aggravate GERD. These products may be consumed depending on individual tolerance.
B. Other modifications for treating GERD
7. Maintain upright posture during and after eating.
8. Stop smoking.
9. Avoid clothing that is tight in the abdominal area.
10. Avoid eating within 3 hours before bedtime.
11. Lose weight if you are overweight.
12. Sleep on your left side.
13. Chew non-mint gum which will increase saliva production and decrease acid in the esophagus.
14. Elevate the head of your bed 4-6 inches by placing bricks under the headboard. (Source)

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(a) http://www.ncbi.nlm.nih.gov/pubmed/15588798
(1) http://www.ncbi.nlm.nih.gov/pubmed/16001646
(2) http://www.ncbi.nlm.nih.gov/pubmed/22542157

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