dietary intake and risk for reflux esophagitis- a case-control study

8/20/2019 Dietary Intake and Risk for Reflux Esophagitis- A Case-Control Study

1/9

Hindawi Publishing CorporationGastroenterology Research and PracticeVolume , Article ID , pageshttp://dx.doi.org/.//

Research ArticleDietary Intake and Risk for Reflux Esophagitis:

A Case-Control Study

Ping Wu,1 Xiao-Hu Zhao,2 Zi-Sheng Ai,3 Hui-Hui Sun,4 Ying Chen,4

Yuan-Xi Jiang,4 Yi-Li Tong,4 and Shu-Chang Xu4

Department o Clinical Nutrition, ongji Hospital o ongji University, Shanghai , China Department o Radiology, ongji Hospital o ongji University, Shanghai , China

Department o Preventive Medicine, ongji University School o Medicine, Shanghai , China Department o Gastroenterology, ongji Hospital o ongji University, Shanghai , China

Correspondence should be addressed to Ping Wu; [email protected] and Shu-Chang Xu; [email protected]

Received October ; Revised March ; Accepted March

Academic Editor: P. Marco Fisichella

Copyright © Ping Wu et al. Tis is an open access article distributed under the Creative Commons Attribution License, whichpermits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background . Specic dietary components have been associated with gastroesophageal reux disease (GERD) in Europe and theUnited States. However, the relationship between dietary components and GERD in Chinese still remains unclear. Methods. Atotal o patients who were newly diagnosed as reux esophagitis (RE) in Outpatient Endoscopy Center o ongji Hospital were

recruited. In addition, sex- and age-matched subjects werealso recruited as controls. Te body measurements were determined,andthe dietary intake during the previousyear was evaluated using ood requency questionnaire (FFQ). Stepwisemultiplelogisticregression analysis was perormed to examine the association between nutrients and RE. Results. Afer adjustment or WC, WHR,total energy intake, and demographics, there were a positive dose-response relationship between RE and calcium, meat, oils, andsalt and a negative dose-response relationship between RE and protein, carbohydrate, calories rom protein (%), vitamin C, grainsand potatoes, ruits, and eggs. Conclusion. High intake o meat, oils, salt, and calcium is associated with an increased risk or REwhile high intake o protein, carbohydrate, calories rom protein (%), vitamin C, grains and potatoes, ruits, and eggs correlateswith a reduced risk or RE.

1. Background

Gastroesophageal reux disease (GERD) is a chronic diseaseusually caused by the reux o acidic gastric and duodenal

contents into the distal esophagus. Te major symptomso GERD include heartburn, acid regurgitation, and non-cardiac chest pain. GERD is a common digestive diseasewith the direct medical costs estimated around . billionannually [], andwith the symptoms portending a low quality o lie []. Reux esophagitis (RE) is one o the most commonphenotypes o GERD []. In Western countries, GERD has ahigh prevalence. Especially in USA, about % o Americanssuffer rom GERD symptoms at least once monthly, % onceweekly, and % once daily [, ]. raditionally, GERD isless common in Asians []. However, it is reported that theprevalence o GERD in Asians is increasing []. Te overallprevalence o RE in adult Japanese population is about %

[]. In aiwan, the prevalence o RE is about % in patientsevaluated or upper gastrointestinal tract symptoms [] andabout .% in Korea healthy subjects []. In Chinese, ew

epidemiological data on GERD are available currently. In, a Chinese study reported that the prevalence o GERDwas .% in Beijing andShanghai, two biggest citiesin China[]. Although GERD is thought to be less prevalent in Chinathan in Western countries and other Asian countries, recentstudies reveal the incidence o GERDis on a rise in China [].

Most o the actors involved in the pathogenesis o gas-troesophageal reux disease (GERD), previously describedin European, Australian, and American studies, are presentin Chinese patients with GERD, but at a lower scale. A low-at diet probably contributes to a more avorable gastric dis-tribution []. Another study reported GERD is highly prev-alent in adult in Urumqi, especially in Uygur. Male, civil

http://dx.doi.org/10.1155/2013/691026http://dx.doi.org/10.1155/2013/691026


2/9

Gastroenterology Research and Practice

servant, smoking, strong tea, alcohol drinking, meat diet, andBMI are risk actors correlated to GERD []. In Europe andthe United States, some investigators have shown that dietary at, cholesterol, saturated atty acid (SFA), dietary ber, andother nutrients are associated with GERD. However, thisassociation is absent in other studies. An epidemiologic sur-

vey showed that there was a link between high at intake andGERD [], and in clinical studies, esophageal pH provideddirect evidence on the association between dietary at andacid reux. In contrast, a number o studies reported thata high-at diet had no inuence on the transient lower eso-phageal sphincter relaxation (LESR) or esophageal acidexposure [, ]. Moreover, dietary ber, especially cerealber, has been ound to decrease the risk or esophagealand gastric adenocarcinoma [], or which GERD is well-known risk actor. Te mechanism may be that dietary ber decreases the intake o gastric nitrites, which havebeen implicated in promoting reux by relaxing the low esophageal sphincter (LES) []. Similar effects were also

seen in a recent study by El-Serag et al. []. In this cross-sectional study, EL-serag and his colleagues postulated thathigh-ber diet played a protective role. However, Bouin et al.[] suggested that dietary ber decreased the number o gastrooesophageal reux, but increased their duration andhad no signicant effect on gastric emptying and gastric acidsecretion. Another independent risk actor or GERD-relatedsymptoms is alcohol [], but some studies ail to identiy such relationship [, ].

In general, the effects o diet on GERD are not wellunderstood, and the currently available data in Westerncountries do not support a strong relationship betweenGERD and dietary at, ber, alcohol, and other nutrients.Although there are conicting data regarding the role o dietary nutrients in GERD, there is no direct evidence thatsome nutrients promote or protect against GERD. Due tothe difference in dietary nutrients between Chinese andWesterns, and ew studies reporting the association betweendietary nutrients and GERD in China, we employed oodrequency questionnaire (FFQ) to evaluate the relationshipbetween dietary components and RE in a Chinese populationin the present study aiming to clariy whether the diet habitsaffect the prevalence o RE.

2. Materials and Methods

.. Patients. A total o Han Chinese were recruited rom

the Endoscopy Center o ongji Hospital between May and May in Shanghai. Because the diet habits vary indifferent peoples and Han Chinese account or .% o pop-ulation in China, the Han Chinese were recruited in order tomaximally ensurethe accuracy o data. Among these subjects,the age o patientswho werenewly diagnosedas REbasedon the Los Angles (LA) classication [] ranged rom to years, and controls aged – years. Te controlsreceived routine health examinations including annual upperendoscopy, and all the controls were normal on uppergastrointestinal endoscopy and had no reux symptoms. REpatients and controls were randomly selected and matchedin the gender and age. Subjects were excluded i they had

peptic ulcer (active or quiescent), endoscopic gastrointestinaltumors, history o upper gastrointestinal surgery, and over-the-counter medication (histamine--receptor antagonists,proton pump inhibitors, etc.) or were unable to complete thequestionnaire and physical examination.

.. Ethical Considerations. Te whole protocolwas approvedby the Ethics Committee o ongji Hospital. All subjects gavewritten inormed consent beore study.

... Dietary Questionnaire. All subjects were trained tocomplete a detailed FFQ. Beore survey, all subjects wererequired to complete a Reux Diagnostic Questionnaire(RDQ), including “any symptoms including heartburn, acidregurgitation, and noncardiac chest pain,” and “ofen chang-ing dietary habits and avoiding certain oods.” Controls withRDQ score o > were also excluded although the normalndings were present in the endoscopic examination. Inorder to avoid the inuence o symptoms on the dietary intake, these subjects were asked to record the dietary intakebeore the onset o reux symptoms. FFQ based on theChinese Dietary Pagoda [] was adapted or the Chinesepopulation to enable completion within – min. A totalo kinds o ood were included in the questionnairebased on the oods with high intake requency in ChineseNutrition Survey in and the new oods emerging inrecent years. Te ood categories included grains, potatoes,meat, sh and shrimps, eggs, dark-colored vegetables, light-colored vegetables, ruits, nuts, beans and bean products,milk and dairy products, desserts, condiments, sof drinks,alcohol, western-style ast ood, and animal oils. Participantswere asked to report the oods (≥) consumed in the pastyear. Te intake o major oods was estimated according tothe ood moulds. Te requency o ood intake in the FFQranged rom “never or less than once monthly” to “twicedaily.” Each question included three options or portion size.Using these data, the total requency o intake o each oodwas calculated in a xed period. Te intake o each nutrientwas calculated using the ollowing ormula: (reported intakerequency daily) × (portion size in grams) × (nutrient contentper grams)/. Te intake o plant oils, salt, and sugarwas surveyed and converted according to the monthly con-sumption in each amily and the number o amily members.

... Anthropometric Measurements. Te height, weight,waist circumerence (WC), and hip circumerence (HC) were

measured under asting conditions ollowed by endoscopy.Height was measured to the nearest . cm using a stadiome-ter, and weight to the nearest . kg in light clothing and

without shoes using standard digital scales. BMI (kg/m2) wascalculated as a ratio o weight (kg) to the square o height

(m2). WC and HC were measured to the nearest . cm andthe mean o three measurements was obtained. Waist-hipratio(WHR)was calculatedas a ratioo WC (cm)to HC(cm).

.. Quality Control and Methods. All investigators receivedproessional training to collect and analyze data withstringent quality control standards. Te investigators whocollected anthropometric and dietary data were blind to


3/9


the ndings in endoscopy. An investigator supervised andchecked all data. A nutrient calculator sofware designed by the Department o Clinical Nutrition o ongji Hospital onthe basis o China Food Composition ables [] was used tocalculate the daily intakes o calories and nutrients.

.. Statistical Analysis. Statistical analysis was perormedusing SPSS version . or Windows (Chicago, IL, USA).All data were expressed as mean ± standard deviation (SD).2 test and Kruskal-Wallis test were used to compare thecategorical variables, and test to compare the parametriccontinuous variables. Stepwise multiple logistic regressionanalysis wasemployedto examine variables. Te main predic-tors in the model were the dietary variables serving as con-tinuous variables. Te model was adjusted or the requency matched variables: WC, WHR, total energy per day, age, sex,and education level. Odds ratios (OR) were calculated on thebasis o interquartile range or each nutrient and thus show risk comparing the th centile o intake or each nutrient

with the th centile. A value o < 0.05 was consideredstatistically signicant.

3. Results

.. Characteristics o Participants. able provides detailedcharacteristics o subjects. RE patients were differentrom the controls in terms o education level ( < 0.05). REpatients had a higher WC and WHR than controls ( < 0.05)and there were no differences in the height, weight, BMI,and HC ( > 0.05) between them. able displays theanthropometric measurements o two groups. Te extento oesophageal mucosal damage was assessed using the LA

grading system []. O the patients with RE, hadgrade A, had grade B, had grade C, and had gradeD oesophageal mucosal damage. Patients with mild REaccounted or .% (Grade A and B).

.. Mean Daily Intake o Nutrients and Food. Data onnutrient and ood intake obtained rom the FFQ are shownin able .

Te daily intake o total energy, protein, at, carbohydrate,total SFA, dietary ber, selenium, milk and dairy products,beans, and nuts was signicantly higher in the RE group thanin the control group ( < 0.05). Te calories rom protein(%), calcium, -carotene, vitamin C, and vegetables weremarkedly lower in the RE group than in the control group

( < 0.05).Tere were no signicant differences in the intake o

calories rom ats and carbohydrates (%), cholesterol, zinc,errum, vitamin E, grains and potatoes, ruits, meat, sh andshrimps, eggs, alcohol, oils, and salt ( > 0.05).

.. Relationship between RE and Intake o Various Nutrientsand Food. Afer adjustment or WC, WHR, total energy intake, and demographics (sex,age and education level), therewas a positive dose-response relationship between RE andcalcium (OR ., % CI .–.), meat (OR ., % CI.–.), oils (OR ., % CI .–.), and salt (OR .,% CI .–.), and there was an inverse dose-response

: Comparison o the RE group and control group.

Variables RE group (%) Control group (%)

P ( = 268) ( = 269)

Age (years) 50.9 ± 0.9 48.5 ± 0.8 .

mean (SD)

– (.) (.) .– (.) (.)

– (.) (.)

– (.) (.)

≥ (.) (.)

Sex

Men (.) (.) .

Women (.) (.)

Education level

Illiteracy (.) (.)


4/9


: Mean daily intake o nutrients and ood in two groups.

Variables/day RE group ( = 268) Control group ( = 269) P

otal energy (kcal) 2438.6 ± 53.7 2148.2 ± 38.4


5/9


: Risk or RE in patients with different intake o dietary nutrients and ood groups.

Daily intake OR % CI P

Nutrients

Protein (g/day)

Unadjusted . .–. .

Adjusted∗ . .–. .

Fat (g/day)


Adjusted . .–. .

Carbohydrate (g/day)


Adjusted . .–. .

otal SFA (g/day)


Adjusted . .–. .

Alcohol (g/day)


Adjusted . .–. .

Cholesterol (mg/day)


Adjusted . .–. .

Calories rom protein (%)

Unadjusted . .–.


6/9


: Continued.

Daily intake OR % CI P

Calcium (mg/day)

Unadjusted . .–.


7/9


was observed between RE and alcohol afer adjustment orconounding variables, which was consistent with previously reported [, ]. Te discrepancy may be due to the differ-ence in the methodology. Pehl et al. showed that alcoholintake was correlated with obesity andsuggested that patientswith reux symptoms should avoid intake o > mL o

alcohol or beer [].Some previous studies ound that an increase in saltconsumption was associated with GERD [, ], which wasattributed to the delayed gastric emptying and increasedpancreaticobiliary secretion afer high salt intake []. Sim-ilarly, our results also revealed a relationship between saltintake and RE. However, Aanen et al. [] ound that highdietary sodium did not increase the gastroesophageal reuxin healthy volunteers but reduced the LESP. Mizuta et al.also showed that slight increase in daily salt intake mightbe insufficient to affect the prevalence o RE []. Furtherinvestigations are needed to clariy this association.

Some experts proposed that high intake o vitamin Ccould exert a protective effect against GERD [, ]. Ourndings revealed that excessive intake o animal products andless intakeo vegetables may lead to vitamin C deciency. Ourresults provided evidence supporting a relationship o highintake o vitamin C and ruits with prevention against RE.Our study suggests that RE patients should eat less energy-rich oods and more healthy oods such as vegetables andruits, or health concerns.

Calcium is an important nutrient related to many dis-eases. However, to date, no studies have conrmed therelationship between calcium and GERD. o our knowledge,this is the rst study to reveal the relationship betweencalcium intake and RE afer adjustment or conounding

variables. Nevertheless, the mechanism o such relationshipis unknown. We speculated that calcium may stimulate thegastric acid secretion [, ], which may increase the eso-phageal acid exposure in GERD. Further studies are requiredto conrm the relationship between calcium and GERD.

Te incidence o GERD is on the rise in China due tohigh intake o meat, oils, salt, and calcium, while high intakeo protein, carbohydrate, calories rom protein (%), vitaminC, grains and potatoes, ruits, and eggs correlates with areduced risk or GERD, which is different rom the ndingsin the study o El-Serag et al. Te conicting data may beattributed to differences in not only the race, geographicspecicities, diet habit, and culture between Chinese and theWestern, but the denitiono GERD because studies based on

GERD symptoms may be overinclusive, and our study basedon GERD complications such as esophagitis is restrictive.Further studies are needed to clariy this association.

Our study has some limitations: rst, in the present study,incomplete data on vitamin and calcium supplements werenot included or analysis, which may affect the determinationo vitamin and calcium intakes; second, the olate, lutein,and other micronutrients were not employed or analysisand discussion since they are not included in Chinese FoodComposition ables; third, FFQ is not a particularly accuratedietary assessment tool, and there is potential or measure-ment error. However, FFQ is one o the most well validatedand commonly used ood requency questionnaires; orth,

the recall bias and residual conounding might also inuencethe results.

5. Conclusions

Our results indicate that high intake o calcium, meat, oils,

and salt is associated with an increased risk or RE while highintake o protein, carbohydrate, calories rom protein (%), vitamin C, grains and potatoes, ruits, and eggs correlateswith a reduced risk or RE in Han Chinese. Further studiesare required to explore the relationships among diet, obesity,and RE comprehensively.

Conflict of Interests

Te authors declare that they have no conict o interests.

Authors’ Contribution

Ping Wu contributed to the study design, data analysis, paper

drafing and participated in the survey; Shu-Chang Xu andXiao-Hu Zhao contributed to the study design, participatedin the survey, and revised the paper critically; Zi-ShengAi helped to design the study and analyze the data; YingChen contributed to the study design and participated in thesurvey; Hui-Hui Sun contributed to the study design andpar-ticipated in the survey; Yuan-Xi Jiang and Yi-Li ong partici-pated in the survey. All authors read and approved the paper.

Acknowledgments

Tis work was supported by the Shanghai Science andechnology Commission, China (no. ) and par-

tially by the National Natural Science Foundation o China(, ). Te authors thank the Endoscopy Center o ongji Hospital.

References

[] R. S. Sandler, J. E. Everhart, M. Donowitz et al., “Te burdeno selected digestive diseases in the United States,” Journal o Gastroenterology , vol. , no. , pp. –, .

[] P. Wu, S. C. Xu, Y. Chen, F. F. Zheng, C. Wang, and L. W. Yao,“Evaluation o symptoms and quality o lie o None-erosivereux disease patients,” Chinese Journal o Digestive, vol. , pp.–, .

[] R. Fass, “Erosive esophagitis and nonerosive reux disease

(NERD): comparison o epidemiologic, physiologic, and thera-peutic characteristics,” Journal o Clinical Gastroenterology , vol., no. , pp. –, .

[] O. . Nebel, M. F. Fornes, and D. O. Castell, “Symptomatic gas-troesophageal reux: incidence and precipitating actors,” American Journal o Digestive Diseases, vol. , no. , pp. –, .

[] J. Dent, H. B. El-Serag, M. A. Wallander, andS. Johansson, “Epi-demiology o gastro-oesophageal reux disease: a systematicreview,” Gut , vol. , no. , pp. –, .

[] K. L. Goh, C. S. Chang, K. M. Fock, M. Ke, H. J. Park, and S.K. Lam, “Gastro-oesophageal reux disease in Asia,” Journal o Gastroenterology and Hepatology , vol. , no. , pp. –,.


8/9


[] H. J. Song, K. N. Shim, S. J. Yoon et al., “Te Prevalence andclinical characteristics o reux esophagitis in Koreans and itspossible relation to metabolic syndrome,” Journal o Korean Medical Science, vol. , no. , pp. –, .

[] N. Furukawa, R. Iwakiri, . Koyama et al., “Proportion o reuxesophagitis in Japanese adults: prospective evaluation by endoscopy,” Journal o Gastroenterology , vol. , no. , pp. –

, .

[] C. Yeh, C. . Hsu, A. S. Ho, R. E. Sampliner, and R. Fass, “Ero-sive esophagitis and Barrett’s esophagus in aiwan. A higherrequency than expected,” Digestive Diseases and Sciences, vol., no. , pp. –, .

[] G. Pan, G. Xu, H. Guo et al., “An epidemiologic study onsymptomatic GER in Beijing and Shanghai,” Chinese Journal o Digestive, vol. , no. , pp. –, .

[] S. R. Lin, G. M. Xu, P. J. Hu et al., “China consensus on gastroe-sophageal reux disease,” Chinese Journal o Gastroenterology , vol. , pp. –, .

[] D. Sirim and X. Zhang, “Pathophysiology o GERD in China:the same actors at a lower scale,” American Journal o Gastroen-terology , vol. , no. , pp. –, .

[] C. Y. Niu, Y. L. Zhou, R. Yan et al., “Incidence o gastroesophag-eal reux disease in Uygur and Han Chinese adults in Urumqi,”World Journal o Gastroenterology , vol. , pp. –, .

[] H. B. El-Serag, J. A. Satia, and L. Rabeneck, “Dietary intake andthe risk o gastro-oesophageal reux disease: a cross sectionalstudy in volunteers,” Gut , vol. , no. , pp. –, .

[] C. Pehl, A. Peiffer, A. Waizenhoeer, B. Wendl, and W. Schepp,“Effecto caloric density o a meal on loweroesophagealsphinc-ter motility and gastro-oesophageal reux in healthy subjects,” Alimentary Pharmacology and Terapeutics, vol. , no. , pp.–, .

[] M. Mangano, P. Colombo, P. A. Bianchi, and R. Penagini, “Fatand esophageal sensitivity to acid,” Digestive Diseases and Scien-

ces, vol. , no. , pp. –, .[] G. R. Locke, N. J. alley, S. L. Fett, A. R. Zinsmeister, and L.

J. Melton, “Risk actors associated with symptoms o gastroe-sophageal reux,” American Journal o Medicine, vol. , no. ,pp. –, .

[] M. E. Moller, R. Dahl, andO. C. Bockman, “A possible role othedietary bre product, wheat bran, as a nitrite scavenger,” Food and Chemical oxicology , vol. , no. , pp. –, .

[] M. Bouin, G. Savoye, S. Herve, M. F. Hellot, P. Denis, and P.Ducrotte, “Does the supplementation o the ormula with breincrease the risk o gastro-oesophageal reux during enteralnutrition? A human study,” Clinical Nutrition, vol. , no. , pp.–, .

[] I. Mohammed, P. Nightingale, and N. J. rudgill, “Risk actors

or gastro-oesophageal reux disease symptoms: a community study,” Alimentary Pharmacology and Terapeutics, vol. , no., pp. –, .

[] M. Nilsson, R. Johnsen, W. Ye, K. Hveem, and J. Lagergren,“Prevalence o gastro-oesophageal reux symptoms and theinuence o age and sex,” Scandinavian Journalo Gastroenterol-ogy , vol. , no. , pp. –, .

[] M. Nilsson, R. Johnsen, W. Ye, K. Hveem, and J. Lagergren,“Liestylerelatedrisk actors in the aetiology o gastrooesophag-eal reux,” Gut , vol. , no. , pp. –, .

[] L. R. Lundell, J. Dent, J. R. Bennett et al., “Endoscopic assess-ment o oesophagitis: clinical and unctional correlates andurther validation o the Los Angeles classication,” Gut , vol. ,no. , pp. –, .

[] Chinese Nutrition Society, Chinese Dietary Guidelines, ibetPeople’s Publishing Company Press, ibet, China, .

[] Y. X. Yang, G. Y. Wang, and X. C. Pan, Chinese Food Compositionable, Medical Department o Beijing University Press, Beijing,China, .

[] C. S. Chang, S. K. Poon, H. C. Lien, and G. H. Chen, “Teincidence o reux esophagitis among the Chinese,” American Journal o Gastroenterology , vol. , no. , pp. –, .

[] H. Hampel, N. S. Abraham, and H. B. El-Serag, “Meta-analysis:obesity and the risk or gastroesophageal reux disease and itscomplications,” Annals o Internal Medicine, vol. , no. , pp.–, .

[] B. C. Jacobson, S. C. Somers, C. S. Fuchs, C. P. Kelly, and C. A.Camargo, “Body-mass index and symptoms o gastroesophag-eal reux in women,” Te New England Journal o Medicine, vol., no. , pp. –, .

[] Y. Fujiwara, K. Higuchi, M. Shiba et al., “Differences in clinicalcharacteristics between patientswith endoscopy-negative reuxdisease and erosive esophagitis in Japan,” American Journal o Gastroenterology , vol. , no. , pp. –, .

[] D. A. Corley, A. Kubo, and W. Zhao, “Abdominal obesity, eth-nicity and gastro-oesophageal reux symptoms,” Gut , vol. ,no. , pp. –, .

[] L. Piretta, F. Alghisi, F. Anzini, and E. Corazziari, “Prevalenceo overweightedness in patients with gastro-esophageal reux,”World Journal o Gastroenterology , vol. , no. , pp. –, .

[] H. B. El-Serag, D.Y. Graham, J.A. Satia, and L. Rabeneck, “Obe-sity is an independent risk actor or GERD symptoms anderosive esophagitis,” American Journal o Gastroenterology , vol., no. , pp. –, .

[] M. Shapiro, C. Green,J. M. Bautista et al., “Assessmento dietary nutrients that inuence perception o intra-oesophageal acidreux events in patients with gastro-oesophageal reux disease,”

Alimentary Pharmacology and Terapeutics, vol. , no. , pp.–, .

[] M. Fox, C. Barr, S. Nolan, M. Lomer, A. Anggiansah, and .Wong, “Teeffects odietary at andcaloriedensity onesophag-eal acid exposure and reux symptoms,” Clinical Gastroenterol-ogy and Hepatology , vol. , no. , pp. .e–.e, .

[] A. Kubo, . R. Levin, G. Block et al., “Dietary antioxidants,ruits, and vegetables and the risk o barrett’s esophagus,” Amer-ican Journal o Gastroenterology , vol. , no. , pp. –,.

[] P. J. Veugelers, G. A. Porter, D. L. Guernsey, and A. G. Casson,“Obesity and liestyle risk actors or gastroesophageal reuxdisease, Barrett esophagus and esophageal adenocarcinoma,”Diseases o the Esophagus, vol. , no. , pp. –, .

[] J. V. Schoneld and D. F. Evans, “Fat, spices and gastro-oeso-phageal reux,” Zeitschrif ur Gastroenterologie, vol. , no. ,pp. –, .

[] R. Penagini, “Fat and gastro-oesophageal reux disease,” Euro- pean Journal o Gastroenterology and Hepatology , vol. , no. ,pp. –, .

[] D. O. Castell, J. A. Murray, R. utuian, R. C. Orlando, andR. Arnold, “Review article: the pathophysiology o gastrooeso-phageal reux disease—oesophageal maniestations,” Alimenta-ry Pharmacology and Terapeutics, Supplement , vol. , no. ,pp. –, .

[] R. Vemulapalli, “Diet and liestyle modications in the manage-ment o gastroesophageal reux disease,” Nutrition in Clinical Practice, vol. , no. , pp. –, .


9/9


[] M. S. Rosaida and K. L. Goh, “Gastro-oesophageal reuxdisease, reux oesophagitis and non-erosive reux disease in amultiracial Asian population: a prospective, endoscopy basedstudy,” European Journal o Gastroenterology and Hepatology , vol. , no. , pp. –, .

[] C. O’Leary, J. McCarthy, M. Humphries, F. Shanahan, and E.Quigley, “Te prophylactic use o a proton pump inhibitorbeore ood and alcohol,” Alimentary Pharmacology and Ter-apeutics, vol. , no. , pp. –, .

[] J. H. Wang, J. Y. Lou, L. Dong, J. Gong, and M. ong, “Epide-miology o gastroesophageal reux disease: a general popula-tion-based study in Xi’an o Northwest China,” World Journal o Gastroenterology , vol. , no. , pp. –, .

[] C. Pehl, B. Wendl, and A. Peiffer, “White wine and beer inducegastro-oesophageal reux in patients with reux disease,” Ali-mentary Pharmacologyand Terapeutics,vol.,no.,pp.–, .

[] I. Mohammed, “Are diet and physical activity risk actors orgastro-oesophageal reux disease symptoms: a study o discord-ant twins?” Journal o Gastroenterology , vol. , p. M,

.[] . anaka, A. Mizumoto,S. Muramatsu et al., “Postprandial nor-

mal saline intake delays gastric emptying o solids in consciousdogs: partial involvement o CCK in its mechanism,” DigestiveDiseases and Sciences, vol. , no. , pp. –, .

[] M. C. Aanen, A. J. Bredenoord, and A. J. P. M. Smout, “Effecto dietary sodium chloride on gastro-oesophageal reux: a ran-domized controlled trial,” Scandinavian Journal o Gastroenter-ology , vol. , no. , pp. –, .

[] A Mizuta, K. Adachi, K. Furuta et al., “Different sex-relatedinuences o eating habits on the prevalence o reux esophagi-tis in Japanese,” Journal o Gastroenterology and Hepatology , vol., no. , pp. –, .

[] J. A. Levant, J. H. Walsh, and J. I. Isenberg, “Stimulation o gas-

tric secretion and gastrin release by single oral doses o calciumcarbonate in man,” Te New England Journal o Medicine, vol., no. , pp. –, .

[] M. K. Floor, S. Jahangeer, C. D’Ambrosio, and O. Alabaster,“Serum gastrin increases with increasing dietary calcium butnot with increasing dietary at or ber in Fischer- rats,” Journal o Nutrition, vol. , no. , pp. –, .

dietary intake and risk for reflux esophagitis- a case-control study

Documents