Gastroesophageal Reflux Disease
- MRAM FADHEL
- Mar 6, 2018
- 5 min read
السلام عليكم ورحمة الله وبركاته
قبل فترة جاءت احدى الحالات بالعيادة
وكانت تشتكي من ارتجاع المريء و انها طهقت من الحرقان
وان الدنيا مقفلة في وجهها و تريد قعلا ان تنزل وزنها
فخلال سؤالي عن 24 HOUR RECALL
جاوبتني بأنها تتناول منقوع النعناع يوميا في الصباح؟!
ومن المعروف ان النعناع يمتك خاصة حمضية عالية !!
ارتجاع المريء من أهم الأمراض لأخصائيين التغذية
وكثير من الجمعيات الطبية تؤكد دور التغذية في السيطرة على الأعراض والتقليل منها
من أهم الطرق المجربة في التخفيف من الأعراض هي مشي ١٠ دقايق بعد كل وجبة
مجربتها مع كثير من المرضى ولكن اؤكد لا يوجد مرجع يثبت هذه المعلومة
ولكن طريقة لا يوجد منها ضرر
وايضا من خلال محادثتي مع المرضى
keep food symptom journals to identify the specific foods triggers
من افضل الطرق المجربة فعلا المريض راح يكون طبيب أعراضه
ومراجعتها مع المرضى كل أسبوع
وإزالة كل الاغذية المسببة من الدايت
according to Krauses Food & Nutrition Therapy
avoid eating several hours before retiring
large high fat meal will lower (lower esophageal sphincter LES) pressure, delay gastric emptying, and increase latent acid production, all of which increase the risk of reflux
avoiding late evening meals
large meal and desserts that are high in fat or caloric density stimulate significant amount of gastric secretion and slow gastric emptying.
during sleep gastric emptying is already delayed, salivary are decreased, and swallowing occurs less frequently. the combination of delayed emptying, decreased clearance of esophagus, increased digestive secretion, and the recumbent position increase the opportunity for prolonged reflux.
the role of spices in the pathology of upper GI disorders is not clear, and one cannot generalize symptoms to all spices at all doses. some spices have been shown to increase GI permeability and some may cause significant allergic reaction in some individuals, other spices may be viewed as beneficial because they increase GI secretion and improve mucosal protective system
in survey of patient with GI lesion, the use of foods highly seasoned with chili powder and pepper are commonly but not universally incriminated in causing discomfort. the type of chili and amount of capsaicin consumed seem to make the difference
certain food have been reported to lower (lower esophageal sphincter) pressure such as peppermint and coffee, but little research has been done to establish their clinical significance in GERD symptoms
peppermint oil its use in GERD should be limited.
chewing gum has been shown to increase salivary secretion which help to raise esophgeal pH >> that is mean gum is useful for GERD.1
according to Nutrition and Diagnosis Related Care BOOK
Provide an individual diet reflecting patient needs. Assess intake of fat, alcohol, spices, and caffeine.
• If needed, a reduced-energy diet should be used to promote weight loss.
• During acute episodes, provide small, frequent feedings of soft foods.
• Diet should be high in protein to stimulate gastrin secretion and to increase LES pressure. Avoid foods that decrease LES pressure, including chocolate, peppermint, onions, garlic, and spearmint.
• Use fewer fried foods, cream sauces, gravies, fatty meats, pastries, nuts, potato chips, butter, and margarine.
• Dietary fiber and physical exercise may be protective. Increased fiber intake benefits a number of GI disorders
Avoid foods that may irritate the esophagus, such as citrus juices, tomatoes, and tomato sauce. Other spicy foods are to be eliminated according to individual experience.
If there is EoE, try a dietary elimination diet and add back foods one at a time to identify potential allergens.2
according to American College of Gastroenterology
the first management of GERD is >> Weight loss is recommended for GERD patients who are overweight or have had recent weight gain.
weight loss is the strongest recommended treatment from the ACG's guidelines for any patient with a BMI >25.(Conditional recommendation, moderate level of evidence).
Head of bed elevation and avoidance of meals 2 – 3 h before bedtime should be recommended for patients with nocturnal GERD. (Conditional recommendation,
low level of evidence)
Routine global elimination of food that can trigger reflux (including chocolate, caffeine, alcohol, acidic and / or spicy foods) is not recommended in the treatment of
GERD. (Conditional recommendation, low level of evidence).3
Nurses' Health Study showed that weight loss resulting in a reduction of 3.5 kg/m2 BMI also reduced symptoms of GERD.4
according to National Institute of Diabetes and Digestive and Kidney Diseases
losing weight if you’re overweight or obese
wear loose-fitting clothing around your abdomen. Tight clothing can squeeze your stomacharea and push acid up into your esophagus.
stay upright for 3 hours after meals. Avoid reclining and slouching when sitting.
sleep on a slight angle. Raise the head of your bed 15 - 20 cm by safely putting blocks under the bedposts. Just using extra pillows will not help.
quit smoking and avoid secondhand smoke.
If certain foods appear to make your symptoms worse, avoiding those foods could help. The problems are often caused by specific things, such as coffee, chocolate, very fatty or spicy foods,peppermint, greasy or spicy foods, tomatoes and tomato products, citrus fruits or fizzy drinks. It might take time and patience to find out which types of food you don't tolerate well.5
according to American Academy of Family Physicians
Avoid large meals.
Avoid acidic foods (citrus- and tomato-based products), alcohol, caffeinated beverages, chocolate, onions, garlic, and peppermint.
Decrease dietary fat intake.
Avoid lying down within three to four hours after a meal.
Avoid medications that may potentiate GERD symptoms, including calcium channel blockers, beta agonists, alpha-adrenergic agonists, theophylline, nitrates, and some sedatives.
Elevate the head of the bed 10 to 20 cm (4 to 8 inches).
Avoid wearing clothing that is tight around the waist.
Lose weight.
Stop smoking.6
و أخيرا حسب 5 مراجع مهمة جدا لايوجد اكل معين عند تجنبه تخف الحموضة و لا يوجد اكل معين عند
تناوله يخف الحرقان ولكن بتغيير نمط الحياة الى حياة صحية ممكن يقلل من الاعراض
حسب تعاملي مع كثير من حالات ارتجاع المريء هناك معلومة منتشرة بين المرضى ان النعناع يخفف من الحرقان خصوصا لو تم تناوله في ساعات الصباح الاولى ؟؟!!
لا أعلم من الناشر لهذه المعلومة ولكن تستمر معلومات المرضى التي مصدرها الواتس او فاشيونيستا كويتية ؟؟!!
لا أعلم متى ينتهي هذا الهراء؟!
ولكن اتمنى ان يستمر دوري و دور كل اخصائي/ة تغذية للتقليل من هذه الشائعات
طبعا ارفقت بالبوست ورقة تعليمات للمرضى بإمكانكم استخدامها
ورقة التعليمات
1.L.Kathleen mahan. krause's food & nutrition therapy BOOK
2.Sylvia Escott-Stump.Nutrition andDiagnosis-Related Care BOOK
3.Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013
4. Jacobson BC, Somers SC, Fuchs CS, Kelly CP, Camargo CA Jr. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 5.Eating, diet, & nutrition for GER & GERD. National Institute of Diabetes and Digestive and Kidney Diseases website. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/eating-diet-nutrition. Updated November 2014.
6. Joel J,Heidelbaugh, M.D., Timothy T. Management of Gastroesophageal Reflux Disease. Am Fam Physician. 2003 Oct 1;68(7):1311-1319.
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