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GERD and Barrett’s Esophagus

March 2, 2009 Written by JP    [Font too small?]

Almost everyone is familiar with the term heartburn, which is also known as GERD (Gastro Esophageal Reflux Disease). When GERD is left untreated it can create other problems. One possible health consequence of GERD is a condition called Barrett’s Esophagus (BE). Barrett’s Esophagus comes into the picture when acid reflux continually makes contact with the lining of the esophagus. This can be problematic because people with Barrett’s Esophagus are 30 to 40 times more likely to develop esophageal cancer than the average population.

BE is particularly dangerous because it generally doesn’t present obvious symptoms. It is most often detected by accident when investigating other conditions that require endoscopic testing, such as trying to locate an ulcer. While the detection of BE is often elusive, it is estimated to affect about 5% of the general population.

Eat, Drink and B.E. Merry

Wine Protects the EsophagusSeveral recent studies provide hope in the area of BE prevention. In the March edition of the journal Gastroenterology, consuming wine was shown to reduce the risk of Barrett’s Esophagus by 56%. Here are some specifics of the study:

  • For three years, 953 men and women were surveyed about their daily alcohol consumption.
  • Those who drank at least one glass of wine a day showed a dramatic (56%) drop in the risk of having Barrett’s Esophagus.
  • The participants who consumed other forms of alcohol did not show any benefit at all.

These results were somewhat surprising because alcohol is typically thought of as an irritant. In the case of BE, the cells in the esophageal lining are already irritated. The theory is that naturally occurring antioxidants in wine may account for the preventive effect.

The lead researcher of the study, Dr. Douglas A. Corley, summarized his views in the following manner, “My advice to people trying to prevent Barrett’s Esophagus is: keep a normal body weight and follow a diet high in antioxidants and high in fruits and vegetables.” He went on to add that, “We already knew that red wine was good for the heart, so perhaps here is another added benefit of a healthy lifestyle and a single glass of wine a day.”

Another just published study found that wine appeared to reduce the risk of not only Barrett’s Esophagus, but also reflux esophagitis (a lesser inflammation of the esophagus) and esophageal adenocarcinoma (cancer).

Barrette's Esophagus

But what if you don’t drink alcohol? Are there other steps that can be taken to reduce the likelihood of esophagus problems? There certainly are. In addition to maintaining a healthy weight, modern science has also noted a protective effect for certain common dietary options. Here are a few of the best choices:

  • Eat a fiber rich diet. A recently completed study, that will be published in April of 2009, clearly shows that eating plentiful fiber can lower the risk of both Barrett’s Esophagus and Esophageal cancer. But beware of high glycemic carbohydrates, which are typically high in sugar and starches. They appear to raise the risk of this form of cancer.
  • Include plenty of fruits and vegetables in your daily menu. A recent analysis presented in the American Journal of Clinical Nutrition found that both men and women who ate the most fruits and vegetables had the lowest incidence of Barrett’s Esophagus.
  • Berries are tops. Berries have been shown to be particularly efficient in protecting the cells of the esophagus. They’re an excellent dietary choice because they’re rich in fiber, low in sugar and they contain antioxidants similar to what you’d find in red wine.

If you suffer from chronic heartburn or if you’re overweight with a family history of esophageal cancer, please ask your doctor about your risk of Barrett’s Esophagus. As you can see, there are safe and natural steps you can take to shift the odds in your favor – both with regard to prevention, and possibly even improvement of existing inflammation.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Alternative Therapies, Food and Drink, Nutrition

6 Comments & Updates to “GERD and Barrett’s Esophagus”

  1. JP Says:

    Updated 07/16/15:


    Dis Esophagus. 2015 Jul 14.

    Adherence to a predominantly Mediterranean diet decreases the risk of gastroesophageal reflux disease: a cross-sectional study in a South Eastern European population.

    Our aim was to assess the association of a Mediterranean diet and gastroesophageal reflux disease among adult men and women in Albania, a former communist country in South Eastern Europe with a predominantly Muslim population. A cross-sectional study was conducted in 2012, which included a population-based sample of 817 individuals (≥18 years) residing in Tirana, the Albanian capital (333 men; overall mean age: 50.2 ± 18.7 years; overall response rate: 82%). Assessment of gastroesophageal reflux disease was based on Montreal definition. Participants were interviewed about their dietary patterns, which in the analysis was dichotomized into: predominantly Mediterranean (frequent consumption of composite/traditional dishes, fresh fruit and vegetables, olive oil, and fish) versus largely non-Mediterranean (frequent consumption of red meat, fried food, sweets, and junk/fast food). Logistic regression was used to assess the association of gastroesophageal reflux disease with the dietary patterns. Irrespective of demographic and socioeconomic characteristics and lifestyle factors including eating habits (meal regularity, eating rate, and meal-to-sleep interval), employment of a non-Mediterranean diet was positively related to gastroesophageal reflux disease risk (fully adjusted odds ratio = 2.3, 95% confidence interval = 1.2-4.5). Our findings point to a beneficial effect of a Mediterranean diet in the occurrence of gastroesophageal reflux disease in transitional Albania. Findings from this study should be confirmed and expanded further in prospective studies in Albania and in other Mediterranean countries.

    Be well!


  2. JP Says:

    Updated 08/15/15:


    Dis Esophagus. 2015 Jul 30.

    Short-term and long-term effect of diaphragm biofeedback training in gastroesophageal reflux disease: an open-label, pilot, randomized trial.

    This study investigated the effectiveness of diaphragm biofeedback training (DBT) for patients with gastroesophageal reflux disease (GERD). A total of 40 patients with GERD treated at the Peking Union Medical College Hospital between September 2004 and July 2006 were randomized to receive DBT and rabeprazole proton pump inhibitor (PPI) or rabeprazole alone. The DBT + rabeprazole group received DBT during the 8-week initial treatment; the rabeprazole group did not. During the 6-month follow up, all patients took acid suppression according to their reflux symptoms, and the patients in the DBT + rabeprazole group were required to continue DBT. The primary outcome (used for power analysis) was the amount of acid suppression used at 6 months. Secondary outcomes were reflux symptoms, health-related quality of life (HRQL), and esophageal motility differences after the 8-week treatment compared with baseline. Acid suppression usage significantly decreased in the DBT + rabeprazole group compared with the rabeprazole group at 6 months (P < 0.05). At 8 weeks, reflux symptoms and GERD-HRQL were significantly improved in both groups (P < 0.05), without difference between them. Crural diaphragm tension (CDT) and gastroesophageal junction pressure (GEJP) significantly increased in the DBT + rabeprazole group (P < 0.05), but without change in lower esophageal sphincter (LES) pressure. There was no significant change in CDT, GEJP, and LES pressure compared with baseline in the rabeprazole group. In conclusion, long-term DBT could reduce acid suppression usage by enhancing the anti-reflux barrier, providing a non-pharmacological maintenance therapy and reducing medical costs for patients with GERD. Be well! JP

  3. JP Says:

    Updated 09/16/15:


    Int J Cancer. 2015 Sep 10.

    Association between dietary vitamin C intake and risk of esophageal cancer: A dose-response meta-analysis.

    While several epidemiological studies have investigated the association between vitamin C and risk of esophageal cancer, the results remain inconsistent. In the present study, a meta-analysis was conducted to assess the impact of dietary vitamin C intake on esophageal cancer risk. Online databases were searched up to March 29, 2015, for studies on the association between dietary vitamin C intake and esophageal cancer risk. Pooled risk ratios (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Dose-response analyses were was performed using the method of restricted cubic splines with four knots at percentiles of 5%, 35%, 65%, and 95% of the distribution. Publication bias was estimated using Egger’s tests and funnel plots. In all, 15 articles were included in this meta-analysis, including 20 studies, containing 7063 controls and 3955 cases of esophageal cancer. By comparing the highest versus the lowest categories of vitamin C intake, we found that vitamin C was inversely associated with the risk of esophageal cancer [overall OR=0.58 95%CI=0.49-0.68, I2 =56%]. A linear dose-response relationship was found. With an increase in dietary vitamin C intake of 50 mg/day, the risk of esophageal cancer statistically decreased by 13% (RR=0.87, 95%CI =0.80-0.93, P linearity = 0.0002). In conclusion, our analysis suggested that the higher intake of dietary vitamin C might have a protective effect against esophageal cancer.

    Be well!


  4. JP Says:

    Updated 06/26/16:


    Nutrients. 2016 Jun 8;8(6). pii: E350.

    Flavonoids, Flavonoid Subclasses, and Esophageal Cancer Risk: A Meta-Analysis of Epidemiologic Studies.

    Flavonoids have been suggested to play a chemopreventive role in carcinogenesis. However, the epidemiologic studies assessing dietary intake of flavonoids and esophageal cancer risk have yielded inconsistent results. This study was designed to examine the association between flavonoids, each flavonoid subclass, and the risk of esophageal cancer with a meta-analysis approach. We searched for all relevant studies with a prospective cohort or case-control study design published from January 1990 to April 2016, using PUBMED, EMBASE, and Web of Science. Pooled odds ratios (ORs) were calculated using fixed or random-effect models. In total, seven articles including 2629 cases and 481,193 non-cases were selected for the meta-analysis. Comparing the highest-intake patients with the lowest-intake patients for total flavonoids and for each flavonoid subclass, we found that anthocyanidins (OR = 0.60, 95% CI: 0.49-0.74), flavanones (OR = 0.65, 95% CI: 0.49-0.86), and flavones (OR = 0.78, 95% CI 0.64-0.95) were inversely associated with the risk of esophageal cancer. However, total flavonoids showed marginal association with esophageal cancer risk (OR = 0.78, 95% CI: 0.59-1.04). In conclusion, our study suggested that dietary intake of total flavonoids, anthocyanidins, flavanones, and flavones might reduce the risk of esophageal cancer.

    Be well!


  5. JP Says:

    Updated 06/27/17:


    Clin Gastroenterol Hepatol. 2017 Jun 8.

    Efficacy of a 4-Food Elimination Diet for Children With Eosinophilic Esophagitis.

    BACKGROUND & AIMS: A 6-food elimination diet induces remission in most children and adults with eosinophilic esophagitis (EoE). The effectiveness of empiric elimination of only 4 foods has not been studied in children. We performed a prospective observational outcome study in children with EoE treated with dietary exclusion of cow’s milk, wheat, egg, and soy. The objective was to assess the clinical, endoscopic, and histologic efficacy of this treatment in EoE.

    METHODS: We recruited children (1-18 years old, diagnosed per consensus guidelines) from 4 medical centers. Study participants (N=78) were given a proton pump inhibitor twice daily and underwent a baseline esophagogastroduodenoscopy. Subjects were instructed on dietary exclusion of cow’s milk, wheat, egg, and soy. Clinical, endoscopic, and histologic assessments were made after 8 weeks. Responders had single foods reintroduced for 8 weeks, with repeat endoscopy to assess for recurrence of active disease. The primary endpoint was histologic remission (fewer than 15 eosinophils per high-powered field). Secondary endpoints included symptom and endoscopic improvements and identification of foods associated with active histologic disease.

    RESULTS: After 8-weeks on 4-food elimination diet, 50 subjects were in histologic remission (64%). The subjects’ mean baseline clinical symptoms score was 4.5 which decreased to 2.3 after 8 weeks of 4-food elimination diet (p<0.001). The mean endoscopic baseline score was 2.1 which decreased to 1.3 (p<0.001). After food reintroduction, the most common food triggers that induced histological inflammation were cow's milk (85%), egg (35%), wheat (33%), and soy (19%). One food trigger that induced recurrence of esophageal inflammation was identified in 62% of patients and cow's milk-induced EoE was present in 88% of these patients.

    CONCLUSIONS: In a prospective study of children with EoE, 8 weeks of 4-food elimination diet induced clinical, endoscopic, and histological remission in more than 60% of children with EoE. While less restrictive than 6-food elimination diet, 4-food elimination diet was nearly as effective, and can be recommended as a treatment for children with EoE.

    Be well!


  6. JP Says:

    Updated 10/26/18:


    Clin Transl Gastroenterol. 2018 Oct 25;9(10):199.

    Increasing Dietary Fiber Intake Is Associated with a Distinct Esophageal Microbiome.

    INTRODUCTION: There is increasing evidence that the microbiome contributes to esophageal disease. Diet, especially fiber and fat intake, is a known potent modifier of the colonic microbiome, but its impact on the esophageal microbiome is not well described. We hypothesized that dietary fiber and fat intake would be associated with a distinct esophageal microbiome.

    METHODS: We collected esophageal samples from 47 ambulatory patients scheduled to undergo endoscopy who completed a validated food frequency questionnaire quantifying dietary fiber and fat intake. Using 16S high-throughput sequencing, we determined composition of the esophageal microbiome and predicted functional capacity of microbiota based on fiber and fat intake.

    RESULTS: Among all samples, the most abundant phyla were Firmicutes (54.0%), Proteobacteria (19.0%), Bacteroidetes (17.0%), Actinobacteria (5.2%), and Fusobacteria (4.3%). Increasing fiber intake was significantly associated with increasing relative abundance of Firmicutes (p = 0.04) and decreasing relative abundance of Gram-negative bacteria overall (p = 0.03). Low fiber intake was associated with increased relative abundance of several Gram-negative bacteria, including Prevotella, Neisseria, and Eikenella. Several predicted metabolic pathways differed between highest and lowest quartile of fiber intake. Fat intake was associated with altered relative abundance of few taxa, with no alterations at the phylum level and no changes in microbiome functional composition.

    CONCLUSIONS: Dietary fiber, but not fat, intake was associated with a distinct esophageal microbiome. Diet should be considered an important modifier of the esophageal microbiome in future studies. Studies are also needed to elucidate how the effects of dietary fiber on the esophageal microbiome may contribute to esophageal disease.

    Be well!


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