4.5- Digestive Disorders

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (G.E.R.D.) is a persistent form of acid reflux that occurs more than two times per week. Acid reflux occurs when the acidic contents of the stomach leak backward into the esophagus and cause irritation. This is often referred to as “heartburn”. It is estimated that G.E.R.D. affects 25 to 35 percent of the US population. An analysis of several studies published in the August 2005 issue of Annals of Internal Medicine concludes that G.E.R.D. is much more prevalent in people who are obese.¹ While the links between obesity and G.E.R.D. are not completely known, they likely include that excess body fat puts pressure on the stomach, overeating increases pressure in the stomach, and fatty foods are triggers for G.E.R.D. symptoms. The most common G.E.R.D. symptom is heartburn, but people with G.E.R.D. may also experience regurgitation (flow of the stomach’s acidic contents into the mouth), frequent coughing, and trouble swallowing. Approximately 35 percent of children born in the United States have G.E.R.D.. In babies, the symptoms are more difficult to distinguish from what babies do normally. The symptoms are spitting up more than normal, incessant crying, refusal to eat, burping, and coughing. Most babies outgrow G.E.R.D. before their first birthday but a small percentage do not.

^{1Hampel, H. MD, Ph.D., N. S. Abraham, MD, MSc(Epi) and H. B. El-Serag, MD, MPH. “Meta-Analysis: Obesity and the Risk for Gastroesophageal Reflux Disease and Its Complications.” Ann Intern Med 2005,143(3): 199–211. Accessed June 19, 2019.}

Facts about G.E.R.D.

There are other causative factors of G.E.R.D. that may be separate from or intertwined with obesity. The sphincter that separates the stomach’s internal contents from the esophagus often does not function properly and acidic gastric contents seep upward. Sometimes the peristaltic contractions of the esophagus are also sluggish and compromise the clearance of acidic contents. In addition to having an unbalanced, high-fat diet, some people with G.E.R.D. are sensitive to particular foods—chocolate, garlic, spicy foods, fried foods, and tomato-based foods—which worsen symptoms. Drinks containing alcohol or caffeine may also worsen G.E.R.D. symptoms. G.E.R.D. is diagnosed most often by a history of the frequency of recurring symptoms. A more proper diagnosis can be made when a doctor inserts a small device into the lower esophagus that measures the acidity of the contents during one’s daily activities. Sometimes a doctor may use an endoscope, which is a long tube with a camera at the end, to view the tissue in the esophagus. About 50 percent of people with G.E.R.D. have inflamed tissues in the esophagus. A condition known as Barrett’s esophagus may develop over time in some people who have G.E.R.D.. Barrett’s esophagus refers to a structural difference in the tissue of the esophagus, which is caused by recurrent tissue damage. It occurs in 5 to 15 percent of patients diagnosed with G.E.R.D. and less than 1 percent of these patients may develop cancer of the esophagus, a highly lethal cancer.

The first approach to G.E.R.D. treatment is dietary and lifestyle modifications. Suggestions are to reduce weight if you are overweight or obese, avoid foods that worsen G.E.R.D. symptoms, eat smaller meals, stop smoking, and remain upright for at least three hours after a meal. There is some evidence that sleeping on a bed with the head raised at least six inches helps lessen the symptoms of G.E.R.D.. People with G.E.R.D. may not take in the nutrients they need because of the pain and discomfort associated with eating. As a result, G.E.R.D. can be caused by an unbalanced diet and its symptoms can lead to a worsening of nutrient inadequacy, a vicious cycle that further compromises health. Many medications are available to treat G.E.R.D., including antacids, histamine2 (H2) blockers, and proton-pump inhibitors. Some evidence from scientific studies indicates that medications used to treat G.E.R.D. may accentuate certain nutrient deficiencies, namely zinc and magnesium. When these treatment approaches do not work, surgery is an option.

Constipation is the most common chronic gastrointestinal disorder and occurs in around 2-20% of the population.² It is defined as bowel movements that are infrequent,  hard, and difficult to pass.  The normal frequency of bowel movements could be anywhere from three times a day to three times per week. People suffering from constipation may also feel bloated,  find it painful and may need to strain to have a bowel movement. Hemorrhoids may form as a result of the straining that occurs with frequent constipation.  Increasing fiber, fluids, and regular exercise may help relieve constipation.

^{2Locke GR, Pemberton JH, Phillips SF (December 2000). “American Gastroenterological Association Medical Position Statement: Guidelines on constipation“. Gastroenterology. 119 (6): 1761–6.} 

Diarrhea

IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome is a disorder of bowel function that appears to be caused by hypersensitivity in the large intestine.  The cause is currently unknown and is characterized by alternating patterns of diarrhea, constipation, and abdominal pain that may continue for years.   Some factors that may play a role include muscle contractions in the intestine, nervous system changes, inflammation, infection, and/or changes in the microbiota. Approximately 10-155 of the population suffers from this condition.  There is no known cure and treatment is targeted at reducing the symptoms.  The FODMAP diet may help but should be undertaken with the help of a Registered Dietitian Nutritionist to avoid nutrient deficiencies. The term FODMAP is an acronym, derived from “Fermentable Oligo-, Di-, Mono-saccharides, And Polyols”. These substances are not well absorbed in the small intestine and are easily fermented by the bacteria in the large intestine. By reducing these substances temporarily, severe symptoms can be reduced in about 70% of individuals