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Relationship Between Gastroesophageal Reflux Symptoms and Dietary Factors in Korea

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Relationship Between Gastroesophageal Reflux Symptoms and Dietary Factors in Korea J Neurogastroenterol Motil, Vol. 17 No. 1 January, 2011 DOI: 10.5056/jnm.2011.17.1.54 Original Article JNM Journal of Neurogastroenterology and Motility Relationship Between Gastroesophageal Reflux Symptoms and Dietary Factors in Korea Ji Hyun Song,1 Su Jin Chung,1 Jun Haeng Lee,2 Young-Ho Kim,2 Dong Kyung Chang,2 Hee Jung Son,2 Jae J Kim,2 Jong Chul Rhee2 and Poong-Lyul Rhee2* 1Healthcare System Gangnam Center, Seoul National University Hospital, Healthcare Research Institute, Seoul, Korea, 2Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea ㅋ Background/Aims The incidence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study was to evaluate the rela- tionship between GERD symptoms and dietary factors in Korea. Methods From January 2007 to April 2008, 162 subjects were enrolled (81 in GERD group and 81 in control group). They were asked to complete the questionnaires about GERD symptoms and dietary habits. The symptom severity score was recorded by visual analogue scale. Results Subjects with overweight or obesity had an increased risk for GERD (OR, 2.52; 95% CI, 1.18-5.39). Irregular dietary intake was one of the risk factors for GERD (OR, 2.33; 95% CI, 1.11-4.89). Acid regurgitation was the most suffering (2.85 ± 2.95 by visual analogue scale) and frequent reflux-related symptom (57.5%) in GERD. Noodles (OR, 1.22; 95% CI, 1.12-1.34), spicy foods (OR, 1.09; 95% CI, 1.02-1.16), fatty meals (OR, 1.20; 95% CI, 1.09-1.33), sweets (OR, 1.42; 95% CI, 1.00-2.02), alcohol (OR, 1.16; 95% CI, 1.03-1.31), breads (OR, 1.17; 95% CI, 1.01-1.34), carbonated drinks (OR, 1.69; 95% CI, 1.04-2.74) and caffeinated drinks (OR,1.41; 95% CI, 1.15-1.73) were associated with symptom aggravation in GERD. Among the investigated noodles, ramen (instant noodle) caused reflux-related symptoms most frequently (52.4%). Conclusions We found that noodles, spicy foods, fatty meals, sweets, alcohol, breads, carbonated drinks and caffeinated drinks were asso- ciated with reflux-related symptoms. (J Neurogastroenterol Motil 2011;17:54-60) Key Words Diet; Food habits; Gastroesophageal reflux disease; Symptom Received: October 22, 2010 Revised: December 3, 2010 Accepted: December 11, 2010 CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. *Correspondence: Poong-Lyul Rhee, MD Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: +82-2-3410-3409, Fax: +82-2-3410-6983, E-mail: [email protected] Financial support: None. Conflicts of interest: None. ⓒ 2011 The Korean Society of Neurogastroenterology and Motility 54 J Neurogastroenterol Motil, Vol. 17 No. 1 January, 2011 www.jnmjournal.org GERD and Dietary Factors to confirm erosive esophagitis or other combined disorder. In case of erosive reflux disease, the severity of erosive esophagitis Introduction seen on EGD was graded from A to D according to the Los Gastroesophageal reflux disease (GERD) is a condition whi- Angeles (LA) classification.8 In the same period, randomly se- ch develops when the reflux of gastric contents cause troublesome lected subjects attending Seoul National University Hospital symptoms and/or complications.1 A recent systematic review iden- Healthcare System Gangnam Center for routine health check-up tified a 10%-20% prevalence of GERD, defined by at least week- to be confirmed without erosive esophagitis or hiatal hernia by ly heartburn and/or regurgitation in the Western world; while in EGD were recruited as control group. Subjects with typical re- Asia, the prevalence was less than 5%.2 It has been suggested that flux symptoms more than once a week within the last 1 year were there is an increasing trend in the prevalence of GERD over the excluded in control group. last 2 decades and that reflux disease is more common in Asian Subjects were excluded if they have other gastrointestinal dis- countries than previously recognized.3 For the differences in pre- eases (for example, active peptic ulcer disease, infectious con- valence rate in different countries, there are several potential ex- ditions of the intestine and gastric malignancy), a history of gas- planations; such as lifestyle factors, dietary factors, overweight/ trectomy or severe health problems. Exclusion criteria also con- obesity and genetic factors. However, the exact pathogenetic role tained the subjects who require daily use of NSAIDs, oral steroid of these factors is still under debate and the beneficial effect of or aspirin, on proton pump inhibitors or histamine-2 receptor an- recommending specific modification in lifestyle habits is also con- tagonists over the preceding 4 weeks, and currently pregnant troversial.4 women. GERD is a multi-factorial disease with both environmental The participants were asked to complete the questionnaires and genetic risk factors, and several epidemiological data lend consisted of questions about the patient’s demographics, reflux support to this concept.5 Various lifestyle factors are thought to related symptoms and diet factors. Body mass index was calcu- be associated with GERD symptoms, including body weight, lated as a ratio between weight (kg) and the square of height (m2) nutrition, alcohol consumption, smoking, the intake of NSAIDs and further categorized as follows based on recommended cut- and sleeping position.6 There are many patients who are more offs: normal (< 23), overweight or obesity (≥ 23). A total of likely to experience a perceived reflux event when they eat some 162 subjects (81 in GERD group and 81 in control group) agreed foods like noodles. It is a common belief that some foods may in- to complete the questionnaire and were enrolled in this study. duce or worsen GERD symptoms. In fact, in daily clinical prac- Written informed consents were obtained from all participants. tice, this belief leads to advising patients to avoid the suspected This study received approval from the institutional review board foods.7 Furthermore, since GERD symptoms are most com- of the Samsung Medical Center and Seoul National University monly reported postprandially, the role of dietary components in Hospital. inducing symptoms has been suggested.7 However, no definitive data exist regarding the role of diet and specific foods or drinks in Questionnaire influencing on GERD symptoms.7 The aim of this study was to The questionnaire consisted of the following questions: evaluate the relationship between GERD symptoms and dietary (1) Questions about dietary habits (large-volume meal, rapid factors, especially regular meals in Korea. food intake, irregular intake, eating between meals and late-eve- ning meal) A. How much do you take each meal? Materials and Methods B. How long does it take to eat a regular meal? C. Do you eat regularly? Subjects D. Do you eat between meals? From January 2007 to April 2008, patients attending depart- E. Do you eat in late evening or at night? ment of medicine in Samsung Medical Center with frequent (2) Do you suffer from the following symptoms? How often? (more than weekly) typical reflux symptoms such as acid regur- How severe are the symptoms? (recorded by visual analogue gitation or heartburn were recruited as GERD group. All of scale [VAS]) these patients underwent esophagogastroduodenoscopy (EGD) A. Heartburn Vol. 17, No. 1 January, 2011 (54-60) 55 Ji Hyun Song, et al B. Acid regurgitation potential risk factors of GERD. Age- and sex-adjusted data of C. Chest discomfort dietary habits, reflux-related symptoms and specific foods were D. Chest pain also analyzed by multiple logistic regression. All P-values were E. Hoarseness 2-tailed, and P-values of less than 0.05 were considered statisti- F. Globus sensation cally significant. G. Cough H. Epigastric pain I. Epigastric soreness Results J. dyspepsia The clinical characteristics of the study subjects are presented (3) How long do you suffer from the symptoms? in Table 1. Mean ages were 57 years in GERD group and 50 (4) Did you feel the symptom development or aggravation af- years in control group (P < 0.001). Subjects with overweight or ter eating specific food? What was(were) the food(s)? And how obesity had an increased risk for GERD (OR, 2.52; 95% CI, severe were the symptoms? (recorded by VAS) 1.18-5.39) (Table 2). In GERD group, endoscopic findings were Diet factors as follows; 13 patients (16.0%) had non-erosive reflux disease, 30 The questionnaires also asked whether they suffered from re- patients (37.0%) were LA-A, 34 patients (42.0%) were LA-B and flux-related symptoms with specific food intake. The foods possi- 4 patients (5.0%) were LA-C. In our study population, there was bly causing reflux-related symptoms were listed in Korean’s fa- no patient with LA-D. vorite foods extracted from the Third Korea National Health & Table 3 shows the relationship between dietary habits and Nutrition Examination Survey (KNHANES III).9 GERD. The odds ratio of irregular dietary intake was 2.33 (95% Symptom assessment CI, 1.11-4.89), but other habits (large-volume meal, rapid food The severities of reflux related symptoms (heartburn, acid re- intake, eating between meals and late-evening meals) did not show gurgitation, chest discomfort, chest pain, hoarseness, globus sen- statistical significance. Table 4 shows the comparison of dietary sation, cough, epigastric pain, epigastric soreness and dyspep- habits according to the endoscopic severity of GERD.
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