Rationale and Efficacy of Conservative Therapy for Gastroesophageal Reflux Disease

Kitchin, Llewellyn I.; Castell, Donald O.

doi:10.1001/archinte.1991.00400030018004

Cited by 121 publications

(24 citation statements)

References 75 publications

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“…The literature on the associations of diet and obesity with gastroesophageal reflux disease is similar but less consistent. Whereas obesity is associated with gastroesophageal reflux disease in multiple studies (37)(38)(39)(40)(41)(42), the association between dietary fat and gastroesophageal reflux disease is controversial. In rat models, dietary fat in conjunction with exposure of the distal esophagus to gastroduodenal juice promotes development of Barrett esophagus and esophageal adenocarcinoma (43,44).…”

Section: Discussionmentioning

confidence: 99%

Low-Fat, High Fruit and Vegetable Diets and Weight Loss Do Not Affect Biomarkers of Cellular Proliferation in Barrett Esophagus

Kristal

2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Risk factors for esophageal adenocarcinoma include obesity, high fat intake, and low consumption of fruits and vegetables. This trial tested whether an intervention to reduce these risk factors in patients with Barrett esophagus, a preneoplastic condition for esophageal adenocarcinoma, could reduce biomarkers of cellular proliferation and, by inference, the risk of neoplastic progression. Eighty-seven men and women with Barrett esophagus were randomized to an intensive dietary intervention or control group. At baseline, 18 and 36 months after intervention, biopsies were obtained at 2-cm intervals throughout the length of the Barrett segment. Ki67/DNA content flow cytometry was used to assess (a) % Ki67-positive proliferating diploid G 1 cells, (b) % total Ki67-positive proliferating cells, (c) presence of aneuploidy, and (d) presence of >6% of cells in the 4N (G 2 / tetraploid) fraction of the cell cycle. We also assessed reepithelialization and length of the Barrett segment, reflux symptoms, and medication use. The intervention effects for energy, fat, fruits and vegetables, and weight were, respectively, À314 kcal, À12.2% energy, 1.8 servings/d, and À4.0 kg at 18 months (all P < 0.005) and were smaller but remained significant at 36 months. There were no significant effects of the intervention on any biomarker of cellular proliferation. The intervention effects F SE for mean %G 1 Ki67+ cells were 0.98 F 1.58 at 18 months and 1.79 F 1.31 at 36 months; the relative risks (95% confidence interval) for developing >6% of cells in 4N were 0.5 (0.1-2.6) at 18 months and 0.75 (0.2-3.1) at 36 months. A single control participant developed aneuploidy. There were no significant effects on re-epithelialization, segment length, or reflux medication use. We conclude that substantial dietary change has no short-term effects on biomarkers of cellular proliferation in Barrett esophagus or on clinical observations of the Barrrett segment.

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Section: Discussionmentioning

confidence: 99%

Low-Fat, High Fruit and Vegetable Diets and Weight Loss Do Not Affect Biomarkers of Cellular Proliferation in Barrett Esophagus

Kristal

2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…9,19 As GERD is not a serious disease, people do not always have to visit a hospital. 20 According to a systematic review using the PubMed database between 1997 and 2011, the prevalence of GERD symptoms, majorly defined by weekly or frequent heartburn, did not differ between women and men (19.4 ± 2.3% vs 18.9 ± 2.4%, P = 0.87) or between regions (US or Europe vs Asian countries, P = 0.22).…”

Section: Population-based Studymentioning

confidence: 97%

Sex and Gender Differences in Gastroesophageal Reflux Disease

Kim

2016

J Neurogastroenterol Motil

128

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It is important to understand sex and gender-related differences in gastroesophageal reflux disease (GERD) because gender-related biologic factors might lead to better prevention and therapy. Non-erosive reflux disease (NERD) affects more women than men. GERD symptoms are more frequent in patients with NERD than in those with reflux esophagitis. However, men suffer pathologic diseases such as reflux esophagitis, Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC) more frequently than women. The prevalence of reflux esophagitis is significantly increased with age in women, especially after their 50s. The mean age of EAC incidence in women is higher than in men, suggesting a role of estrogen in delaying the onset of BE and EAC. In a chronic rat reflux esophagitis model, nitric oxide was found to be an aggravating factor of esophageal injury in a male-predominant way. In addition, the expression of esophageal occludin, a tight junction protein that plays an important role in the esophageal defense mechanism, was up-regulated in women. This explains the male predominance of reflux esophagitis and delayed incidence of BE or EAC in women. Moreover, the symptoms such as heartburn, regurgitation, and extra-esophageal symptoms have been more frequently reported by women than by men, suggesting that sex and gender play a role in symptom perception. Differential sensitivity with augmented symptoms in women might have diagnostic and therapeutic influence. Furthermore, recent studies have suggested that hormone replacement therapy has a protective effect against esophageal cancer. However, an anti-inflammatory role of estrogen remains compelling, which means further study is necessary in this area.

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“…15,20 Intrinsic tooth erosion may occur if gastric acid reaches the mouth due to vomiting, regurgitation or gastroesophageal reflux disease (GORD). 21 In anorexic or bulimic individuals the frequency of vomiting episodes may be associated with erosion experience. 22 Indices for recording tooth erosion After reviewing many indices that had been used previously to record erosion, Smith and Knight devised a Tooth Wear Index (TW1) 23 to record all three main types of toothwear irrespective of aetiology.…”

Section: Verifiable Cpd Papermentioning

confidence: 99%

A multifactorial analysis of factors associated with dental erosion

2004

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Objectives This study prospectively examines the relationship of possible aetiological factors to the presence of tooth erosion in a cohort of children. Patients and methods A random sample of 1,753 children was examined at age 12 and 1,308 of the same children were re-examined at age 14 years. The children were asked to complete questionnaires on both occasions, 1,149 subjects gave usable replies. The erosion index used was based upon the 1993 Survey of Children's Dental Health. Results were analysed using logistic regression. Results At age 12 significant positive associations were found between erosion and decay experience (odds ratio [OR]=1.48), drinking fruit juice (OR=1.42) or fizzy pop (OR = 1.59-2.52, depending on amount and frequency). The presence of calculus (OR 0.48) or eating fruit other than apples or citrus fruit (OR 0.48) reduced the chances of erosion. High consumption of carbonated drinks increased the odds of erosion being present at 12 years by 252% and was a strong predictor of the amount of erosion found at age 14. Conclusions Of the factors investigated, a history of dental caries and a high consumption of carbonated drinks were most closely related to the presence of dental erosion. The risk of erosion bore a strong relationship to the amount and frequency of carbonated drink consumption.It is only relatively recently that tooth erosion has been recognized as presenting a dental health problem in children. In 1993, the prevalence of erosion was reported as part of the national survey of Children's Dental Health in England and Wales 1 for the first time. Fifty per cent of 6-year-olds were found to have erosion and in 23% of children it had progressed into dentine. Thirty two per cent of 14-year-old children had erosion of the permanent dentition, with dentinal involvement present in 2%.The three main types of non-carious loss of dental hard tissue are attrition, abrasion and erosion. 2 Attrition implies removal of tooth surface due to movement of teeth against one another, pos-

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Rationale and Efficacy of Conservative Therapy for Gastroesophageal Reflux Disease

Cited by 121 publications

References 75 publications

Low-Fat, High Fruit and Vegetable Diets and Weight Loss Do Not Affect Biomarkers of Cellular Proliferation in Barrett Esophagus

Low-Fat, High Fruit and Vegetable Diets and Weight Loss Do Not Affect Biomarkers of Cellular Proliferation in Barrett Esophagus

Sex and Gender Differences in Gastroesophageal Reflux Disease

A multifactorial analysis of factors associated with dental erosion

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