-IBIS-1.5.0-
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digestive system
gastroesophageal reflux/dyspepsia
nutrition

dietary guidelines

eating principles:
Eat small meals frequently throughout day, increase foods rich in Vitamin A

fresh juices:
Carrot (Walker, p. 135)
Carrot and spinach (Walker, p. 135)
Carrot, beet, and cucumber (Walker, p. 135)
Carrot, spinach, celery, and parsley (Walker, p. 135)

specific remedies:
Drink 6 fl oz. freshly blended pineapple juice once or twice per day
Eat 6 oz. papaya 3 times per day after meals (Shefi)
2 oz. fresh coriander blend with a small amount of sesame oil
Almond milk (Shefi)

avoid:
Avoid foods that decreases lower esophageal sphincter (LES) pressure and increases acid secretion:
Coffee: decreases LES pressure and increases acid secretion (Dennish and Castel. Am. J. Dig. Dis. 18:391,1 973)
Chocolate: decreases LES pressure
Tomato: decreases LES pressure
Milk: delays gastric emptying and stimulates acid secretion (allergy mediated) (Forget and Arends. Eur. J Pediatr. 144:298, 1985)
Alcohol (Hogen. J. Appl. Physiol 32:755, 1972)
Medications such as NSAID, aspirin, etc.
Meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar, chocolate, tomato

drug interactions:
Phosphorous and aluminum hydroxide: aluminum binds dietary Phosporous, potentially causing depletion
Calcium and aluminum hydroxide: aluminum causes increased urinary and stool Calcium (Spencer and Kramer, 1983; 143: p. 657-658)
Cimetidine (Tagamet) and ranitidine (Zantac) inhibit gastric alcohol dehydrogenase, interfering with alcohol breakdown, and substantially increasing serum alcohol levels (DiPadova, et al., JAMA 1992; 267: 83-86)

» Esophagitis:
Relax while eating
Tell the patient to sit down without getting up until the meal is complete
Direct the patient to put utensils down between bites
Count the number of chews
Prohibit TV, reading, or other distracting activities during meals. Avoid excessive chatter which distracts from thorough chewing.
Eat small meals with low fat content. High fat foods tend to stay in the stomach. This increases intra-abdominal pressure and also decreases LES pressure.
Avoid foods that commonly aggravate esophagitis:
Coffee: decreases LES pressure and increases acid secretion (Dennish and Castel. Am. J. Dig. Dis. 18:391,1 973)
Chocolate: decreases LES pressure
Tomato: decreases LES pressure
Milk: delays gastric emptying and stimulates acid secretion (allergy mediated) (Forget and Arends. Eur. J Pediatr. 144:298, 1985)
Alcohol (Hogen. J. Appl. Physiol 32:755, 1972)
Medications such as NSAID, aspirin, etc.
Increased fiber decreases intra-abdominal pressure by softening stools. Fiber also increases positive peristalsis which prevents stagnation and keeps stools from becoming hard and dry.
Avoid nicotine: a major factor in decreasing LES pressure
(Marz, p. 378, 1997)

Clinical note
: Severe untreated esophagitis may lead to Barretts esophagus in which the squamous mucosa of the lower esophagus is replace by columnar epithelium. These cellular changes may lead to adenocarcinoma. The prevalence of adenocarcinoma in Barretts esophagus is about 10%, which is 40x the rate of the general population. Surgical treatment has a poor prognosis. One study showed that of the patients with surgically treatable cancer only 27% survived the first year and 10% survived 5 years.
(Marz, p. 378, 1997)


supplements

hydrochloric acid after acute phase
digestive enzymes
Choline 3 g per day
lecithin 6 caps per day
B12, if on cimetidine (Tagamet), see below

Esophagitis:
Choline: has been used even in pregnancy to increase LES pressure. Can also use lecithin in the form of phosphatidyl choline.
Pantothenic acid: 1gm twice daily and thiamin 500 mg per day
Manganese (citrate): 50 mg per day
HCL: Dr. Jonathan Wright is a strong believer in HCL therapy (see Healing with Nutrition). It is probably a good idea to do a Heidelberg first. (Marz, p. 378, 1997)

» drug interactions:
B12 and cimetidine: cimetidine (Tagamet) reduces B12 absorption (Salom, et al., 1982; 17: 129-131)


footnotes

Dennish and Castel. On the genesis of Heartburn. Am. J. Dig. Dis. 18:391,1 973. Abstract: Coffee at a dosage of 1-2 cups decreased LES pressure slightly and greatly stimulated HCL secretion.

Forget and Arends. Cows milk protein allergy and gastroesophageal reflux. Eur. J Pediatr. 144:298, 1985.
Alcohol

Hogen. Ethanol induced acute esophageal sphincter motor dysfunction. J. Appl. Physiol 32:755, 1972. Abstract: Alcohol was found to relax the LES and decrease peristaltic force.