Beruflich Dokumente
Kultur Dokumente
com
wjg@wjgnet.com
doi:10.3748/wjg.15.1690
REVIEW
Davide Festi, Eleonora Scaioli, Fabio Baldi, Amanda Vestito, Francesca Pasqui, Anna Rita Di Biase,
Antonio Colecchia
Davide Festi, Eleonora Scaioli, Fabio Baldi, Amanda
Vestito, Francesca Pasqui, Anna Rita Di Biase, Antonio
Colecchia, Department of Clinical Medicine, University of
Bologna, Bologna 40138; Department of Pediatrics, University
of Modena, Modena 41100, Italy
Author contributions: Colecchia A, Baldi F, Festi D concepted
and designed the manuscript; Vestito A, Pasqui F drafted the
manuscript; Scaioli E, Di Biase AR acquired data.
Correspondence to: Davide Festi, MD, Department of
Clinical Medicine, S. Orsola-Malpighi Hospital, Via Massarenti
9, Bologna 40138, Italy. davide.festi@unibo.it
Telephone: +39-51-6364123 Fax: +39-51-6364123
Received: December 10, 2008 Revised: March 4, 2009
Accepted: March 11, 2009
Published online: April 14, 2009
Abstract
INTRODUCTION
While lifestyle modifications are currently used as firstline treatment for subjects with gastroesophageal
reflux disease (GERD), the pathogenetic role of lifestyle factors and consequently, the efficacy of lifestyle
measures is controversial. Our aim was to systematically review the pathogenetic link between overweight/
obesity, dietary habits, physical activity and GERD, and
the beneficial effect of specific recommended changes,
by means of the available literature from the 1999 to
the present. Obesity, in particular, abdominal obesity,
plays a key role in determining GERD symptoms and
complications through mechanical and metabolic effects. Controlled weight loss (by diet or surgery) is
effective in improving GERD symptoms. No definitive
data exist regarding the role of diet and, in particular,
of specific foods or drinks, in influencing GERD clinical
manifestations. Moderate physical activity seems to
be beneficial for GERD, while vigorous activity may be
dangerous in predisposed individuals. In conclusion,
being obese/overweight and GERD-specific symptoms
and endoscopic features are related, and weight loss
significantly improves GERD clinical-endoscopic manifestations. The role of dietary behavior, mainly in terms
of specific dietary components, remains controversial.
Mild routine physical activity in association with diet
modifications, i.e. a diet rich in fiber and low in fat, is
advisable in preventing reflux symptoms.
2009 The WJG Press and Baishideng. All rights reserved.
www.wjgnet.com
1691
www.wjgnet.com
CN 14-1219/R
World J Gastroenterol
Volume 15
Number 14
Year
Country
Nilsson et al
Nandurkar et al[41]
Hampel et al[13]
Corley et al[14]
Jacobson et al[38]
Nocon et al[39]
Corley et al[37]
Nocon et al[40]
Zheng et al[43]
2003
2004
2005
2006
2006
2006
2007
2007
2007
Norway
Population-based
USA
Population-based
USA
Meta-analysis
USA
Meta-analysis
USA
Cross-sectional, women
Germany
Population-based
USA
Cross-sectional
Germany
Population-based
Sweden
Swedish twin registry
Andersen et al[44]
Lagergren et al[46]
Talley et al[45]
Zagari et al[47]
1991
2000
2004
2008
Denmark
Sweden
Australia
Italy
[42]
Study design
Population-based
Cross-sectional
Cross-sectional
Population-based
Population size
65363
211
10545
7124
80110
6215
27717
1321
820
777
1033
Obesity index
BMI
Questionnaire
BMI
Validated questionnaire
BMI
Validated symptoms score
BMI
Questionnaire
BMI
Questionnaire
BMI
Interview
BMI and abdominal diameter
Questionnaire
BMI
Validated questionnaire
BMI
Questionnaire, telephone
interview
BMI
Validated questionnaire
BMI
Interview
BMI
Questionnaire
BMI
Questionnaire
Association
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
www.wjgnet.com
1693
Ruhl et al
Hampel et al[13]
Nocon et al[40]
Kim et al[48]
Kang et al[51]
Lee et al[50]
Chung et al[52]
Year
Country
Study design
Population size
Obesity index
1999
2005
2007
2007
2007
2008
2008
USA
USA
Germany
South Korea
South Korea
South Korea
South Korea
Cohort
Meta-analysis
Population-based
Population-based
Population-based
Population-based
Cross-sectional
12349
Japan
Italy
Italy
Cross-sectional
Cohort
Population-based
6010
1542
1033
BMI
BMI
BMI
BMI
BMI, waist circumference
BMI, waist-to-hip ratio
BMI, waist circumference,
visceral adipose tissue
BMI
BMI
BMI
6215
27319
2457
3363
7078
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Upper endoscopy
Upper endoscopy
Upper endoscopy
No
No
No
www.wjgnet.com
CN 14-1219/R
World J Gastroenterol
Volume 15
Number 14
www.wjgnet.com
1695
Year
Country
Study design
Population
size
Case series
Case-control
10
20
Nebel et al[86]
Iwakiri et al[89]
Holloway et al[90]
Meyer et al[91]
1976
1996
1997
2001
USA
Japan
Australia
USA
Population-based
Population-based
Case-control
Population-based
1004
20
23
11
El-Serag et al[87]
2005
USA
Cross- sectional
371
Shapiro et al[88]
2007
USA
Case series
50
Ruhl[49]
1999
USA
Epidemiological
Phel[92]
Colombo[93]
Nandurkar[41]
1999
2002
2004
Germany
Italy
USA
Zheng[43]
2007
Sweden
Case series
Case series
Population-based,
nested case-control
Swedish Twin
Registry
2002
2007
Italy
UK
Case series
Case series
12349
12
13
211
27717
Effects
Lowered LESP
Increased
esophageal acid
exposure
Worsened reflux
symptoms
Symptom questionnaire
pH-monitoring
Esophageal manometry and pH-monitoring
Esophageal perfusion with HCl and duodenal
perfusion with fat and saline, symptoms interview
and scales
Dietary and symptom questionnaire and upper
endoscopy
GERD symptoms checklist, upper endoscopy, 24-h
pH-metry, dietary intake records
Upper endoscopy, symptoms interview, total
No association
dietary servings of high fat foods
with GERD
symptoms,
Esophageal manometry, pH-metry
reflux episodes
pH-metry in three solid/liquid meals
or lower
GERD, energy expediture, dietary intake
esophageal
questionnaires
sphincter
Questionnaire, telephone interview
pressure
13
15
2005
USA
Cross- sectional
Zheng et al[43]
2007
Sweden
Alcohol
OLeary et al[97]
2003
Ireland
Rosaida et al[98]
2004
Malayia
Wang et al[96]
Mohammed et al[95]
Talley et al[102]
Stanghellini et al[101]
Nilsson et al[99]
Zheng et al[43]
2004
2005
1994
1999
2004
2007
China
UK
USA
Multinational
Norway
Sweden
Shapiro et al[88]
2007
Coffee
Price et al[103]
371
Improved
symptoms
No association
56
Worsened
reflux
symptoms
1000
27717
2789
1533
1644
5581
> 40000
27717
USA
Epidemiological
Population-based
Cross-sectional
Cross-sectional
Case-control
Swedish Twin
Registry
Case series
50
Reduced
perception of
acid reflux
1978
USA
Population-based
66
Stanghellini et al[101]
Boekema et al[104]
1999
1999
Multinational
Netherlands
Wang et al[96]
Zheng et al[43]
2004
2007
China
Sweden
Cross-sectional
Randomized
controlled crossover
study
Epidemiological
Swedish Twin
Registry
Worsened
reflux
symptoms
No association
5581
15
2789
27717
No association
Protective factor
www.wjgnet.com
CN 14-1219/R
World J Gastroenterol
Volume 15
Number 14
www.wjgnet.com
1697
Year
Vigorous/agonistic exercise
Clark et al[134]
1989
Country
Study design
USA
Crossover
Schoeman et al[132]
1995
Australia
Randomized
controlled crossover
Peters et al[135]
2000
Netherlands
Randomized
controlled crossover
Collings et al[128]
2003
USA
Case series
Pandolfino et al[129]
2004
USA
Case-control
Nandurkar et al[41]
2004
USA
2005
Ireland
Population-based,
nested case-control
Randomized
controlled crossover
[130]
Ravi et al
Population size
Association/Effect
Yes
Yes
Yes
Yes
Yes
Yes
Yes
27717
Yes
37 GERD pz
Yes
CONCLUSION
There is sufficient evidence to support the relationship
between being obese/overweight and GERD, expressed
as specific symptoms and endoscopic features.
Furthermore, available evidence suggests that controlled
weight loss (by diet or surgery) is able to induce a
significant improvement in GERD symptoms and/or
in GERD clinical-endoscopic manifestations. Definitive
data still do not exist regarding the association between
dietary behavior, mainly in terms of specific dietary
components and GERD manifestations. Moderate
www.wjgnet.com
CN 14-1219/R
World J Gastroenterol
16
17
18
19
20
21
22
REFERENCES
1
23
24
25
26
27
28
29
30
31
32
33
34
Volume 15
Number 14
www.wjgnet.com
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
1699
www.wjgnet.com
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
CN 14-1219/R
World J Gastroenterol
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
Volume 15
Number 14
www.wjgnet.com
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
1701
www.wjgnet.com
E- Editor Ma WH