Diseases affecting the esophagus lead to impaired swallowing , the achievement of the bolus in the stomach and gastric containment.
In principle, nutrition is NOT directly involved in the pathogenesis of these diseases, however it can be decisive in reducing symptoms and related complications, both in the short and long term.
Esophagus and disease
The esophagus is an organ that connects the mouth and the stomach; it is hollow, tubular in shape and about 25-30 cm long in the adult. The esophagus begins at the cricopharyngeal sphincter (superiorly) and ends at the cardia (inferiorly).
Like all anatomical structures of the human body , the esophagus is subject to pathological alterations which compromise its structural integrity, and consequently the physiological mechanism of action. It is therefore deducible that diseases of the esophagus essentially determine the alteration of peristaltic motility… which translated in simple terms means the impairment of food transport from the pharynx to the stomach.This occurs thanks to a “wave” movement which progressively squeezes the esophageal content from top to bottom: while an upstream segment of esophageal muscle contracts, the downstream section relaxes; subsequently the latter will contract and so on, in succession from top to bottom until the food bolus has completely descended into the stomach.
Diseases of the esophagus are of two types: some called hypermotility , or determined by: an increased contractile capacity in conjunction with a lack of coordination between stimuli and the inability to release the cardia; others classifiable for hypomotility, or generated by the containment insufficiency of the cardia. With regard to the latter, the predominant clinical manifestation is GERD – gastroesophageal reflux disease which, if neglected, can lead to chronic inflammation to the point of determining esophagitis and/or Barrett’s esophagus .
Nutrition in reflux disease
The hygienic-food advice concerning diseases of the esophagus, in reality, basically refer to gastroesophageal reflux disease (GERD).
GERD is a chronic and potentially recurring disease, therefore specific nutrition should not be considered a transient therapy, but a permanent condition.
Gastroesophageal reflux disease is frequently associated with another disorder, or rather, with an anatomical alteration that tends to worsen the symptoms and the related complications: hiatus hernia ; the latter is nothing more than an invagination (a kind of “suction”) of the upper gastric portion (cardiac part) above the diaphragm , where the esophagus should end.
Hiatal hernia, GERD and related complications are closely related to inappropriate eating habits, overweight and above all visceral obesity ; it follows that, in the event that subjects suffering from GERD and hiatal hernia are characterized by an excess of fat or visceral fat , the first dietary measure useful for correcting their diet is OVERALL ENERGY REDUCTION. Furthermore, it would be desirable to associate:
- the reduction of consumption portions, therefore a reduction in the volume of meals;
- The consumption of very little abundant breakfasts , lunches and dinners, as the excess favors both the appearance and the chronicisation of the symptoms.
- the drastic reduction (better the abolition) of spices , tea and coffee ; these condiments / foods promote both acidity and the release of gastric contents into the esophagus.
- The elimination of the components that REDUCE the tone of the LOWER ESOPHAGEAL SPHINTER, worsening gastric containment and facilitating reflux; they are respectively: cocoa and/or chocolate , cigarette smoke and mint .
- It would also be desirable to follow the dietary advice useful for reducing gastric acidity , for example moderating the portions of high-protein and high-lipid foods (both overcooked and undercooked), limiting alcoholic beverages , paying attention to the digestibility of milk , etc.
Summarizing the guidelines for a diet aimed at reducing the symptoms of GERD (also preventive towards esophagitis and Barrett’s esophagus), we recall that it is ESSENTIAL TO AVOID :
- Fat -rich foods
- Large portions in general and above all of high protein and/or high fat foods , both overcooked and raw
- Coffee, tea, spirits , carbonated and acidic drinks
- Chocolate, mint and spices
- Onion and garlic
- Very cold and very hot foods
- Abundant evening meals and milk before sleep
- To go to bed after meals
- To eat quickly by chewing little
- To perform physical efforts after meals
- Wearing too tight clothes and belts after meals.
N.B. _ Instead, the use of chewing gum is RECOMMENDED as it can facilitate esophageal clearance by stimulating salivation and the frequency of swallowing. A correct lifestyle is able to reduce symptoms in 20-30% of cases .
