Gastroesophageal reflux consists of the involuntary and repetitive return of the stomach contents to the esophagus. The most common symptom is heartburn (painful burning sensation and relatively short duration radiating behind the sternum), with or without regurgitation of gastric contents to the mouth. His symptomatology also includes chest pain, hiccups, coughs after meal, hoarseness and greater intensity of symptoms at bedtime. Moreover, the female sex is more susceptible to the development of the pathology, as well as bad life habits, smoking, sedentary lifestyle and medication abuse are risk factors.
Its pathophysiology, in turn, is due to the defect of one or more defense mechanisms of the esophagus, among them: dysfunction of the antireflux barrier, peristaltic movements or resistance mechanisms that are present in the esophageal epithelium (mucus, bicarbonate, firm intercellular junctions, blood supply).
Proton Pump Inhibitors
Acid suppressor drugs predominate for the treatment of these conditions, known as proton pump inhibitors, popularly known as “prazois” or, scientifically, IBPs. These act in the suppression of gastric acid secretion by specific inhibition of the enzyme H+/K+ – ATPase on the secretory surface of the gastric parietal cell, being able to reduce almost completely the production of hydrochloric acid in the stomach.
However, the inappropriate use of this type of medication is worrisome, since it acts to block the release of acid until the synthesis of new enzymes is prevented, which culminates in the development of gastric hypochlorhydria.
Gastric hypochlorhydria
This condition consists of one of the possible consequences of prolonged use of “prazois”, characterized by fasting gastric pH above 4, common also in patients with H. pylori, autoimmune/atrophic gastritis and HIV infected. In addition, when hypochlorhydria occurs for prolonged periods, it is possible to observe several chemical changes such as dysbiosis, compromised digestion and absorption process (mainly for calcium, iron and vitamin B12) and greater susceptibility to infections.
Clinical practice
In the case of nutritional management, the aim of reducing the exposure of the esophagus to gastric contents is necessary, for this, it is necessary to avoid the performance of high volume meals with high concentrations of lipid. In addition, to reduce the acidity of gastric secretions, coffee and alcoholic beverages should be avoided, as well as to analyze the individual tolerance of each patient to certain foods.
For supplementation, the literature approaches the use of melatonin, because it presents an inhibiting action on gastric acid secretion and positive effects on ulcer healing. Tryptophan, vitamins B6 and B12, have analgesic effect and can help in the relief of acute pain due to promoting a greater availability of norepinephrine and serotonin, inhibitory neurotransmitters in the nociceptive system. In addition to the indication of aloe vera, psyllium, turmeric and probiotics are also effective in the management of gastroesophageal reflux.
Bibliographic references
Reading Suggestion:
Diet in gastrointestinal diseases
Watch Denise de Carvalho’s lecture on the Science Play platform –
Hypochlorhydry and the low protein use of the diet: causes and solutions
Pereira Rde S.
Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole.
J Pineal Res. 2006 Oct;41(3):195-200. doi: 10.1111/j.1600-079X.2006.00359.x. PMID: 16948779.
