If you have gastroesophageal reflux disease, or GERD, you are at risk for developing Barrett esophagus. This is a condition in which the cells that line the esophagus, the tube that connects your mouth and stomach, change to the type of cells that line your intestines. These abnormal changes can occur in people with severe and longstanding acid reflux -- in response to the esophagus being repeatedly exposed to the harsh and regurgitated stomach contents. Although there are no specific diet recommendations for Barrett esophagus, certain diet modifications, such as avoiding meals within 2 to 3 hours of bedtime, might help manage or prevent GERD symptoms. Many foods and beverages have been implicated in worsening symptoms of acid reflux, yet these restrictions are not backed up by research. However, over time you may identify certain foods or beverages that worsen your symptoms, so you can tailor your diet accordingly.
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Individual Tolerance of Foods
Because GERD is the cause of Barrett esophagus, the foods that trigger your acid reflux are best omitted from your diet. However, the American College of Gastroenterology in its 2013 clinical practice guidelines advises against universally restricting specific foods for GERD symptom relief. Instead, these guidelines acknowledge that an individual approach is useful. You might benefit from keeping a daily journal of your food choices, including the times of your meals and your symptoms. If you find that a specific food triggers your GERD symptoms, a trial to eliminate the offending food may be in order so you can learn what works for you.
Fatty and Spicy Foods
Fatty foods have long been believed to worsen acid reflux, as high-fat meals stay in the stomach longer. A high-fat meal -- regardless of the type of fat -- could increase pressure on the stomach and make reflux of stomach contents more likely. Another common belief is that spicy foods, such as cayenne pepper, onion or garlic, trigger acid reflux. You might even notice that both spicy and fatty foods, such as pizza or sausage, worsen your symptoms. While the American College of Gastroenterology's stance is that specific foods may not need to be avoided, its guidelines support avoiding high-fat meals 2 to 3 hours before bedtime to minimize GERD symptoms.
Alcohol and caffeine are known to cause relaxation of the muscular band at the bottom of the esophagus. If this band is not tightly closed, stomach contents are more likely to travel up into the esophagus. Certain caffeinated drinks can also increase acidity of stomach contents. As a result, these beverages have long been suspected of worsening symptoms of GERD. According to American College of Gastroenterology guidelines, however, avoiding alcohol or caffeine has not been proved to improve symptoms.
Because carbonated drinks can cause increased pressure and bloating in the stomach, these beverages have been linked to aggravating acid reflux. However, a March 2010 review in "Alimentary Pharmacology and Therapeutics" summarized that there is no direct evidence that carbonated beverages cause or worsen GERD. If you notice worsened symptoms after consuming a certain type of beverage, a trial elimination can be helpful to individualize management of your GERD.
Historically, many other foods have been linked to worsening GERD symptoms. Lentils and other legumes have been blamed on worsened symptoms because they cause gas and bloating, presumably making reflux into the esophagus more likely. A diet high in salt has been linked to an increased risk of acid reflux. Chocolate and mint often make the list of foods to avoid with acid reflux, since these foods are believed to relax the muscle that connects the esophagus and stomach. Acidic foods, such as citrus or tomato sauce, while not a direct cause of reflux, are commonly blamed for irritating an already damaged esophagus. However, an extensive review published in the May 2006 "Archive of Internal Medicine" concluded that there is little evidence that most commonly prescribed diet restrictions help improve GERD symptoms.
Treatment of Barrett Esophagus
Barrett esophagus is caused by serious and longstanding GERD and, if left untreated, can increase the risk of esophageal cancer. Work with your doctor on a strategy to manage your GERD. Lifestyle management of GERD includes weight loss, elevation of the head of the bed and avoidance of late-night meals. Eliminating certain foods may help if you find they worsen your symptoms. Some people find they can relieve their heartburn with cilantro, ginger, parsley and even chewing gum. If you have GERD, your doctor will most likely prescribe an over-the-counter or prescription medication as part of your treatment program. In some cases, surgery may be recommended. See your doctor right away if you have frequent and persistent heartburn, or if your current lifestyle and medication management are not controlling your symptoms. Also, regular medical care and follow-up is essential if you have been diagnosed with Barrett esophagus.
Medical advisor: Jonathan E. Aviv, M.D., FACS