Food Sensitivity and Reflux

Reflux is a disorder where the stomach’s contents “reflux” or flow back into the esophagus.  The lining of the stomach is coated with a mucous layer so that the acid content does not irritate it while the esophagus does not have this protection.  While it is typically assumed that it is the high acidity of the stomach contents that causes the generation of symptoms in the esophagus, that is not always the case.  One other common cause is an inflammatory reaction triggered by a food sensitivity.

A food sensitivity is similar to a food allergy in that it is an inappropriate immune response against some food molecule, and the immune reaction typically causes symptoms.  They are distinct from food allergies in that they involve an immune response by a different part of the immune system than allergy, and their manifestations are typically delayed and slow onset which makes their diagnosis challenging.

Food sensitivities typically cause digestive symptoms, although they may also cause symptoms such as eczema/rash, joint pain, brain fog, mood disorders and many others.  A common digestive symptom complex associated with food sensitivities is reflux with about 1 in 3 patients having these symptoms.

 

The idea that food sensitivity could cause the reflux symptom complex has been supported by research for many years.  A significant number of patients with symptoms of reflux do not respond to treatment which reduces stomach acid such as proton pump inhibiting drugs (PPIs).

The early immune response to foods trigger mainly inflammation which may produce pain, burning, cough and sinus drainage.  The later stages of this immune reaction may trigger the infiltration of eosinophils which are a type of white blood cells commonly involved in allergies.  If this becomes pronounced, it is called eosinophil esophagitis which is known to be associated with immune food reactions.

Many persons with reflux symptoms associated with food sensitivities will have other digestive symptoms such as abdominal bloating, discomfort and nausea, while other persons only have classic reflux symptoms.  While the use of acid inhibiting drugs may reduce symptoms, they are also associated with important adverse effects with ongoing use.  If it is a food induced reaction, the ideal treatment is for that to be identified and the offending food avoided.

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