Esophagitis is an inflammatory lesion that affects the tissues of the esophagus.
Belonging to the digestive tract, the esophagus represents the duct which (thanks to a peristaltic action) carries food from the mouth to the stomach.
Esophagitis can cause pain and difficulty in swallowing, and chest pain.
The causes for which it occurs are attributable to gastroesophageal reflux disease (GERD), infections, autoimmunity, use of certain oral medications and some allergies.
Treatment for esophagitis depends on the underlying cause and the severity of the tissue damage. Most of the time, a diet against gastroesophageal reflux is needed.
Left untreated, esophagitis can damage the mucosa, interfere with normal esophageal function, and induce various complications (scarring, strictures, and difficulty swallowing).
Esophagitis and GERD
Normally, the acidic contents of the stomach are isolated from the esophagus by a valve structure called the lower esophageal sphincter.
If this valve does not close properly or opens out of time, stomach contents can flow back into the esophagus causing gastroesophageal reflux.
When acid reflux becomes frequent or continuous, the condition is called gastroesophageal reflux disease (GERD).
The main complications related to this pathology are chronic inflammation and tissue damage. Remember that GERD is related to the onset of Barrett's esophagus, which in turn predisposes cancer of the esophagus.
For the prevention and treatment of reflux oesophagitis, the most important factor is undoubtedly the dietary and behavioral factor.
Risk factors for reflux esophagitis are:
- Hiatal hernia: sometimes congenital or independent of diet, but other times caused by incorrect nutritional habits
- Night feeding: typical of evening / night workers; for example catering technicians
- Any meals taken before bed (including lunch followed by afternoon sleep)
- Too large portions and meals
- Hardly digestible meals
- Harmful nutritional molecules
- Foods that are too cold or too hot
- Tight clothing in the abdomen, especially at meals
- Stomach acidity
How to organize the diet
Fragmentation of Meals and Reduction of Portions
The portions and meals of those suffering from reflux esophagitis should be moderate.
To avoid distorting the energy intake, this dietary correction is based on:
- Increase in the number of courses at each meal
- Increase in the number of meals, giving more importance to secondary ones.
The table shows an example of switching the normal diet to that for esophagitis. The energy intake remained unchanged, the nutritional quality increased, and meals and courses were divided
|PREVIOUS DIET||DIET FOR REFLUXE ESOPHAGITIS|
|Breakfast: 350ml whole milk, coffee, 6 rusks with hazelnut spread||Breakfast: 200ml soy milk, 30g corn flakes,|
|Snack I: 1 apple, 1 low-fat milk yogurt and 6 biscuits|
|Lunch: 150g amatriciana pasta||Lunch: 200g tuna fillet, 200g of grilled vegetables|
|Snack II: 1 pear, 1 low-fat milk yogurt and 6 biscuits|
|Dinner: 400g rib of beef, 200g grilled vegetables, 4 slices of bread and 2 glasses of red wine||Snack III: 4 slices of bread with 8 slices of bresaola|
|Dinner: 80g tomato pasta, 50g lettuce and 100g chicken breast|
The reflux esophagitis diet requires an increase in overall digestibility; in this regard, it is necessary to make the following changes:
- Decrease portions and total meal volume (see above)
- Choose foods that are more digestible, while keeping the same food group. Eg:
- Replace whole milk with semi-skimmed or skimmed milk (vegetable only if reinforced with calcium and riboflavin).
- Replace the brioches with low-fat bread and jam.
- Replace fatty pork (such as ribs) with chicken breast.
- Replace the omelette with soft-boiled eggs.
- Replace fatty cheeses (such as gorgonzola) with light cottage cheese or lean ricotta.
- Replace vegetables with poorly digestible peel (peppers, tomatoes, aubergines, etc.) with the same peeled ones or with others that are easier to digest (zucchini, chicory, fennel, etc.).
- Reduce total fat to 25% of total calories. If in excess, the lipids increase the residence time in the stomach. To achieve this dietary result, it is sufficient to use only lean foods and season each recipe with 5g of extra virgin olive oil.
- Bring a share of fiber that is around 30g / day. These, if in excess, hinder gastric emptying. If the intake of fruit and vegetables is normal, it is better not to overdo it with whole foods and legumes that are still peeled.
- Replace animal fats with extra virgin olive oil. Not everyone knows that this product, in normal portions, is able to improve digestion as it favors the emulsion of other lipids.
- Use low-fat cooking methods that are effective enough to allow protein denaturation, but not excessive.
Proteins are nutrients that require gastric digestion (carbohydrates and fats don't need them). Cooking is a physical process that allows you to denature proteins and increase their digestibility. This benefit does NOT occur if the heat treatment is insufficient or excessive.
The most suitable systems are: boiling, steam, pressure, bain-marie, vacuum-packed and in jars.
NB. Grinding is also a physical treatment that increases the digestibility of protein foods.
- Place the meal with the highest protein content at lunch, while the one with the highest carbohydrates (and therefore more digestible) at dinner.
Other Foods to Avoid
In addition to those mentioned in the previous chapter, there is a range of foods that worsen the state of reflux oesophagitis:
- Ethyl alcohol: alcoholic beverages increase gastric acidity and promote reflux, which is why they should be abolished.
- Coffee, Tea, Cocoa: due to the presence of caffeine, theophylline and theobromine, even if in a less evident way than alcohol, they increase acidity and gastric contraction.
- Energy Drink: for the same reasons as coffee, tea and cocoa.
- Carbonated drinks: create an increase in pressure in the stomach and tend to accentuate the rise of the gastric contents into the esophagus.
- Spicy spices: this is the case of chilli, pepper, horseradish, onion, garlic and ginger. They irritate both the lining of the stomach (increasing acidity) and that of the esophagus. Generally, it is recommended to reduce spices (including mixed ones).
- Mint: has a favorable action on gastroesophageal reflux.
- Other foods: although there is no logical explanation, it seems that certain foods worsen reflux and esophagitis. Among these we recognize acidic foods such as tomatoes (especially preserved ones) and citrus fruits. In theory, the gastric mucosa should tolerate much lower pHs (gastric acid is about 1-2, while tomato juice barely reaches 3,9); nevertheless, most people with reflux oesophagitis report worsening of symptoms with each intake.
Other articles on 'Diet for Esophagitis'
- Medicines for the treatment of Barret's esophagus
- Esophagitis: diagnosis and treatment
- Medicines for the treatment of esophagitis
- Barrett's esophagus