Gastroesophageal reflux is a very common disorder and occurs often in the working age group. This condition also strongly depends on our lifestyle and by situations or times of anxiety and stress.

Dr. Beatrice Salvioli , gastroenterologist in Humanitas, discussed this during the television program Whole Health on Rai 3 Italian network.


What are the typical symptoms of gastroesophageal reflux?

“There are some typical symptoms sufficient to make a diagnosis of gastroesophageal reflux: these are burning behind the chest and acid regurgitation in the mouth.

In addition to these symptoms there are those so-called atypical or extraesophageal symptoms. Furthermore your respiratory system could be affected. You could experience dry coughing, hacking, asthmahoarseness, deepening of the voice, the need to clear your throat, as well as insomnia“.


What tests can be done to diagnose the reflux?

“The only diagnostic test is endoscopy, ie the insertion of a tube through the mouth with a small camera. This explores the walls of the esophagus, stomach and upper digestive tract. However, in 70% of cases you do not see anything because in reality, the diagnosis is clinical”.


If I have a cough or my voice is deepening who should I see?

“It usually is means you should see a otolaryngologist. They will use specialized tools to view the upper airways and run diagnostics for laryngitis (ie inflammation of the larynx) compatible with gastroesophageal reflux.”


What are the main causes of reflux?

“There may be an anatomical cause, such as a laxity (a weakness) of certain tissues such as those controlling the esophageal sphincter. This is a small valve located between the esophagus and the stomach. When we eat, as there is acid in the stomach, usually we have small reflux of acid in the esophagus. The problem arises when these reflux actions increase. This is due to the fact that the valve does not seal well because of the ligaments in the diaphragm level. Another cause can be slow digestion“.


Is there a link between reflux and stress?

“It is not easy to establish a cause-effect relationship between stress and gastroesophageal reflux. Certainly stress is a real condition and it is not only psychological and physical, but also due to hormone level problems, and nerve endings and impulses. So our digestive system, which is our “second brain”, can be upset.”


Can reflux be associated hiatal hernia?

Yes, when it no longer runs through the esophageal sphincter. The hiatal hernia is when part of the stomach passes up through the sphincter. The hernia can be small or very large (5 or 6 cm). Small hiatal hernias are very frequent and cause no problems. ”


Is being overweight a possible cause for reflux?

“Being overweight is another serious factor in the sense that it increases the intra-abdominal pressure. For example in pregnant women, the stomach is squeezed, predisposing it to reflux.”


And anxiety?

“When we have a situation of anxiety breathing and the diaphragm tend to block which creates an air lock. However, we can not claim that the anxiety itself causes reflux. ”


At what age is reflux more frequent?

“Reflux is more frequent in working ages, but also in children. In this second case it is a physiological reflux: the esophageal sphincter is forming and consolidates in the first two years of life. For this reason children have “regurgitation”. For example when the passage of the milk into the esophagus is blocked and there is leakage from the mouth. A recommended way to avoid it is to put the baby in a crib on its back, lifting by placing a pillow behind their back so you hold it up to 30°”.


What are the foods that increase the risk of reflux?

“There are so-called acidic foods, which induce an acid reaction and create more discomfort than others in a situation of inflammation of the stomach. The foods to avoid or eliminate are:

  • coffee
  • tomato
  • citrus
  • alcohol and spirits
  • fat and smoked meats
  • chocolate
  • mint
  • sausages
  • fat cheeses, fermented and spicy
  • sauces and gravies prepackaged


Can you give us some food tips?

“It would be better to avoid consuming coffee in the morning, because it increases the production of hydrochloric acid. Also anything associated with milk makes for a very long digestion.

You must eliminate anything that slows digestion, as well as fat.

The same is true for fiber that’s generally good. Reflux sufferers have a hard time tolerating it because it is difficult to digest and creates a traffic jam in the stomach.

Many have the habit of consuming fruit after a meal. It is a mistake because it tends to ferment and slow digestion. It should rather be taken at the beginning of the meal.

Finally: drink between meals, because the water dilutes the gastric juices causing slow digestion”.


Is chocolate bad?

“Being an acidic food it is not good if you suffer from gastritis or reflux because it worsens the symptoms. Especially during times when you are re-adjusting, such as the change of seasons. Surely it is to be avoided after a meal”.


What are the most appropriate medications to counter reflux?

“The most suitable drugs are those that block the acidity. It is however a symptomatic drug, that is blocking the symptom but not the cause. They are: the proton pump inhibitors, the antacid, and the H2 antagonists. The first are on the market for many years and have been used by hundreds of millions of people. They are excellent gastroprotectives that inhibit long acidity. They must always be prescribed by your doctor. Antacids both in the form of tablets or sachets to be dissolved in water have the property of inducing immediate relief of symptoms”.