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Sugar is a risk factor for reflux disease and esophageal cancer

19.11.2017 by Reflux Medical

Accurate diagnosis (patient history, Endoscopy, manometry and Reflux test of the esophagus) enable a tailored therapy (medical, surgical) (1).

Recent data (2-4) indicate that nutrition plays an important and outstanding role for the development of GERD and esophageal cancer. As such recent studies demonstrated a positive correlation between regular intake of food and beverages containing:

  • concentrated sugar,
  • sweeteners,
  • artificial sugars


  • the development of GERD and Barrett‘s esophagus.


Thus, the recent data (1-4) justify the inclusion of low carb diet into the therapy and management of GERD and Barrett‘s esophagus, as performed in our center.

Feel free to contact us for further informations regarding your GERD, Barrett‘s esophagus and dietary management.



1. Springer Paper Riegler Schoppmann,

2. Eur J Epidemiol. 2017 Sep 1. doi: 10.1007/s10654-017-0301-8. [Epub ahead of print]

Dietary sugar/starches intake and Barrett's esophagus: a pooled analysis.

Li N1, Petrick JL2, Steck SE3, Bradshaw PT4, McClain KM5, Niehoff NM5, Engel LS5, Shaheen NJ5,6, Corley DA7, Vaughan TL8, Gammon MD5.

Author information


Barrett's esophagus (BE) is the key precursor lesion of Esophageal adenocarcinoma, a lethal cancer that has increased rapidly in westernized countries over the past four decades. Dietary sugar intake has also been increasing over time, and may be associated with these tumors by promoting hyperinsulinemia. The study goal was to examine multiple measures of sugar/starches intake in association with BE. This pooled analysis included 472 BE cases and 492 controls from two similarly conducted case-control studies in the United States. Dietary intake data, collected by study-specific food frequency questionnaires, were harmonized across studies by linking with the University of Minnesota Nutrient Database, and pooled based on study-specific quartiles. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race, total energy intake, study indicator, body mass index, frequency of gastro-esophageal Reflux, and fruit/vegetable intake. In both studies, intake of sucrose (cases vs. controls, g/day: 36.07 vs. 33.51; 36.80 vs. 35.06, respectively) and added sugar (46.15 vs. 41.01; 44.18 vs. 40.68, respectively) were higher in cases than controls. BE risk was increased 79% and 71%, respectively, for associations comparing the fourth to the first quartile of intake of sucrose (ORQ4vs.Q1 = 1.79, 95% CI = 1.07-3.02, P trend = 0.01) and added sugar (ORQ4vs.Q1 = 1.71, 95% CI = 1.05-2.80, P trend = 0.15). Intake of sweetened desserts/beverages was associated with 71% increase in BE risk (ORQ4vs.Q1 = 1.71, 95% CI = 1.07-2.73, P trend = 0.04). Limiting dietary intake of foods and beverages that are high in added sugar, especially refined table sugar, may reduce the risk of developing BE.


Added sugar; Barrett’s esophagus; Diet; Sweetened desserts/beverages

Int J Epidemiol. 2017 Sep 23. doi: 10.1093/ije/dyx203. [Epub ahead of print]


3. A pooled analysis of dietary sugar/carbohydrate intake and esophageal and gastric Cardia adenocarcinoma incidence and survival in the USA.

Li N1, Petrick JL2, Steck SE3, Bradshaw PT4, McClain KM1, Niehoff NM1, Engel LS1, Shaheen NJ1,5, Risch HA6, Vaughan TL7, Wu AH8, Gammon MD1.

Author information



During the past 40 years, esophageal/gastric Cardia adenocarcinoma (EA/GCA) incidence increased in Westernized countries, but survival remained low. A parallel increase in sugar intake, which may facilitate carcinogenesis by promoting hyperglycaemia, led us to examine sugar/carbohydrate intake in association with EA/GCA incidence and survival.


We pooled 500 EA cases, 529 GCA cases and 2027 controls from two US population-based case-control studies with cases followed for vital status. Dietary intake, assessed by study-specific food frequency questionnaires, was harmonized and pooled to estimate 12 measures of sugar/carbohydrate intake. Multivariable-adjusted odds ratios (ORs) and hazard ratios [95% confidence intervals (CIs)] were calculated using multinomial logistic regression and Cox proportional hazards regression, respectively.


EA incidence was increased by 51-58% in association with sucrose (OR Q5vs.Q1  = 1.51, 95% CI = 1.01-2.27), sweetened desserts/beverages (OR Q5vs.Q1  = 1.55, 95% CI = 1.06-2.27) and the dietary glycaemic index (OR Q5vs.Q1  = 1.58, 95% CI = 1.13-2.21). Body mass index (BMI) and gastro-esophageal Reflux disease ( GERD) modified these associations ( Pmultiplicative- interaction  ≤ 0.05). For associations with sucrose and sweetened desserts/beverages, respectively, the OR was elevated for BMI < 25 (OR Q4-5vs.Q1-3  = 1.79, 95% CI = 1.26-2.56 and OR Q4-5vs.Q1-3  = 1.45, 95% CI = 1.03-2.06), but not BMI ≥ 25 (OR Q4-5vs.Q1-3  = 1.05, 95% CI = 0.76-1.44 and OR Q4-5vs.Q1-3  = 0.85, 95% CI = 0.62-1.16). The EA-glycaemic index association was elevated for BMI ≥ 25 (OR Q4-5vs.Q1-3  = 1.38, 95% CI = 1.03-1.85), but not BMI < 25 (OR Q4-5vs.Q1-3  = 0.88, 95% CI = 0.62-1.24). The sucrose-EA association OR for GERD < weekly was 1.58 (95% CI = 1.16-2.14), but for GERD ≥ weekly was 1.01 (95% CI = 0.70-1.47). Sugar/carbohydrate measures were not associated with GCA incidence or EA/GCA survival.


If confirmed, limiting intake of sucrose (e.g. table sugar), sweetened desserts/beverages, and foods that contribute to a high glycaemic index, may be plausible EA risk reduction strategies.


Sucrose; Esophageal adenocarcinoma; glycaemic index; sweetened desserts/beverages


4. Send to Curr Med Chem. 2017 May 15. doi: 10.2174/0929867324666170515123807. [Epub ahead of print]

Food and Gastroesophageal reflux disease.

Surdea-Blaga T1, Negrutiu DE1, Palage M2, Dumitrascu DL1.

Author information


Gastroesophageal reflux disease is a chronic condition with a high prevalence in western countries. Transient lower esophageal sphincter relaxation episodes and a decreased lower esophageal sphincter pressure are the main mechanisms involved. Currently used drugs are efficient on Reflux symptoms, but only as long as they are administered, because they do not modify the Reflux barrier. Certain nutrients or foods are generally considered to increase the frequency of gastroesophageal Reflux symptoms, therefore physicians recommend changes in diet and some patients avoid bothering foods. This review summarizes current knowledge regarding food and gastroesophageal Reflux. For example, fat intake increases the perception of Reflux symptoms. Regular coffee and chocolate induce gastroesophageal Reflux and increase the lower esophageal exposure to acid. Spicy foods might induce Heartburn, but the exact mechanism is not known. Beer and wine induce gastroesophageal Reflux, mainly in the first hour after intake. For other foods, like fried food or carbonated beverages data on gastroesophageal Reflux is scarce. Similarly, there is few data about the type of diet and gastroesophageal Reflux. Mediterranean diet and a very low carbohydrate diet protect against Reflux. Regarding diet-related practices, consistent data showed that a "short-meal-to-sleep interval" favors Reflux episodes, therefore some authors recommend that dinner should be at least four hours before bedtime. All these recommendations should consider patient's weight, because several meta-analysis showed a positive association between increased body mass index and Gastroesophageal reflux disease.

Copyright© Bentham Science Publishers; For any queries, please email at


Gastroesophageal reflux disease; alcohol; chocolate; coffee; diet; fat intake; Heartburn

PMID: 28521699 DOI: 10.2174/0929867324666170515123807

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