Regional Food Causing Symptoms of Gastroesophageal Reflux Disease.

Food is an important contributor to functional gastrointestinal disorders (FGID). Food is associated with symptom onset or exacerbation in a significant proportion of FGID,1 and a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet have been associated with significant symptom improvement in patients with irritable bowel disease.2

However, there are several difficulties in revealing the correlation between food and symptoms of FGID. First, the types of foods consumed is very different depending on race, geographic specificity, diet habit, and culture. Second, there are many other symptom-inducing factors besides food, so it is difficult to see the relationship between symptoms and food alone.3 Lastly, the external condition of the patient will also be important, since psychological stress is widely believed to play a major role in FGID.4

In this issue of Journal of Neurogastroenterology and Motility, Choe et al5 tried to investigate the relationship between gastroesophageal reflux disease (GERD) and regional food, and concluded that hot spicy stews, rice cakes, ramen noodles, fried foods, and topokki were the foods frequently inducing typical symptoms in Korea. These results are consistent with those of previous reports in Western countries that high-fat foods, spicy foods, chocolate, mint, and citrus fruits are closely related to GERD symptoms.6–8

The results of this study were meaningful in that food information that would directly help gastroesophageal reflux patients were provided. However, 3 months’ duration of GERD symptoms, the recall bias, small sample size, heterogeneous participants, possibility of aggravating factor rather than a causative factor, and residual confoundings (eating habits, lifestyle, and genetic risk factors) were major limitations of this paper. Further research considering such problems will be necessary in the future.