University of Palermo, Department of Surgical, Oncological and Oral Sciences, Via Liborio Giuffrè 5, 90127 Palermo, Italy.
Med Hypotheses. 2019 Apr;125:84-88. doi: 10.1016/j.mehy.2019.02.034. Epub 2019 Feb 11.
The habit of snacking and drinking soft beverages between breakfast, lunch and dinner, which is very widespread in the western world, could be a primum movens, thereby contributing to the development and subsequent persistence of gastroesophageal reflux disease (GERD). WHAT DOES THE PROPOSED HYPOTHESIS BASED ON?: The high prevalence of GERD suggests that it is very probably caused by factors, which are intrinsic and widespread in a western lifestyle. Ingesting snacks or imbibing soft drinks between breakfast, lunch and dinner causes additional gastric acid secretion, acid pocket formation, and additional transient lower esophageal sphincter relaxations (TLESRs) with acid reflux; the latter are proportional to the number of ingestions. Moreover, there is increased esophageal acid exposure, which can last up to several hours in a 24-h period. The majority of patients with GERD do not have a hiatal hernia, and TLESRs are the main pathophysiological factor, resulting in an increase in esophageal acid exposure and, therefore, symptoms and the disease. Overweight/obese people very frequently consume snacks and imbibe soft drinks between breakfast, lunch and dinner and they would, therefore, share according to the hypothesis of the authors of this paper. That is, the same eating habit can cause the two conditions obesity and GERD.
Every time a snack is ingested or a soft drink imbibed between the three daily meals, gastric acid is re-secreted, the acid pocket reforms, the TLESRs are triggered again and acid reflux events recur. The greater the number of snacks and/or soft drinks consumed, the greater the esophageal engagement of the cleaning system with, over time, increasing impairment. This mechanism may account for disease onset. According to the hypothesis outlined in this paper, GERD patients should consume moderate portions constituting three meals a day, thereby limiting the quantity of acid reflux from TLESRs.
在早餐、午餐和晚餐之间吃零食和喝软饮料的习惯在西方世界非常普遍，这可能是一个主要的驱动因素，从而导致胃食管反流病（GERD）的发展和随后的持续存在。
提出的假设基于什么？：GERD 的高患病率表明，它很可能是由西方生活方式中内在和普遍存在的因素引起的。在早餐、午餐和晚餐之间吃零食或喝软饮料会导致额外的胃酸分泌、酸口袋形成和额外的短暂性食管下括约肌松弛（TLESRs）伴胃酸反流；后者与摄入次数成正比。此外，食管酸暴露增加，在 24 小时内可长达数小时。大多数 GERD 患者没有食管裂孔疝，TLESRs 是主要的病理生理因素，导致食管酸暴露增加，从而导致症状和疾病。超重/肥胖的人经常在早餐、午餐和晚餐之间吃零食和喝软饮料，因此根据本文作者的假设，他们会有相同的饮食习惯导致肥胖和 GERD 这两种情况。
每次在三餐之间吃零食或喝软饮料，胃酸就会重新分泌，酸口袋重新形成，TLESRs 再次被触发，胃酸反流事件再次发生。摄入的零食和/或软饮料越多，清洁系统与食管的接触就越大，随着时间的推移，损伤会逐渐增加。这种机制可能解释了疾病的发生。根据本文提出的假设，GERD 患者应适量进食，构成一日三餐，从而限制 TLESR 引起的胃酸反流量。
