- In a prospective cohort of 48,308 women participating in the Nurses' Health Study II, coffee, tea and soda consumption were each associated with significantly increased risk of gastroesophageal reflux (GER) symptoms
- In contrast, there were no associations between GER symptoms and consumption of water, milk or juice
- Substitution of coffee, tea or soda with water led to modest reductions in the risk of GER symptoms
Patients often ask how beverage choices affect gastroesophageal reflux (GER) symptoms, but the question has never been addressed in a prospective study. Accordingly, practice guidelines of the American College of Gastroenterology and the American Gastroenterological Association do not recommend routine reduction or elimination of specific beverages to prevent or minimize GER symptoms.
By analyzing data from the Nurses' Health Study II, Raaj S. Mehta, MD, fellow in the Division of Gastroenterology at Massachusetts General Hospital, Andrew T. Chan, MD, MPH, director for Cancer Epidemiology in the Mass General Cancer Center, chief of the Clinical and Translational Epidemiology Unit (CTEU) in the Department of Medicine and vice chief for clinical research in the Division of Gastroenterology, and colleagues have documented that coffee, tea and soda consumption are each associated with increased risk of GER symptoms. Their research is published in Clinical Gastroenterology and Hepatology.
The Nurses' Health Study II is an ongoing prospective cohort study of female registered nurses that began in 1989. Every two years the participants complete questionnaires about lifestyle exposures, medical history and newly diagnosed diseases, and every four years they complete a validated food and beverage frequency questionnaire.
For the current analysis, the research team examined data from 2007 to 2013 on 48,308 study participants who were 42–62 years old in 2007. Prior to 2007, they were free of regular GER symptoms, free of cancer and not using proton pump inhibitors or histamine H2-receptor agonists.
In the 2005, 2009 and 2013 questionnaires, participants were asked, "In the last year, how often have you had heartburn or acid reflux?" The answer choices were "None in the past year," "Less than once/month," "About once/month," "About once/week," "Several times/week" or "Daily." 7,961 participants reported at least weekly symptoms and were analyzed as cases.
In the comparison of participants who consumed more than six servings/day with those who consumed no servings, adjusted hazard ratios for GER were:
- Coffee: 1.34 (95% CI, 1.13–1.59; P for trend < .0001)
- Tea: 1.26 (95% CI, 1.03–1.55; P for trend = .001)
- Soda: 1.29 (95% CI, 1.05–1.58; P for trend < .0001)
For increments of two servings/day, hazard ratios were 1.06 for coffee, 1.07 for tea and 1.11 for soda.
The results were similar for caffeinated versus decaffeinated coffee and soda. Interestingly, consumption of decaffeinated tea was associated with a higher risk of GER compared with caffeinated tea consumption.
The association between coffee, tea or soda consumption and GER did not vary according to selected GER risk factors: smoking status, body mass index, use of menopausal hormone therapy or use of medications that may relax the lower esophageal sphincter (calcium channel blockers, benzodiazepines and antidepressants).
There was no association between GER and other common beverages, including water, milk or juice. In fact, replacing two servings of coffee, soda or tea with two servings of water was associated with reduced risk of GER by 4% for coffee and tea and 8% for soda.
Takeaways for Clinicians
The risk of heartburn and acid reflux is beverage-specific and seems to increase with a greater number of servings of coffee, tea or soda per day. Contrary to popular opinion, citrus juice does not seem to increase the incidence of GER symptoms.
Clinicians should consider advising patients who have GER symptoms to drink more water in place of coffee, tea and soda, especially if they are currently consuming four or more servings of any of those beverages per day.
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