Michael Reed Leader
The Association between Food Allergy and Gastroesophageal Reflux Disease
Several authors have implicated gastroesophageal reflux disease (GERD) as a potential trigger of allergic asthma, but none of the studies critically considered an allergic etiology for gastroesophageal reflux. Moreover, anecdotal reports have suggested that food allergy may be a contributing factor in the pathogenesis of reflux disease in a subset of patients. This project sought to determine the role of food allergy in the etiology of GERD. The initial hypothesis was that reflux episodes are mediated by a type I response triggered by specific food allergens. This project consisted primarily of a literature search; over 100 medical journal and textbook articles were examined for possible associations between GERD and food allergy. In addition, 25 volunteers were interviewed about their personal allergy and reflux histories in order to establish an epidemiological database. Furthermore, several mammals were dissected in order to gain a better understanding of the anatomy of the upper GI tract. The literature search revealed a number of associations between GERD and food allergy. For example, there is an explicit pathophysiologic connection between GERD and cow’s milk allergy in children. Moreover, there is much evidence to support an interaction between GERD and food allergy in the etiology of allergic eosinophilic esophagitis. Also, a genome study mapped the GERD gene to a region on chromosome 13q, which also contains several candidate genes for asthma and atopy. For the volunteer interviews, only 7 (28%) of the 25 cases seemed to support my working hypothesis to some degree, while the majority (72%) did not support a concrete role for food allergy in the etiology of GERD.