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Jury Still Out on Whether Coffee Induces Reflux

WebMD Health News

Nov. 29, 1999 (Atlanta) -- Patients with heartburn are often advised by their doctors not to drink coffee, but new research shows that a cup of java has a minimal effect, if any, on acid reflux disease. The findings, published in the November issue of the European Journal ofGastroenterology & Hepatology, conflict with the results of previous studies.

The new research was conducted in the Netherlands and included seven men and women between the ages of 20 and 61 with mild reflux disease and eight participants without the disease. One group consumed coffee and the other drank warm water at standard intervals over 24 hours as a special catheter monitored each participant's esophageal activity. The process was then repeated a week later with participants drinking the other beverage. During this time, standard meals were provided and reflux medication was discontinued.

The investigators found that coffee had no significant effect on esophageal activity except when consumed on an empty stomach by people with reflux disease.

The study's lead researcher emphasizes another factor in reflux. "It's important for people to know that meals consumed during our study induced much more reflux than the coffee did," says Paul Boekema, MD, a gastroenterologist at University Medical Center in Utrecht.

Boekema tells WebMD that one aspect of the study limits the interpretation of the findings. "Physical activity was limited to offset the subjects' age range, yet reflux can be induced just by bending over at the waist. Still, the esophageal activity in the reflux group was very different from that of the control group."

Boekema also says the study builds on previous research. "Our design allowed us to control some additional variables. We ensured that each subject consumed the same amount of coffee, over the same time, and that food intake was identical." Aside from these differences, Boekema says conflicting results may be due to the coffee itself. "Brands and brewing techniques might actually be independent variables. In future studies, standardization would yield more reliable data and facilitate better comparison."

In a previous study, German researchers showed that coffee consumed in large quantities in a short time did induce reflux in coffee-sensitive patients. In a subsequent study, regular coffee was shown to induce reflux in 16 people without heartburn. With the same design, decaffeinated coffee was shown to reduce reflux in subjects with heartburn.

So what should heartburn patients do? According to the researchers of the current study, they should simply enjoy regular or decaffeinated coffee if their system can tolerate it.

Another doctor says that toleration may vary from person to person. "Anecdotal reports from patients indicate that coffee exacerbates reflux, although individual tolerance seems to vary," says David Nelson, MD. Nelson is an assistant professor of family medicine and emergency medicine at the Medical College of Virginia in Richmond. "It's probably a good idea to cut back during flare-ups and reintroduce it slowly to learn how much is too much."

"We don't really know why coffee exacerbates reflux. It may be caffeine, oils, and/or some aspect of processing. But patients seem to do better with decaf," says Vincent Barba, MD, an internist and clinical assistant professor of medicine at the New Jersey Medical School in Newark. "Until we know more, [reducing coffee intake] just seems like the prudent thing to do. Besides, it's better for health overall."

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