Jury Still Out on Whether Coffee Induces Reflux
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
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
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
"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."