Different factors are accountable for the impact of exercise or physical activity on the onset of gastroesophageal reflux disease (GERD), a session of Journées Francophones d'Hépato-gastroentérologie et d'Oncologie Digestive (JFHOD) 2023, a hepato-gastroenterology and digestive oncology conference held in Paris revealed.

 

High-intensity or Vigorous or mostly sports activities have a negative consequence on GERD…

Out of many causes that may weigh into GERD, high-intensity workouts or primarily sports-related activities may affect GERD. About 60% of people who are active in sports have reported GERD symptoms linked to a rise in abdominal pressure due to abdominal contraction that occurs during exercise.

Other pathophysiological factors may include a decline in lower esophageal sphincter (LES) pressure and esophageal motility, along with dissociation phases amongst the LES and the diaphragm (that occurs during most episodes of GERD). It may seem as if sports-linked exercise has a comparatively damaging impact on anti-GERD mechanisms and gastroesophageal junction. But, this does not apply to non-sports-linked exercises.

 

What do studies say?

Keeping in view, only in those people whose GERD has been validated through esophageal pH monitoring, exercise does not seem to considerably affect GERD symptoms or the features witnessed on pH monitoring. This has been established from a study of hundred volunteers whose exercise level was examined with the aid of the International Physical Activity Questionnaire (IPAQ). It was stated utilizing standard metric of metabolic rate by minutes of performance during a week (METs-minute/week).

IPAQ is used to assess exercise and splits patients into 3 groups (low, moderate, or high) as per their level of exercise. It takes into consideration exercise duration but not the category (expert, recreational, etc.) or strength. Thus, it results in a vital methodological issue to consider during the analysis, for instance, of the outcomes of a larger meta-analysis on the matter. This meta-analysis comprised 78000 patients, out of which 10000 presented with symptoms of GERD.

Exercise was found to lower GERD risk by approximately one-third, following the adjustment for body mass index (BMI). It should be noted that adjusting for BMI without providing the non-adjusted data flunks to recognize if exercise decreases the risk of GERD due to its effect on BMI. The data on other complications of GERD, such as Barrett's esophagus or adenocarcinoma are scarce and less robust, with mostly negative case-control studies.

No link was found between nonsports-related exercise and the inception of Barrett's esophagus in two studies. Now it is apparent that vigorous (sports-associated) exercise contributes to GERD by modifying anti-reflux obstacles (LES/diaphragm dissociation) and growing constraints on esophageal junction (abdominal pressure). Regular exercise likely minimizes pathological GERD risk in the general population.

 

There are still a lot of perplexing aspects that need to be resolved…

There are many confusing aspects that the studies often do not address. Factors like age, gender or BMI are included, but a healthy lifestyle (linked to exercise) is never addressed. The same is the case with a high-calorie or high-fat diet (linked to the occurrence of GERD), alcohol intake,  and profession.

Those who regularly exercise possibly eat healthier compared to a sedentary person, which comes with the probability of a reduced risk of GERD symptoms. One thing is for sure, exercise impacts GERD via established pathophysiology. Exercise or physical activity possibly lowers GERD risk but not associated problems in the general population.