A possible role of food intolerance in the pathogenesis of gastroesophageal reflux disease.

To the Editor: Gastroesophageal re ux disease (GERD) is an extremely common condition characterized by symptoms of heartburn and acid regurgitation. ˜ e etiopathogenetic steps of GERD remain largely unknown even though up to 20 % of the adult population in Western coun-tries is thought to be a( ected by re ux symptoms on a weekly basis (1) , natural-history studies indicate that patients with GERD symptoms su er from a chronic relapsing course of disease, with at least 50 % remaining on continuous medical therapy (2) , and the condition is known to predispose to an increased cancer risk. We know that GERD is caused by an abnormal contact of gastrointestinal contents with esophageal mucosa, and insu cient clearance of the esophageal body, lower esophageal sphinter incom-petence, and delayed gastric emptying have been identi- ed as putative patho-physiological mechanisms of disease, but the exact etiology of this backward displacement of gastrointestinal contents has yet to be elucidated. Because a possible role for food intol-erance in the etiology of GERD has not, to our knowledge, been investigated, and the so-called typical symptoms are con-sidered speci c, although not sensitive, for the diagnosis (3) , we decided to retro-spectively evaluate the results of a leuko-cytotoxic test for food intolerance using a panel of 60 foods (Allergoline Biotech & Research, Modena, Italy). ˜ e test was performed at the local center of a food ple that has come into direct contact with speci c food substances. On the basis of observation of the leukocytes, degrees of reaction to the food extracts are rated according to the following scale: level 0 = n egative ,level 1 = s lightly positive, level 2 = m oderately positive ,and level 3 = highly positive .˜ ese levels corre-spond to (i) the state of the leukocytes, which react by swelling, then developing research group, ACSIAN (Associazione Centro Studie Ricerche delle Intolleranze Alimentari e della Nutrizione) , from the date of the opening of the center in April 2007 to April 2008, in 16 patients su ering from typical GERD symp-toms (heartburn and regurgitation, in the absence of dysphagia) and 7 healthy subjects. ˜ is test is based on the optical evaluation of leukocytes in a blood sam-