Apple juice acid reflux
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Apple Juice and Acid Reflux: Insights from Recent Research
Apple Juice and Gastroesophageal Reflux in Children
Postcibal Gastroesophageal Reflux (GER) in Children
Research has shown that apple juice can significantly influence gastroesophageal reflux (GER) in children. A study involving both asymptomatic children and those with GER symptoms found that apple juice feedings led to frequent GER episodes for up to 2 hours post-consumption in asymptomatic children, and even longer in symptomatic children1. This suggests that apple juice may exacerbate GER symptoms, particularly in children already prone to reflux.
Comparison with Milk-Formula Feedings
When comparing apple juice to milk-formula feedings, it was observed that milk-formula resulted in decreased esophageal acidity during the first 2 hours post-consumption. However, beyond this period, the type of feeding did not significantly affect GER in asymptomatic children1. This indicates that while milk-formula may offer temporary relief from acidity, apple juice tends to maintain or increase GER episodes shortly after consumption.
Gastric Emptying and GER
Gastric Emptying Rates
Another study examined the relationship between gastric emptying and GER in children, using apple juice as a test liquid. The findings revealed that the measured gastric emptying rates of apple juice were similar in both normal children and those with GER, regardless of the GER pattern type2. This suggests that apple juice does not necessarily slow down gastric emptying in children with GER.
Effective Gastric Emptying
Interestingly, the study also found that many children with GER demonstrated increased effective gastric emptying when postcibal reflux was accounted for. This was particularly evident in children with type I, II, and III GER patterns, indicating that while apple juice may not slow gastric emptying, it could still contribute to reflux episodes2.
Acid Resistance of Pathogens in Apple Juice
Salmonella spp. Adaptation
Research has also explored the survival of pathogens like Salmonella spp. in apple juice. It was found that Salmonella serovars adapted in apple juice displayed enhanced acid resistance when exposed to simulated gastric fluid (SGF)3. This adaptation could potentially increase the risk of Salmonella outbreaks, as the pathogens become more resilient in acidic environments like the human stomach.
Escherichia coli O157:H7 Survival
Similarly, studies on Escherichia coli O157:H7 have shown that this pathogen can survive better in apple juice compared to other acidic environments. The survival rate was particularly high when the juice was stored under refrigerated conditions, suggesting that apple juice constituents other than organic acids may protect E. coli O157:H74. This highlights a potential safety concern for consuming apple juice, especially in terms of pathogen survival and subsequent infection risk.
Conclusion
In summary, apple juice has been shown to exacerbate gastroesophageal reflux in children, particularly within the first 2 hours post-consumption. While it does not significantly affect gastric emptying rates, it can contribute to increased reflux episodes. Additionally, apple juice can enhance the acid resistance of pathogens like Salmonella spp. and E. coli O157:H7, posing potential health risks. These findings suggest that individuals prone to acid reflux or concerned about foodborne pathogens may need to moderate their apple juice intake.
Sources and full results
Most relevant research papers on this topic
Postcibal gastroesophageal reflux in children.
Frequent GER for up to 2 hours after clear liquid meals is physiologic in children, with effective control of vomiting by medical or surgical therapy best reducing GER more than 2 hours post-meal.
Non-RCTGastric emptying in children with gastroesophageal reflux. I. An estimate of effective gastric emptying.
Children with gastroesophageal reflux (GER) may have increased effective gastric emptying, even if measured gastric emptying appears not to be decreased.
Observational StudyAdaptation of Salmonella spp. in juice stored under refrigerated and room temperature enhances acid resistance to simulated gastric fluid.
Salmonella spp. adapted in juices at refrigerated and room temperatures can enhance their acid resistance, potentially increasing the risk of Salmonella outbreaks in juice.
Highly CitedSurvival of Escherichia coli O157:H7 in synthetic gastric fluid after cold and acid habituation in apple juice or trypticase soy broth acidified with hydrochloric acid or organic acids.
E. coli O157:H7 survival in acidified trypticase soy broth is significantly reduced when stored in apple juice, suggesting that cold temperature and acidity alone can enhance its survival in synthetic gastric fluid.
Highly CitedCharacterisation of malolactic conversion by Oenococcus oeni to reduce the acidity of apple juice
Malolactic conversion by Oenococcus oeni effectively reduces the acidity of apple juice, potentially enabling the production of low-acid apple juice.
Lack of efficacy of thickened feeding as treatment for gastroesophageal reflux.
Thickened feedings in infants have no significant effect on gastroesophageal reflux, except in those in the 30-degree prone position, where they may increase reflux time.
Non-RCTHighly CitedInfluence of 4 lactic acid bacteria on the flavor profile of fermented apple juice
Lactic acid bacteria, particularly L. acidophilus, significantly influence the flavor profile and aromatic components of fermented apple juice, with L. rhamnosus and L. casei producing larger acids and higher microbial viability.
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