***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Patients report that the prophylactic consumption of a proton pump inhibitor minimizes gastrointestinal symptoms expected to be provoked by late‐night food and alcohol consumption . The efficacy of this practice has not been studied formally OBJECTIVES : Perception of sensations arising from the gastrointestinal tract may be diminished in obese subjects and thus facilitate overeating . Alternatively , excess food intake may cause gastrointestinal ( GI ) symptoms in obese patients . We evaluated the relationship between body mass index ( BMI ) and specific GI symptoms in the community . METHODS : Residents of Olmsted County , MN were selected at r and om to receive by mail one of two vali date d question naires . The association of reported GI symptoms with BMI ( kg/m2 ) was assessed using a logistic regression analysis adjusting for age , gender , psychosomatic symptom score , and alcohol and tobacco use . RESULTS : Response rate was 74 % ( 1,963 of 2,660 ) . The prevalence of obesity ( BMI ≥ 30 kg/m2 ) was 23 % . There was a positive relationship between BMI and frequent vomiting ( p = 0.02 ) , upper abdominal pain ( p = 0.03 ) , bloating ( p = 0.002 ) , and diarrhea ( p = 0.01 ) . The prevalence of frequent lower abdominal pain , nausea , and constipation was increased among obese ( BMI ≥ 30 kg/m2 ) compared to normal weight participants , however , no significant association was found between BMI and these symptoms . CONCLUSIONS : In the community , increasing BMI is associated with increased upper GI symptoms , bloating , and diarrhea . Clarification of the cause- and -effect relationships and the mechanisms of these associations require further investigation BACKGROUND & AIMS Data on the association between erosive esophagitis and obesity are inconsistent because of variations in study population s and methods used to determine obesity . METHODS Participants in a prospect i ve health-screening cohort underwent esophagogastroduodenoscopy and computed tomography .  The association between erosive esophagitis and obesity ( measured by body mass index [ BMI ] , waist circumference , and abdominal visceral adipose tissue volume ) was estimated with odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) , adjusting for confounding factors . We also analyzed the association between obesity and erosive esophagitis by sex . RESULTS The  prevalence of erosive esophagitis was 9.3 % ( 495/5329 ) . The OR for erosive esophagitis correlated with obesity measured by BMI , waist circumference , and abdominal visceral adipose tissue volume ( P < .001 for each factor ) . The multivariate OR for erosive esophagitis was 1.97 ( 95 % CI : 1.34 - 2.90 ) for a visceral adipose tissue volume of 500 - 999 cm(3 ) , 2.27 ( 95 % CI : 1.51 - 3.39 ) for 1000 - 1499 cm(3 ) , and 2.94 ( 95 % CI : 1.87 - 4.62 ) for ≥1500 cm(3 ) , compared with participants who had visceral adipose tissue volumes less than 500 cm(3 ) . When measures of obesity were analyzed simultaneously , abdominal visceral adipose tissue volume , but not BMI or waist circumference , was associated with erosive esophagitis . The 3 measures of obesity were significantly associated with erosive esophagitis in males , but only visceral adipose tissue volume was associated with erosive esophagitis in females ( P = .002 ) . CONCLUSIONS In contrast to BMI or waist circumference , abdominal visceral adipose tissue volume is associated with an increased risk of erosive esophagitis in males and females Background —Although fatty foods are commonly considered detrimental in patients with reflux disease , no objective data exist that substantiate this belief . Aims —To investigate the effect of fat on gastro-oesophageal reflux and lower oesophageal sphincter ( LOS ) motor activity . Subjects — Thirteen healthy subjects and 14 patients with reflux disease . Methods —Oesophageal pH , LOS , and oesophageal pressures were recorded for 180 minutes after a high fat ( 52 % fat ) and a balanced ( 24 % fat ) meal ( both 3.18 MJ ) on two different occasions . Eight controls and seven patients were studied in the recumbent position and the others in the sitting position . Results —The percentage of time at pH less than 4 and the rate of reflux episodes were higher ( p<0.01 ) in the patients than in the healthy subjects ( mean 14.1 % versus 1.7 % and 4.4/h versus 0.8/h respectively ) , as was the percentage of transient LOS relaxations associated with reflux ( 62 % versus 32 % , p<0.01 ) . The high fat meal did not increase the rate of reflux episodes nor exposure to oesophageal acid in either group regardless of body posture . The rate of transient LOS relaxations , their association with reflux , and basal LOS pressure were also unaffected . Conclusions —Increasing fat intake does not affect gastro-oesophageal reflux or oesophagogastric competence for at least three hours after a meal Background / Aims : In obesity , many gastro-oesophageal reflux promoting factors are present . Weight reduction is advised to symptomatic overweight subjects . The aim of the present study was to investigate the influences of untreated obesity , weight loss , and chronic gastric balloon distension on the lower oesophageal sphincter ( LOS ) function . Methods : Patients entering a r and omized , double-blind , sham-controlled study of balloon treatment  , consisting of 4 months of either sham balloon or balloon treatment  followed by 4 months of balloon treatment .  Manometry and 24-hour pH measurements were performed at the start of the study and after 13 and 26 weeks . Results : Before treatment , LOS dysfunction was present in 7 of 32 patients ( 21.9 % ) . Increased upright and supine reflux was present in 8 patients ( 25 % ) . Sham treatment result ed in a weight loss of 9.7 % with improved LOS function ( a significant 0.6-cm increase in LOS length and a non-significant 2.6 mm Hg higher LOS pressure ) and in a significantly decreased upright reflux ( acid reflux time decreasing from 8.0 to 5.5 % and number of meal-related and postpr and ial reflux episodes decreasing from 49 to 32 ) . These improved values deteriorated after 4 months of balloon placement , with significantly increasing total , upright , and supine reflux to 7.5 , 7.6 , and 6.7 % of the time , respectively , with oesophageal lesions after an overall 17.8 % weight loss . Four months of balloon treatment induced a similar weight loss ( 9.9 % ) with significantly increased supine reflux from 1.6 to 6.7 % of the time . After a second 4-month balloon period and an overall 13.8 % weight loss , LOS and reflux values returned towards baseline values . A comparison of both groups demonstrated the adverse effects of balloon positioning after a period of substantial sham-induced weight loss . Conclusions : Impaired LOS function and increased gastro-oesophageal reflux were observed in one quarter of the untreated obese subjects .  Weight loss ameliorated manometry and pH values , but subsequent balloon positioning tended to counteract these beneficial changes . In patients on balloon treatment from the start , adverse effects seemed to wear off with prolonged treatment Smoking has been shown to be a factor in acid peptic disease . A recent U.S. multicenter trial investigating use of ranitidine in the treatment of gastroesophageal reflux disease provided an opportunity to compare smokers and nonsmokers with regard to demographic features , manifestations of disease , and symptomatic response to treatment . A comparison of characteristics of smokers and nonsmokers revealed similar pretrial clinical findings . No significant differences between groups were found with regard to previous complications or recent symptoms of gastroesophageal reflux disease . There were also no significant differences in the way smokers and nonsmokers responded to treatment . Subjects on ranitidine , regardless of their smoking status , showed significantly greater improvement in heartburn symptoms and consumed less antacid  than subjects who received placebo . Results of these analyses indicate that smoking as an independent variable was not related to symptomatic response or esophageal healing and that ranitidine was similarly effective in decreasing heartburn symptoms in smokers and nonsmokers STUDY OBJECTIVE To test the potential of distance running to induce  reflux in healthy subjects and the ability of ranitidine to decrease esophageal acid exposure . DESIGN A r and omized , single-blind , crossover study . Objective assessment of reflux was done using an ambulatory intra-esophageal pH monitor during both a baseline hour and 1 hour of running on 2 days of testing . SUBJECTS Fourteen normal volunteers ( 10 men , four women ) between 22 and 37 years of age were studied . All volunteers ran regularly , completing an average of 20 miles weekly for at least 6 months . INTERVENTIONS Ranitidine , 300 mg orally , or an identical placebo was administered after a low-fat breakfast just before the baseline hour of pH recording . SETTING Esophageal motility and pH probe placement was done in the gastroenterology unit at Bowman Gray Medical Center . Running was done on local jogging trials . MEASUREMENTS AND MAIN RESULTS There was more gastroesophageal reflux during running than during the baseline hour when reflux was measured at a pH threshold of 3.0 , 4.0 , or 5.0 ( P less than 0.05 ) . Reflux episodes were usually associated with belching .  Ranitidine , 300 mg administered orally 1 hour before running , significantly ( P less than 0.05 ) reduced the amount of esophageal acid exposure during running . CONCLUSIONS Gastroesophageal reflux occurs during running in healthy volunteers . It is usually associated with belching . Acid suppression with ranitidine decreases intraesophageal acid exposure during running ( P less than 0.05 ) OBJECTIVES : Prospect i ve evidence supporting lifestyle modifications , including avoidance of late evening meals , for gastroesophageal reflux disease ( GERD ) sufferers is lacking . The aim of this study was to determine the difference of supine esophageal acid exposure in patients consuming an early or late st and ard meal relative to bedtime . METHODS : This is a prospect i ve , r and omized unblinded crossover trial . Thirty-two patients with typical reflux symptoms were enrolled and r and omized to consume a st and ard meal either at 6 h or 2 h prior to going to bed for 2 consecutive nights . Acid exposure  was measured for 48-h using a Bravo wireless pH system . Reflux symptom frequency and severity were recorded . RESULTS : Thirty patients successfully completed the study ( 63 % male , 70 % white , mean age 46 [ 24–74 ] , mean body mass index [ BMI ] 28 kg/m2 [ 18–40 ] ) . EGD revealed esophagitis in 37 % and hiatal hernia ( HH ) in 47 % of patients . Following the late evening meal , there was significantly more supine reflux ( P = 0.002 ) when compared to the early meal . Significantly more supine reflux was also noted following the late evening meal in patients with HH , in overweight individuals ( 25 ≤ BMI ≤ 29.9 ) , and those reporting heartburn as their chief complaint . Patients with esophagitis had more supine reflux following both the late and early evening meals . There was no significant difference in total symptom score between the 2 days . CONCLUSIONS : GERD patients consuming a late-evening meal had significantly greater supine acid reflux compared to when they consumed an early meal , especially in overweight patients , and in patients with esophagitis or HH . These findings support the recommendations to our GERD patients to eat dinner early and to lose weight In order to establish whether alcohol in amounts in amounts customarily imbibed during social drinking causes gastro-oesophageal reflux , 12 healthy young individuals , without symptoms of gastro-oesophageal reflux , were studied twice . Each time , distal oesophageal pH  was monitored continuously for three hours after a st and ard meal which included either 180 ml 100 proof vodka or 180 ml water . The order of studies with and without alcohol was r and om . Peak blood alcohol concentrations ranged between 0.63 and 1.29 g/l . Eleven of the 12 subjects refluxed more after alcohol ; and the difference in mean reflux scores for studies with and without alcohol was highly significant . We conclude that relatively modest quanttities of alcohol induce gastro-oesophageal reflux in healthy people This study examines whether eating food at different times has differential effects on intragastric pH. Experiments were done in 23 healthy volunteers ( 1 
    Output:
    
There is recent good evidence that weight reduction and smoking cessation are beneficial in reducing GORD symptoms .
Clinical and physiological studies also suggest that some physical measures as well as modification of meal size and timing can also be beneficial .
However , there is limited evidence for the role of avoiding alcohol and certain dietary ingredients including carbonated drinks , caffeine , fat , spicy foods , chocolate and mint