Moderate Wine Consumption and Gastrointestinal Diseases
Abstract
:1. Introduction
Grapes, Juices, and Alcoholic Beverages in GI Diseases
2. Materials and Methods
3. Results and Discussion
3.1. Celiac Disease
3.2. Gastritis and Gastroesophageal Disease
3.3. Gastrointestinal Motility
- -
- Dehydration. Alcohol increases diuresis, with the greater excretion of liquids. In the event of dehydration, the colon absorbs more water, making the stool harder and more difficult to expel [57].
- -
- Gastrointestinal irritation and inflammation: these conditions can be involved in promoting constipation [58].
- -
- Alcohol can influence the intestinal microbiota, worsening constipation [59].
3.4. Inflammatory Bowel Diseases (IBD)
3.4.1. Crohn’s Disease
3.4.2. Ulcerative Colitis
- 1.
- Studies showing wine consumption to have neither a positive nor a negative role:
- 2.
- Studies that suggest the positive role of wine consumption:
- 3.
- Studies that suggest the negative role of wine consumption:
- 4.
- Studies that suggest that wine consumption plays a controversial role.
3.5. Irritable Bowel Syndrome (IBS)
3.6. Microscopic Colitis (MC)
4. Conclusions
- The consumption of alcoholic beverages (including wine) in subjects with GI diseases must be carefully considered in relation to the disease, the individual symptoms, and tolerance.
- In some cases, complete abstinence is recommended; in others, moderate and/or occasional consumption can be allowed according to medical advice.
5. Limitations
Author Contributions
Funding
Conflicts of Interest
Abbreviations
GI | Gastrointestinal |
IBD | Inflammatory bowel disease |
IBS | Irritable bowel syndrome |
GERD | Gastroesophageal disease |
GID | Gastrointestinal disorder |
CRD | Chron’s disease |
UC | Ulcerative colitis |
MC | Microscopic colitis |
CD | Celiac disease |
CAG | Chronic atrophic gastritis |
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Disease | Study Details | Number of Subjects | Beverages Included and Method | Objectives of the Study | Main Outcomes | Ref. |
---|---|---|---|---|---|---|
Gastritis and Gastroesophageal Disease (GERD) | Epidemiological study: population-based case-control study | 9444 subjects (age: 50–74 yrs) | Beer and wine | To evaluate the association of alcohol consumption with chronic atrophic gastritis (CAG) among older adults. Serological levels of pepsinogen I and II were measured as diagnostic parameters of the disease and antibodies vs. Helicobacter pylori as an index of infection. | Moderate alcohol consumption (<60 g/week) was associated with a significant reduction in CAG risk (odds ratio 0.71) when compared to abstainers. Effects were observed with both beer and wine. | [15] |
Clinical trial: cross-over intervention study | 14 healthy male volunteers (mean age 25 yrs; range 18–35). Not consumers or moderate consumers of alcoholic beverages (less than 1–3 g alcohol/day). The final evaluation was performed on 13 subjects. | 360 mL of red wine (13% alcohol) or tap water. | To monitor oesophageal motility and esophagogastric pH in an ambulatory 24-h study. The participants received the test beverage with a meal. Each subject was their own control. Measures were taken with a portable recording system during the meal (30 min), postprandial (3 h), and after 8 h supine. | The only esophageal motility change was an increase in the number of high-amplitude waves during wine consumption (1.6 vs. 1.2 of water, p = 0.02). The percent reflux time increased during the postprandial period after wine ingestion in comparison with water. Red wine induced heartburn in 2 out of 13 healthy subjects. No significant changes in gastric pH after wine ingestion compared with water during either the postprandial or supine period. | [16] | |
Clinical trial: cross-over intervention study | 20 healthy volunteers (13 M; 7 F; age: 23–37 years) | 300 mL of white wine (8% alcohol) or 8% alcohol solution or tap water with a standardized meal in random order. | To verify whether white wine modified oesophageal peristalsis and acid clearance. Acid clearance was measured via the instillation of 15 mL 0.1 N HCl into the distal oesophagus. | White wine temporarily alters oesophageal clearance by disrupting the initiation of secondary peristalsis and by increasing ineffective contractions. Ethanol alone (8% alcohol solution) does not produce the same effects as white wine. | [17] | |
Clinical trial: cross-over intervention study | Twelve healthy volunteers (5 M; 7 F; median age: 31 yrs, range 25–37). They did not usually drink alcoholic beverages. | 300 mL of white wine or tap water. | To explore the pathogenesis of prolonged reflux duration. The participants received wine or water randomly with a standardized meal. Oesophageal pH and motility were evaluated using a glass pH electrode and a strain gauge manometry probe. | Reflux events of long duration were associated with the intake of white wine. | [18] | |
Clinical trial: cross-over intervention study | 25 participants (18 M; 7 F; mean age: 54 yrs, range 24–84). Clinical evidence: 15 had reflux oesophagitis, 10 non-erosive reflux. | 300 mL of white wine (17 subjects), or 500 mL beer (8 subjects) or water. | To measure the effect of beverages on postprandial reflux. The participants received the test beverage randomly with a standardized meal; after 2 days, they received an equivalent volume of tap water. The oesophageal pH was measured using a glass electrode. | An increase in reflux was observed with both wine and beer in both groups of patients. | [19] | |
Gastrointestinal motility | Clinical trial: randomized cross-over intervention study | 10 healthy participants | 500 mL of beer, red wine or corresponding alcoholic solutions (4 and 10%, respectively), 500 mL of 5.5 or 11.4% glucose solution and water. Moreover, 125 mL of whisky or 40% alcohol solution was followed by 125 mL of water. | To compare the effect of alcoholic beverages on gastric emptying using ultrasonography of the antrum. The fasted participants received randomly, on separate days, the test beverage via oral gavage. | Inhibition of gastric emptying was observed with the 4%, 10%, and 40% (v/v) alcohol solutions. The inhibitory effect of beer and red wine, but not of whisky, was stronger than that of their corresponding ethanol solutions. Mean half-emptying times were 72.6 min for red wine, 39.2 min for beer, and 26.4 min for whisky. | [20] |
Clinical trial: randomized cross-over intervention study | 16 healthy males (mean age ± SD 29 ± 2.1 yrs). They were non-smokers and were not regular consumers of alcoholic beverages | 300 mL of 4 or 10% ethanol, beer, red wine, water, 5.5 or 11.4% glucose. | To assess the effect of alcoholic beverages on gastric emptying. The participants randomly received the test beverage once weekly with a low-calorie (270 kcal) or high-calorie (740 kcal) solid meal. Gastric empty was measured via ultrasonography. | 4 and 10% ethanol solutions and alcoholic beverages (beer and red wine) caused a prolongation of gastric emptying after a solid meal. The inhibitory effect of red wine exceeds that of the corresponding alcoholic solution. The inhibitory effect was independent from the caloric content of the meal. | [21] | |
Clinical trial: cross-over intervention study | A 65-year-old woman with Dumping syndrome characterized by GI symptoms after meals (abdominal pain, bloating, nausea, vomiting and diarrhea). | 8 ounces (240 mL) of Bogle Merlot wine (14.5°) | To study 4-h gastric emptying expressed as the percentage of isotope emptied, after a standardized isotope-labelled meal (255 kcal). | Gastric emptying in this subject at baseline was too fast and was normalized when wine was associated with the meal. Values of emptying at 120 min were 55% vs. 89% at baseline (normal value <80%). The intake of wine eliminated the post-prandial symptoms. | [22] | |
Clinical trial: randomized cross-over intervention study | 23 healthy volunteers (21–32 yrs; 33.3% M; 66.7% F), negative at H. pylori infection; no systematic use of alcoholic beverages. One volunteer participated to 2 sessions and six to 3 sessions. | Participants randomly received 400 mL beer (4.7 %vol ethanol) or 200 mL red wine (13.7 %vol) or 100 mL whisky (43.5 %vol) or corresponding volumes of fluids with equivalent alcoholic content with a solid meal (1485 kJ/355 kcal). | To evaluate gastric myoelectrical activity and emptying, orocecal transit time and gallbladder emptying were monitored noninvasively by electrogastrogram and ultrasonography of gallbladder. | After a solid meal, all alcoholic beverages inhibited gastric and gallbladder emptying. The magnitude of the effect was correlated with the alcoholic content. As regards the orocecal transit, different effects are observed depending on the type of beverage: whiskey causes a delay, while beer and red wine do not. | [23] | |
Clinical trial: randomized cross-over intervention study | 10 healthy male volunteers with no history of GIDs (mean age ± SD 30.8 ± 7.6; range 21–43). | Wine meal: 450 g red wine (alcohol 9.5 g/dL) in 900 g of total meal (882 kcal, 545 from wine). Low-alcohol wine meal: as above, with the previously mentioned wine boiled for 7 min (alcohol 1.13 g/dL). | To assess the effect of an ethanol-containing meal (wine) on gastric emptying using a dual radioisotopic method. The participants received meals in a random order. Seven subjects also received wine and low-alcohol wine without a meal: five received the meal free from wine. | No differences in gastric emptying were observed between the administration of a meal without or with wine/low-alcohol wine. No difference was evident when the beverages were administered without a meal. | [24] | |
Epidemiological study: population-based case-control study | 200 healthy controls (84 M; 116 F; mean age ± SD 50.2 ± 1.2 yrs); 122 patients with chronic constipation (16 M; 106 F; mean age ± SD 51.9 ± 1.3 yrs) 766 patients with IBS with constipation 199 M; 567 F; mean age ± SD 51.0 ± 0.5 yrs) | Different food and beverages considered: beer, black tea, coffee and wine. | To evaluate via a questionnaire the effect of foods and beverages on stool consistency in healthy and chronically constipated populations | In all groups, black tea was classified as a constipating agent, while coffee, beer, and wine were stool softeners. The promoting effect of wine was present in 21% of constipated patients, 8% of IBS–constipated patients, and 30% of controls. | [25] | |
Inflammatory Bowel Disease (IBD) and Chron’s Disease (CRD) and Ulcerative Colitis (UC) | Epidemiological study: prospective cohort study | 237,835 participants from the Nurses’ Health Study, Nurses’ Health Study II, and Health Professional Follow-Up Study. Mean age at baseline: 46.4 yrs (26–80 yrs) | Beer, wine, liquor. | To evaluate the correlation between alcoholic beverage consumption and the risk of CRD and UC via a questionnaire filled out every four years. | Moderate consumption of beer (>1–4 servings/week) was associated with a lower risk of CRD (0.50). Higher risk of UC was observed for the intake of >4 servings/week of liquor. No significant association was found between wine intake and the risk of CRD or UC. | [26] |
Clinical trial: cross-over intervention study | 12 healthy subjects (5 M; 7 F; age 21–52); 20 CRD in remission (9 M; 11 F; age 18–50). | Red wine, white wine, Smirnoff ice, Elephant beer, pure ethanol. For all beverages, the intake was based on: 36 g alcohol for men and 24 g alcohol for women. | To evaluate the effect of alcoholic beverages (randomly consumed) on abdominal discomfort in CRD. After 48 hrs of an alcohol-free diet and at 2-week intervals, participants randomly received one of the 4 test beverages or ethanol solution. Serum ethanol and plasma glucose concentrations were measured at 0, 30, 60, 90, 120, and 180 min. A self-reported pain symptom score was used. | No difference in alcohol absorption was detected between CRD patients and controls. No changes in the acute-phase inflammatory markers were found during the study period. When compared to controls, all drinks determined an increase in abdominal pain in CRD patients. Compared to the other beverages tested, red and white wines determined (1) a lower plasma sugar concentration and (2) a lower effect on self-reported abdominal pain in CRD patients. | [27] | |
Epidemiological study: prospective cohort study | Participants: IBD (mean age ± SD at start 70.2 ± 8.0 yrs; 49.1% M; 50.9% F) 2027 with CRD 4334 with UC 734 with diagnosis for both diseases Non-IBD 495,410 (mean age ± SD at start 69.5 ± 8.1 yrs; 45.5% M; 54.5% F). | Red wine, champagne and white wine, beer, cider, spirits and fortified wine. | To evaluate the correlation between intake of alcoholic beverages and risk of IBD. Participants responded to: “About how often do you drink alcohol?”. The frequency was classified into: (1) high frequency (≥3 times/week); (2) low frequency (<3 times/week); and (3) never/special occasions only. | Compared with abstainers, red wine consumers showed a lower risk of IBD (23% with 3–4 glasses/week). High frequency and high doses of white wine and champagne, low frequency and high doses of spirits, and high doses of beer and cider appeared to increase the risk. | [28] | |
Epidemiological study: prospective cohort study | 81 UC patients 43 M (mean age 53 yrs; 26–78 yrs) 38 F (mean age 47 yrs; 19–74 yrs). | Beer, wines (red, white, and sweet) and spirits | A validated 7-day diet diary was filled. Clinical data were collected, and patients were examined using rigid or flexi-sigmoidoscopy and graded (score 0–6). Scores were confirmed via histological examination. | Beer and wines were responsible for increased UC activity. No correlation was found with spirits. Sulphites more than alcohol could play a role in disease process. | [29] | |
Epidemiological study: population-based case-control study | 167 UC patients diagnosed in Uppsala country from 1945 to 1964 (87 M; 80 F; at interview mean age 13 yrs; range 4–35 yrs). 167 sex-matched controls. | Beer, wine, liquor. | To study, via a face-to-face interview, the role of socioeconomic, dietary (including alcoholic beverages), and personal habits on UC incidence. | No difference was found in the correlation between the consumption of alcoholic beverages and the incidence of UC when the IBD group was compared to the control population. | [30] | |
Epidemiological study: cross-sectional study | Participants: 52 with inactive CRD (20 M; 32 F; mean age 42.4 yrs) 38 with inactive UC (14 M; 24 F; mean age 38.5 yrs). | Beer, wine, and liquor | To evaluate, using validated questionnaires, the correlation between alcoholic beverage consumption and disease activity (the Crohn’s disease activity index or ulcerative colitis clinical activity index). | Patients with inactive IBD consumed alcoholic beverages similarly to the general population. Patients consuming alcoholic beverages described a worsening of GI symptoms (75% in CRD and UC patients), but no correlation was observed between the quantity/type of alcoholic beverage and the severity of GI symptoms. | [31] | |
Epidemiological study: prospective cohort study | Participants: 6 with inactive CRD (4 M; 2 F; median age 31 yrs) 8 with inactive UC (4 M; 4 F; median age 45 yrs) 7 controls (3 M; 4 F; median age 24 yrs). | Red wine (1–3 glasses/day for a week). | To evaluate the role of moderate red wine consumption on IBD. A validated questionnaire was used to confirm the inactive status of disease (Crohn’s disease activity index or ulcerative colitis clinical activity index). Other parameters considered: C-reactive protein and stool calprotectin (inflammatory indices); intestinal permeability. | One week of moderate wine consumption determined no significant change in the clinical disease activity score or C-reactive protein in IBD subjects. Compared to controls, the researchers observed: (1) a significant decrease in stool calprotectin from the starting values; (2) a significant increase in intestinal permeability. | [32] | |
Clinical study: case–control intervention study | 10 UC patients in active phase (both sexes; 18–42 yrs) 8 healthy subjects for the study of the microbiome. | Red wine (125 mL × 2 doses/day for 4 weeks) | To assess the role of moderate red wine consumption on clinical parameters and severity of symptoms. After 2 weeks of wash out (no wine, low-polyphenol diet-LPD), 5 UC patients consumed red wine, and 5 UC patients did not. Intestinal symptoms were collected using a validated questionnaire. Serum and urine were collected to measure biochemical parameters. Intestinal dysbiosis was also considered. | Regular and moderate red wine intake improved the clinical situation and the GI symptoms of patients in the active phase. | [33] | |
Clinical study: case–control intervention study | 10 UC patients in the active phase (both sexes; 18–42 yrs) 8 healthy subjects for the study of the microbiome. | Red wine (125 mL × 2 doses/day for 4 weeks) | To evaluate the effects of moderate red wine consumption on the clinical status and symptoms in UC subjects. After 2 weeks of wash out (no wine, low-polyphenol diet-LPD), 5 UC patients consumed red wine, while 5 UC patients did not. Intestinal symptoms were collected via a validated questionnaire. Serum and urine were collected and analyzed (glucose, lipids, hepatic enzymes, etc.) using an automated biochemical auto-analyzer. | Moderate red wine intake improved the quality of life of UC patients, at least partially mediated by a significant improvement in serum iron and transferrin saturation index (biomarkers of anaemia) and a reduction in the severity of active intestinal symptoms. Calprotectin levels (faecal marker of UC) decreased in intervention group. An effect on the oral and intestinal microbiome was also found in the intervention group, in term of stabilization of biodiversity and increase of positive microbiota. | [34] | |
Epidemiological study: cross-sectional study | 446 CRD subjects (136 M; 283 F) Age at diagnosis: 9.3% <17; 65.8% 17–40; 24.9% >40. | Beer and red wine | To evaluate the self-reported dietary tolerance and intolerance to specific food/beverages using a dietary questionnaire. | Many subjects avoided alcohol based on medical advice, not because of personal negative experience. Beer worsened symptoms in > 55% of patients but helped a few. Red wine worsened symptoms in >50% of patients but was well tolerated by approximately 5%. | [35] | |
Epidemiological study: postal cohort study | 1220 patients with CRD from the Cleveland Clinic Digestive Disease Centre Database | Wine, beer, liquors, or mixed alcoholic beverages | To evaluate the role of dietetic factors on clinical symptoms | A worsening of symptoms was observed in 40% of patients consuming alcoholic beverages, while no change was reported by 41% of patients in the same group. No difference was observed among the alcoholic beverages included. | [36] | |
Irritable Bowel Syndrome (IBS) | Epidemiological study: cross-sectional study | 197 IBS participants (55 M; 142 F; mean age 35 yrs; range 18–72) | Beer and wine | The correlation between different food items and quality of life in IBS was evaluated using a non-formally validated questionnaire | 31% of subjects experienced GI symptoms. No difference between beverages was reported. | [37] |
Case report | A 50-year-old Caucasian male characterized by migraine and acute GI distress triggered by common IBS trigger foods such as insoluble fibre, red wine and large/rich meals. | Wine | To evaluate the putative contributions of wine to the observed symptoms resulting from the dysregulation of the serotoninergic system. | The hypothesis was confirmed by the highly satisfactory improvements in the described symptoms obtained with a low dose of triptan (a seretonin receptor agonist). | [38] | |
Epidemiological study: population-based case-control study | 766 IBS patients with constipation (199 M; 576 F; mean age ± SD 51.0 ± 0.5 yrs) 200 healthy controls (84 M; 116 F; mean age ± SD 50.2 ± 1.2 yrs) | Different food and beverages considered: the beverages included beer, black tea, coffee and wine. | To evaluate via a questionnaire the effect of foods and beverages on constipation in healthy and IBS–constipated populations. | In both groups, black tea was classified as constipating, while coffee, beer, and wine were stool softeners. The effect of wine was present in 8% of IBS patients and 30% of controls. | [25] | |
Epidemiological study: prospective observational study | Women with (166) or without (48) IBS (mean age 32 yrs; 18–48 yrs) with a similar pattern of alcohol intake | Beer, wine and liquor; 1 drink = 118 mL wine 237 g of beer 1 shot of liquor. | To evaluate the role of habits in the presence of GI symptoms by using a daily diary reporting the number of drinks of alcoholic and caffeine-containing beverages consumed, cigarette smoked and level of stress. | The following symptoms were considered: abdominal pain and bloating, intestinal gas, nausea, stomach pain, heartburn, indigestion, diarrhea, and constipation. Moderate and light drinking determined no or weak GI symptoms, while binge drinking (mean intake: 4.9 drinks) was strictly associated with symptoms the next day. No detail is reported on the possible difference between the beverages used. | [39] | |
Epidemiological study: cross-sectional study | 39 participants (7 M, 32 F; mean age 53.2 yrs) | Beer, wine and spirits | To evaluate, by using validated questionnaires, the correlation between alcoholic beverages consumption and worsening of GI symptoms. | Of the current drinkers (21/39), 43% of patients described a worsening of GI symptoms when alcohol was consumed. No correlation was observed between the quantity or type of alcoholic beverage consumed and severity of GI symptoms. | [31] | |
Microscopic colitis (MC) | Epidemiological study: prospective cohort study | 209,902 female participants from the Nurses’ Health Study and Nurses’ Health Study II (mean age at baseline 45.5 yrs, range 28.5–66.7) | Light and regular beer, white and red wine, liquor | To evaluate the association between alcohol intake and the adjusted hazard risk (aHR) of microscopic colitis. Alcohol consumption was obtained using a food frequency questionnaire (updated every 4 years). MC was diagnosed according to histopathological data. | Higher alcohol consumption was associated with an increased risk of MC. When stratified by beverage type, the aHR according to every 2 servings/week seemed strongest with wine (1.08) as compared to beer (1.01) or liquor (1.00). | [40] |
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Restani, P.; Di Lorenzo, C.; Antoce, A.O.; Araujo, M.; Bani, C.; Mercogliano, F.; Ruf, J.-C.; Kosti, R.I.; Teissedre, P.-L. Moderate Wine Consumption and Gastrointestinal Diseases. Nutrients 2025, 17, 1608. https://doi.org/10.3390/nu17101608
Restani P, Di Lorenzo C, Antoce AO, Araujo M, Bani C, Mercogliano F, Ruf J-C, Kosti RI, Teissedre P-L. Moderate Wine Consumption and Gastrointestinal Diseases. Nutrients. 2025; 17(10):1608. https://doi.org/10.3390/nu17101608
Chicago/Turabian StyleRestani, Patrizia, Chiara Di Lorenzo, Arina Oana Antoce, Marcos Araujo, Corinne Bani, Francesca Mercogliano, Jean-Claude Ruf, Rena I. Kosti, and Pierre-Louis Teissedre. 2025. "Moderate Wine Consumption and Gastrointestinal Diseases" Nutrients 17, no. 10: 1608. https://doi.org/10.3390/nu17101608
APA StyleRestani, P., Di Lorenzo, C., Antoce, A. O., Araujo, M., Bani, C., Mercogliano, F., Ruf, J.-C., Kosti, R. I., & Teissedre, P.-L. (2025). Moderate Wine Consumption and Gastrointestinal Diseases. Nutrients, 17(10), 1608. https://doi.org/10.3390/nu17101608