Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease

Abstract

AIMTo investigate the effect of dietary fiber on symptoms and esophageal function testing parameters in non-erosive gastroesophageal reflux disease (GERD) (NERD) patients.METHODSThirty-six NERD patients with low (< 20 g/d) dietary fiber intake were enrolled in the study. They were examined with the use of symptom questionnaire (GERD-Q), high-resolution esophageal manometry, 24-h esophageal pH-impedance examinations, and food frequency questionnaire before and after 10 d of usual diet supplemented by psyllium 5.0 g TID. Complete data of 30 patients were available to the final analysis. The obtained results were analyzed with the use of non-parametric statistics (Wilcoxon matched pairs test).RESULTSThe number of patients experiencing heartburn was less (93.3% at baseline vs 40% at the end of the study, P < 0.001) and the GERD-Q score decreased (mean ± SD: 10.9 ± 1.7 vs 6.0 ± 2.3, P < 0.001) after the treatment period. Minimal resting lower esophageal sphincter (LES) pressure increased from 5.41 ± 10.1 to 11.3 ± 9.4 mmHg (P = 0.023), but no change in residual LES pressure and mean resting pressure was found. Total number of gastroesophageal refluxes (GER) decreased from 67.9 ± 17.7 to 42.4 ± 13.5 (P < 0.001) predominantly by acid and weak acid types of GERs. No significant change in mean esophageal pH and % of time pH < 4 was registered. Maximal reflux time decreased from 10.6 ± 12.0 min to 5.3 ± 3.7 min (P < 0.05).CONCLUSIONFiber-enriched diet led to a significant increase of minimal lower esophageal sphincter resting pressure, a decrease of number of gastroesophageal refluxes, and a decrease of heartburn frequency per week in NERD.

Feasibility and outcomes of anti‐reflux mucosectomy for proton pump inhibitor dependent gastroesophageal reflux disease: First Indian study (with video)

“…The effect of anti-reflux diet with or without additional minimally invasive endoscopic techniques needs assessment. 25 Patients psychological comorbidities in GER 10 need to be assessed separately as anxiety and depression won't respond to conventional anti-reflux treatment.…”

Ineffective esophageal motility: Concepts, future directions, and conclusions from the Stanford 2018 symposium

“…92 Dietary intervention benefits esophageal symptoms mainly by facilitating swallows, but may also impact esophageal contractility. 116 With the hypothesis that dietary fiber binds nitric oxide (NO) contained in food, and could reduce the inhibitory effects of NO in the esophagus, psyllium (15 g/d) was reported to decrease esophageal symptoms and increase LES resting pressure in patients with GERD. 116 However, effects on esophageal contractility were not reported in this open-label study.…”

“…116 With the hypothesis that dietary fiber binds nitric oxide (NO) contained in food, and could reduce the inhibitory effects of NO in the esophagus, psyllium (15 g/d) was reported to decrease esophageal symptoms and increase LES resting pressure in patients with GERD. 116 However, effects on esophageal contractility were not reported in this open-label study. Transcranial direct current stimulation of the brain has been reported to improve esophageal contractility in NERD and functional heartburn in a randomized double-blind sham-controlled study.…”

Letter: dietary fibre benefits for the oesophagus—physical rather than metabolic action?

“…Precise evaluation of the data provided showed that most of the patients in the study had signs of small intestinal bacterial overgrowth according to the hydrogen breath test, which could have impacted the study results. Our own data suggest the contrary: soluble fibre (psyllium) leads to a significant improvement of symptoms in patients with non‐erosive GERD, rather than exacerbate them. Moreover, addition of soluble fibre leads to a decrease in the number of gastro‐oesophageal refluxes per 24‐hour oesophageal pH‐impedance monitoring and an increase in minimal lower oesophageal sphincter resting pressure.…”