Objective ambulatory pH monitoring and subjective symptom assessment of gastroesophageal reflux disease show type of carbohydrate and type of fat matter

Abstract

Background: Rising prevalence of gastroesophageal reflux disease (GERD) in US Veterans is concurrent with increasing excess body weight. Objective: The objective of this cross-sectional study is to examine relationships between dietary macronutrients, gastrointestinal hormones, and GERD status. Methods: Ninety-eight veterans with overweight/obesity and empiric proton pump inhibitor (PPI) treatment were enrolled from the Tennessee Valley Healthcare System. Subjects had esophageal manometry and 24-h pH monitoring. Subjective symptoms were assessed with Gastroesophageal Reflux Disease Questionnaire (GERDQ) and Symptom Assessment Scale (GSAS). The primary outcomes, total acid exposure time (AET) and number of reflux episodes, enabled categorizing subjects as either pathologic GERD or inconclusive GERD. Data analysis included independent T-tests, Spearman Rho correlations, and multivariable linear regression modeling. Results: Higher intake of sugar-sweetened beverages (sugar-sweetened tea, soda, and fruit juice) associated with higher AET. Higher saturated-to-unsaturated fat intake is associated with higher AET and number of reflux episodes. Overall, sugar-sweetened beverage intake, saturated-to-unsaturated fat ratio, tomato-based food items, glucagon-like polypeptide 1 (GLP-1) level, time of first meal, and education status accounted for a significant amount of the variability in AET. Pathologic GERD subjects reported more heartburn ( p = 0.006), regurgitation ( p = 0.01), acid taste (0.001), and nausea severity ( p = 0.04). GERDQ score associated with AET ( r = 0.31, p = 0.005), but GSAS did not ( r = 0.12, p = 0.28). Conclusion: Of the many foods and nutrients tested, the type (not amount) of carbohydrate (simple sugars) and the type (not amount) of fat (saturated vs unsaturated fat) consumed associated with objective and/or subjective GERD testing. These novel findings contribute to the evidence base guiding specific dietary recommendations in the clinical management of GERD.

Management advice for patients with reflux-like symptoms: an evidence-based consensus

“…Eight studies (two prospective cohort [ 38 , 42 ], one case-control [ 16 ], and five cross-sectional [ 22 , 24 , 33 , 41 , 43 ]) suggested that carbonated drinks are associated with an increase in reflux-like symptoms. The prospective cohort study conducted by Mehta et al .…”

“…Eight studies (two prospective cohort [38,42], one case-control [16], and five cross-sectional [22,24,33,41,43]) suggested that carbonated drinks are associated with an increase in reflux-like symptoms. The prospective cohort study conducted by Mehta et al [38] reported an increased risk of reflux-like symptoms (HR, 1.29; 95% CI, 1.05-1.58; P < 0.0001) for those with the highest intake of soda (more than 6 servings/day) compared with the lowest intake (0 servings/day).…”

“…Sixteen studies (one randomised crossover trial [13], one prospective cohort study [14], one before-after study [15], two case-control studies [16,17], eleven cross-sectional studies [18][19][20][21][22][23][24][25][26][27][28]) and two systematic reviews [29,30] supported the association of one or more dietary factors with reflux-like symptoms. The only study assessing a dietary intervention was a before-after study in patients presenting with reflux-like symptoms for the first time in primary care [15].…”

“…Eight studies (one prospective cohort [14], one case-control [16] and six cross-sectional [22,24,25,[43][44][45]) suggested that high dietary fat intake is associated with reflux-like symptoms and increased nocturnal refluxlike symptom severity. Three cross-sectional studies indicated that high saturated fat is an important risk factor [22,25,44], while a further cross-sectional study in an Albanian population [45], found that a predominantly non-Mediterranean diet (processed foods high in sugar, salt and saturated fats) was positively related to refluxlike symptoms versus a Mediterranean diet (frequent consumption of fresh fruit and vegetables, olive oil and fish) (adjusted OR, 2.3; 95% CI, 1.2-4.5). No interventional study assessing reflux-like symptoms after switching from a high-fat to a low-fat diet was identified.…”