The Effects of Modifying Amount and Type of Dietary Carbohydrate on Esophageal Acid Exposure Time and Esophageal Reflux Symptoms: A Randomized Controlled Trial

Abstract

INTRODUCTION: This is the first randomized controlled diet intervention trial to investigate both the amount and type of carbohydrate on symptomatic gastroesophageal reflux disease (GERD). METHODS:Ninety-eight veterans with symptomatic GERD were randomly assigned to high total/high simple, high total/ low simple, low total/high simple, or low total/low simple carbohydrate diet for 9 weeks. The primary outcomes were esophageal acid exposure time (AET) and total number of reflux episodes derived from 24hour ambulatory pH monitoring. Secondary outcomes were esophageal reflux symptoms rated using the Gastroesophageal Reflux Disease Questionnaire (GERDQ) and GERD Symptom Assessment Scale (GSAS).

The Efficacy of Dietary Interventions in Patients with Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Intervention Studies

“…Additionally, the ingestion of some types of carbohydrates, such as lactose and FODMAP, resulted in an increased number of TLESRs in previous physiological studies [22,33]. Interestingly, the effect of low-carbohydrate diets was not related to weight loss, since the benefits could be found even in short-term studies without significant weight reduction seen [16].…”

“…A recent randomized controlled study by Gu et al evaluating the effect of the amount and types of carbohydrate in GERD patients with obesity divided participants into four groups: high total/high simple carbohydrate (HTHS) (control group), high total/low simple carbohydrate (HTLS), low total/high simple carbohydrate (LTHS), and low total/low simple carbohydrate (LTLS) diets. They found that there was a significant reduction in the total GERD-Q scores in the HTLS, LTHS, and LTLS groups [16].…”

“…Three studies were identified that demonstrated a reduction in GERD symptoms after low-carbohydrate diets [14][15][16]. However, meta-analysis could not be performed due to the difference in their GERD-related symptom measurements.…”

“…[15] Gu et al found that both the HTLS and LTHS diet groups had a significant reduction in their 24 h AET, total number of reflux episodes, and number of reflux episodes longer than 5 min compared to baseline. [16] Meta-analysis was performed to measure the mean difference of 24 h AET (%)preand post low-carbohydrate diets in two studies. A significant reduction in AET was found after the ingestion of low-carbohydrate diets (mean difference = −2.834%, 95% confident interval (CI): −4.554 to −1.114, p = 0.001, I 2 = 0.000, Egger's test = 0.229) (Figure 2).…”

Current complementary and alternative therapy forgastroesophageal reflux disease

“…Besides, an interventional trial indicated that a low-carbohydrate diet was associated with the resolution of GERD symptoms and reduced medication use [ 19 ]. A randomized–controlled trial (RCT) including 98 symptomatic GERD patients also demonstrated that reduced intake of simple sugar could lead to a decrease in the AET, frequency, and severity of symptoms [ 20 ].…”