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

Abstract

Background: International guidelines recommend dietary interventions as one of the most important treatments for patients with gastroesophageal reflux disease (GERD). Evidence to confirm the efficacy of these treatment modalities is lacking. The present study aims to evaluate the efficacy of dietary interventions on GERD-related outcomes evaluated in intervention studies on GERD patients. Methods: A systematic review and meta-analysis was performed according to PRISMA. The PubMed/MEDLINE, Web of Sciences, and Scopus databases were utilized for the literature search. Two independent researchers searched for relevant publications published up until June 2023. Intervention studies evaluating the efficacy of dietary interventions in patients with GERD were included. Results: A total of 577 articles were identified during the initial literature search. After reviewing, 21 studies with 16 different types of dietary interventions were included in the analysis. The interventions were divided into low-carbohydrate diets (3 studies), high-fat diets (2 studies), speed of eating studies (3 studies), low-FODMAP diets (2 studies), and other interventions (12 studies). A meta-analysis could be performed for low-carbohydrate diets and speed of eating interventions. Low-carbohydrate diets resulted in a significant reduction in esophageal acid exposure time (mean difference = −2.834%, 95% confidence interval (CI): −4.554 to −1.114), while a slow speed of eating did not lead to a lower percentage of reflux events compared to fast eating (risk ratio = 1.044, 95% CI: 0.543–2.004). Most other interventions showed positive effects in only a single study. Conclusion: Low-carbohydrate diets showed a significant improvement in GERD-related outcomes, while a slow eating speed did not result in a reduction in reflux events. The overall evidence regarding dietary interventions in GERD remains scarce. High-quality, long-term RCTs are still required to confirm the effects of dietary interventions in GERD patients.

Efficacy of a Food Supplement Containing Lactobacillus acidophilus LA14, Peptides, and a Multivitamin Complex in Improving Gastroesophageal Reflux Disease-Related Outcomes and Quality of Life of Subjects Showing Mild-to-Moderate Gastroesophageal Reflux Disease

“…In fact, although PPIs represent the standard of care for GERD, they may not be effective for non-erosive reflux disease (NERD) [ 9 ]; PPIs and histamine-2 receptor antagonists show a limited efficacy when intermittently used [ 10 ] and exhibit relevant adverse effects; and antacids also present adverse effects and limitations of use in specific cases [ 11 ]. Therefore, an increasing demand for an alternative approach to the pharmacological treatment is currently driving research, and as diet has been theorized to be associated with the worsening of GERD symptoms, dietary interventions are one of the main treatment modalities recommended by international guidelines for GERD patients [ 12 ].…”

“…However, the efficacy of treatments based on avoiding trigger foods [ 1 ] is continuously analysed by systematic reviews and meta-analyses [ 13 ] that often point to limitations in these studies, mainly based on observational and epidemiological trials, and to the need of long-term Randomized Control Trials (RCTs) to confirm the effects of interventions. On the other hand, more comprehensive diet interventions, aimed at alleviating the severity and frequency of symptoms of GERD without or with limited adverse effects, represent a significant goal to pursue as they have a positive impact on the quality of life of subjects suffering from this disease [ 12 ].…”