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Randomized Controlled Trial
. 2022 Oct 1;117(10):1655-1667.
doi: 10.14309/ajg.0000000000001889. Epub 2022 Jun 21.

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

Cihang Gu  1 , Timothy Olszewski  2   3 , Karen L King  2 , Michael F Vaezi  2 , Kevin D Niswender  2   3 , Heidi J Silver  2   3
Affiliations
Randomized Controlled Trial

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

Cihang Gu et al. Am J Gastroenterol. .

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 24-hour ambulatory pH monitoring. Secondary outcomes were esophageal reflux symptoms rated using the Gastroesophageal Reflux Disease Questionnaire (GERDQ) and GERD Symptom Assessment Scale (GSAS).

Results: Half of the subjects were White and half African American (mean age, 60.0 ± 12.5 years; mean body mass index, 32.7 ± 5.4 kg/m 2 ). There was a significant main effect of diet treatment on AET ( P = 0.001) and on the total number of reflux episodes ( P = 0.003). The change in AET in the high total/low simple group (-4.3% ± 3.8%) differed significantly from the high total/high simple control group (+3.1% ± 3.7%), (P = 0.04). The reduction in simple sugar intake averaged 62 g less per day. Subjects' ratings of symptoms improved in all carbohydrate modification groups, including significant reductions in heartburn frequency, heartburn severity, acid taste in the mouth, lump/pain in the throat or chest, and sleep disturbance.

Discussion: A modification of dietary carbohydrate intake that targeted a substantial reduction in the intakes of simple sugars improved pH monitoring outcomes and symptoms of GERD that profoundly affect daily life. These findings provide a feasible and clinically applicable contribution to the limited objective data existing for efficacious dietary recommendations in the routine treatment and management of GERD.

Trial registration: ClinicalTrials.gov NCT02384551.

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Conflict of interest statement

Guarantor of the article: Heidi J. Silver, RD, MS, PhD.

Specific author contributions: H.J.S. and K.D.N.: study concept, study design, and funding. T.O., K.L.K., and H.J.S.: protocol implementation. C.G., T.O., and K.L.K.: data acquisition and database entry. C.G. and H.J.S.: statistical analysis. C.G. and H.J.S.: manuscript development. C.G., T.O., M.F.V., K.D.N., and H.J.S.: manuscript revisions and final draft.

Financial support: This study was funded by VA Merit Award #CX001009-05.

Potential competing interests: None to report.

Trail registration: ClinicalTrials.gov NCT02384551.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Consort diagram.
Figure 2.
Figure 2.
Study design.
Figure 3.
Figure 3.
Changes in ambulatory pH monitoring parameters by diet treatment arm.
Figure 4.
Figure 4.
Changes in GERDQ components by diet treatment arm.
See this image and copyright information in PMC

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