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.

Keywords: GERD; diet; dietary therapy; food; gastroesophageal reflux; meta-analysis.

Figure 1

Flow diagram of systematic review.

Figure 2

Mean difference of 24 h esophageal acid exposure time (%)pre- and post low-carbohydrate diets. Austin et al., 2006 [14]; Gu et al., 2022 [16]: low total/high simple carbohydrate (LTHS) diet; Gu et al., 2022 * [16]: low total/low simple carbohydrate (LTLS) diet.

Figure 3

Mean difference of pre- and post−24 h esophageal acid exposure time (%) compared between high- and low-carbohydrate diets among each study arms in a study by Gu et al., 2022 [16] Gu et al., 2022 * [16]: high total/high simple carbohydrate (HTHS) vs. low total/high simple carbohydrate (LTHS) diet; Gu et al., 2022 ** [16]: high total/high simple carbohydrate (HTHS) vs. low total/low simple carbohydrate (LTLS) diet; Gu et al., 2022 *** [16]: high total/low simple carbohydrate (HTLS) vs. LTHS; Gu et al., 2022 **** [16]: high total/low simple carbohydrate (HTLS) vs. LTLS.