Diet and GERD: Role in Pathogenesis and Management

Abstract and Introduction

Abstract

Purpose of review Gastroesophageal reflux disease (GERD) is a common disease that presents with a variety of symptoms including heartburn and acid regurgitation. Although dietary modification is currently regarded as first-line therapy for the disease, the role of diet in the pathogenesis and management of GERD is still poorly understood. The present article aims to review recent literature that examines the relationship of diet and GERD.

Recent findings Increased awareness of medications side effects and widespread overuse has brought nonpharmacological therapies to the forefront for the management of GERD. Recent findings have established the important role of nutrition for the managements of symptoms of GERD. Increasing scientific evidence has produced objective data on the role of certain trigger foods, whereas population studies endorse decreased reflux symptoms by following certain diets. Obesity has been linked with increased symptoms of GERD as well. Furthermore, the importance of lifestyle techniques such as head of bed elevation and increased meal to sleep time may provide nonpharmacologic methods for effective symptom control in GERD.

Summary We provide a comprehensive review on the association between diet and its role in the development and management of GERD.

Introduction

Gastroesophageal reflux disease (GERD) is a common medical condition characterized by the development of chest and epigastric symptoms because of reflux of gastric components into the esophagus.^[1] The most common esophageal symptoms are heartburn, acid regurgitation, dysphagia, and chest pain. However, the disease may be associated with extraesophageal symptoms such as cough, voice change, nausea, and asthma.^[2] As one of the most common gastrointestinal diseases, it affects 13–19% of people worldwide and has a greater prevalence in the western world, with population-based studies suggesting a prevalence of 10–40% in North America and Western Europe.^[3,4] Just as well recognized is the lower prevalence seen in various parts of the world ranging from less than 10% in South America and Eastern Europe to significantly lower in Asia.^[5] Symptoms of GERD can cause lifestyle disturbances by affecting patients' daily functioning and sleep, which may lead to a significant decrease in patients' quality of life measures.^[3] Persistent GERD is also known to lead to complications such as Barrett's esophagus, esophageal strictures, and adenocarcinoma.^[6]

The increasing prevalence of GERD over the last two decades represents a challenge for primary care physicians and specialists alike.^[4] The costs associated with management of this disease also represent a significant burden on health systems. It has been estimated that the annual cost of healthcare and lost productivity because of GERD in the United States alone approaches $24 billion, with 60% of that being spent on medications.^[1] The average annual medical costs for patients with GERD are almost double that of those without the disease because of additional outpatient visits, hospitalizations, emergency department utilization, and pharmacy costs.^[1]

At this time there exists no definitive simple diagnostic test for GERD. The presence of clinical symptoms alone is an indication for treatment with a 2-week trial of proton pump inhibitor (PPI) therapy. Patients without improvement of symptoms may be considered for ambulatory pH monitoring and/or endoscopy to establish a more definitive diagnosis. The prevalent thought is that transient lower esophageal sphincter relaxation and the presence of significant hiatal hernia contribute to development of the disease.^[7] GERD is recognized as a multifactorial disease process with variable findings on endoscopy.^[8] The most common finding on esophagogastroduodenoscopy (EGD) is nonerosive reflux disease in which there is no endoscopic evidence of macroscopic esophagitis.^[4] Erosive reflux disease which is characterized by the presence of mucosal breaks in the lower esophagus at endoscopy is less commonly observed.^[9] Nonerosive disease has been associated with a higher occurrence of functional gastrointestinal disorders and esophageal acid hypersensitivity.^[9] In cases when endoscopy is normal, pH measurement with or without impedance studies may demonstrate esophageal acid reflux.