Diet and Gastroesophageal Reflux Disease: Role in Pathogenesis and Management

Sajiv Sethi; Joel E. Richter


Curr Opin Gastroenterol. 2017;33(2):107-111. 

In This Article


Beverage choice and frequency has been seen to affect GERD symptoms as well. Ingestion of alcohol exacerbates symptoms of GERD by decreasing LES pressure, increasing acid secretion through gastrin stimulation, decreasing esophageal motility, and impairing gastric emptying. Randomized and cross-sectional studies have demonstrated increased prevalence of symptomatic reflux in alcohol users.[12] Nonalcoholic beverages such as soft drinks, which are often carbonated, have been shown to cause a short term reduction in the intra-esophageal pH and a transient decrease in the LES basal pressure, increase gastric acid secretion, and cause gastric distention and acid reflux.[17] Ingestion of carbonated water, caffeinated cola, or caffeine-free cola were associated with a reduced LES pressure compared with tap water ingestion.[17] Patients with moderate to severe symptoms of GERD were found to be more likely to consume beverages such as soft drinks and one or more cups of regular tea as compared to asymptomatic controls.[1] In a multicenter, longitudinal trial, consumption of carbonated drinks was associated with nocturnal heartburn. Thus, patients suffering from nighttime heartburn or awakenings are advised to avoid consumption of carbonated beverages.

Although common practice has associated increased disease activity with drinks such as coffee, a recent meta-analysis noted no significant association between coffee intake and GERD symptoms. The researchers found no correlation between presence of symptoms and severity based upon the amount of coffee intake or assessment of exposure.[18] However, a 2014 cross-sectional cohort study that compared adherence of dietary guidelines in patients with GERD revealed that patients with moderate to severe reflux were more likely to consume one or more cups of tea a day compared to asymptomatic controls [odds ratio (OR) = 1.86; 95% confidence interval (CI), 1.16–2.97, for severe GERD].[1]