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

Eating Behavior

Along with diet, an important lifestyle component of GERD symptoms is the relationship of meals to sleep. Murase et al.[3] demonstrated that decreased duration of sleep was associated with unfavorable dietary habits and increased symptoms of GERD. In addition, both GERD and poor dietary behaviors such as dinner within 2 hours of bed time and snacking after dinner were independently associated with short sleep duration.[3] These results compare favorably with newer studies as well.[15]

Late evening meals are associated with increased time of supine acid exposure as compared to early meal times. Encouraging patients to elevate the head of the bed while supine post prandial has been demonstrated to decrease time of esophageal acid exposure as compared to a flat position.[7] Head of bed elevation has been recommended to patients in an attempt to decrease the reflux of acid stomach contents that may occur when patients are lying flat. As compared to patients sleeping in a flat position, head of bed elevation with 28 cm blocks was associated with faster acid clearing, fewer reflux episodes, and shorter reflux episodes.[12] Sleeping with a wedge has also been associated with decreased esophageal acid exposure. Conversely, sleeping in the right lateral decubitus position was associated with increased reflux possibly because in this position the acid pocket is closer to the esophago-gastric junction.[19] Such a strategy may be especially beneficial in patients with late evening or nocturnal GERD. Furthermore, patients with symptoms of obstructive sleep apnea have an increased risk of development of Barrett's esophagus, which is likely mediated by worsening GERD.[20]