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

Obesity and Exercise

It has not gone unnoticed that the increased global prevalence of GERD is associated with a parallel rise in the obesity epidemic. Currently, more than one third of adults in the United States are obese.[21] Weight loss has long been suggested as a conservative method of GERD management, based on assumed pathophysiology rather than objective data. The development of increased abdominal pressure in patients with obesity leads to the disruption of the gastro-esophageal junction and hiatal hernia. Furthermore, obesity may affect esophageal motility and weight loss has been associated with reduced esophageal acid exposure.[7] Recent literature demonstrates that patients with an increased BMI have more acid reflux by pH testing, more severe and more frequent reflux symptoms and endoscopic findings of erosive esophagitis.[7] This increased time of esophageal acid exposure is supported by several prospective observational studies. Weight gain of as little as 3.5 BMI units was associated with a threefold increased risk of developing reflux symptoms.[4] A seminal article published by Jacobson et al.[22] with data from the cohort of the Nurses' Health study of 10 545 women confirmed a dose-dependently reduced risk of reflux symptoms among women who had a decrease in BMI compared with women with no BMI change (OR = 0.64; 95% CI, 0.42–0.97; BMI decrease >3.5 units; Ptrend < 0.001). In addition, the authors noted that in women with a normal BMI, an increase in BMI of more than 3.5, as compared with no weight changes, was associated with an increased risk of frequent symptoms of reflux (OR = 2.80; 95% CI, 1.63–4.82).[22]

A study by de Bortoli et al.[4] demonstrated that achievement of a 10% weight loss was associated with significant decrease in reflux symptoms, namely heartburn, regurgitation, noncardiac chest pain, and belching. Patients in the weight loss cohort, which demonstrated a 5-point reduction of BMI through the addition of a low calorie diet and aerobic exercise, were more frequently able to decrease the dose of their PPI therapy or discontinue use of these drugs. A noninvasive approach such as weight loss should be encouraged for all patients with symptoms with or without endoscopic disease. It may best be achieved through a low-fat, high-carbohydrate, and low calorie diet. It is also reasonable to assume that an unhealthy diet is a common risk factor for both GERD and obesity.

Along with diet control, regular aerobic exercise may help in the management of GERD. Obese patients are known to have increased incidence of reflux symptoms and decreased frequency of exercise.[4] It has been suggested that regular exercise is associated with strengthening of the striated muscle in the diaphragmatic crura leading to a stronger anti reflux barrier.[8] Population based studies have demonstrated a lower occurrence of GERD in patients who exercise frequently. In addition, the beneficial effects of exercise on overall medical heath and other commodities cannot be understated.