Medical nutrition for gastroesophageal reflux disease

How can you provide your patients experiencing reflux with evidence-based lifestyle and dietary strategies to help manage their symptoms?

Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder that’s characterised by the backflow of acidic stomach contents into the oesophagus. It’s also common, with an estimated 10-20% prevalence in the Western world [1]. When left untreated, GERD can cause chronic inflammation and lead to ulcers, and in serious cases, lead to esophageal cancer.

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While symptoms typically include heartburn and regurgitation, symptoms can also include nausea, vomiting, bloating, and trouble swallowing. There are also cases of silent reflux, where symptoms are less apparent but can still cause damage to the oesophagus.

While the cause of GERD is unknown, there are certain risk factors for GERD including the presence of hiatal hernia, motor abnormalities, being over 50 years of age, excess alcohol, smoking, and certain medications [2].

While GPs can prescribe medications as part of the treatment and management options for GERD, lifestyle modifications can also help to manage GERD, including those highlighted below.

Avoiding trigger foods

The evidence is lacking when it comes to trigger foods for GERD. However, there are frequent anecdotal reports that certain trigger foods can worsen reflux symptoms [3]. Commonly reported trigger foods include citrus, coffee, carbonated beverages, chocolate, fried foods and spicy foods and patients may want to consider trialling limiting these foods.

Increasing fibre

High fibre intakes are associated with reduced GERD symptoms, which may be due to improved gut motility [4]. A 2018 study found that when GERD patients with a typical low fibre intake switched to a fibre-enriched diet with psyllium, there was a significant decrease in the number of gastroesophageal refluxes [4]. Patients can try increasing their intake of vegetables, fruits, whole grains and legumes and/or consider a fibre supplement.

Having small and frequent meals

Studies have found that eating snacks late at night, frequently skipping breakfast, overeating, and eating quickly are positively associated with GERD [5]. Eating regularly by having smaller and more frequent meals, in comparison to fasting throughout the day and having a large portion size at dinner, may help to manage GERD. Patients can also be encouraged to eat slowly.

Avoiding laying down 2-3 hours after eating

Studies have shown that sleeping less than 3 hours after eating dinner is positively correlated with GERD [5]. Patients may benefit from moving their evening meal earlier and allowing at least 2-3 hours between eating their last meal and sleeping, as well as elevating their head while sleeping [6].

While GPs can prescribe medications to help patients manage GERD, patients are becoming more interested in the role of diet and lifestyle in disease management. GPs can support their patients by providing evidence-based advice on lifestyle and dietary strategies which may involve simple, cost-effective changes for some patients.

Learn more with HealthCert's online Professional Diploma program in Medical Nutrition Management.

– Sarah Marko, Accredited Practising Dietitian

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References

[1] Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: A systematic review. Gut 2005;54:710–17.

[2] Eusebi LH, Ratnakumaran R, Yuan Y, Solaymani-Dodaran M, Bazzoli F, Ford AC. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut. 2018 Mar;67(3):430-440. doi: 10.1136/gutjnl-2016-313589. Epub 2017 Feb 23. PMID: 28232473.

[3] Fox M, Gyawali CP. Dietary factors involved in GERD management. Best Pract Res Clin Gastroenterol. 2023 Feb-Mar;62-63:101826. doi: 10.1016/j.bpg.2023.101826. Epub 2023 Feb 17. PMID: 37094911.

[4] Morozov S, Isakov V, Konovalova M. Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World J Gastroenterol. 2018 Jun 7;24(21):2291-2299. doi: 10.3748/wjg.v24.i21.2291. PMID: 29881238; PMCID: PMC5989243.

[5] Zhang M, Hou ZK, Huang ZB, Chen XL, Liu FB. Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review. Ther Clin Risk Manag. 2021 Apr 15;17:305-323. doi: 10.2147/TCRM.S296680. PMID: 33883899; PMCID: PMC8055252.

[6] Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2016 Feb;14(2):175-82.e1-3. doi: 10.1016/j.cgh.2015.04.176. Epub 2015 May 6. PMID: 25956834; PMCID: PMC4636482.