Gastroesophageal Reflux Disease: Nutritional Considerations

The role of dietary factors in GERD remains unsettled. It is noteworthy, however, that cultural differences are associated with differences in prevalence, suggesting a role for diet. The incidence of gastroesophageal reflux disease is lower in China (5% incidence) and certain other countries than in Western countries,⁸ which may reflect differences in eating styles, food choices, and body weight. Although dietary changes (eg, avoidance of offending foods and beverages) are often recommended to improve symptoms, reducing meal size and controlling weight may be equally important. The following factors appear to be associated with reduced GERD symptoms:

Eating more fiber. Persons eating the most fiber have a 30% lower risk for GERD, compared with those who eat the least.⁹ High–fiber bread in particular has been associated with reduced risk for this disease.¹⁰ Controlled clinical trials have not assessed the effectiveness of a high–fiber diet in treating this disorder.

Avoiding irritating foods. Although research is not abundant, available evidence indicates that fried, fatty, or spicy foods; raw onions; chocolate; alcohol; and drinks with high titratable acidity, such as citrus drinks and juices, all cause reflux and heartburn.^11–14

Eliminating coffee. Coffee reduces lower esophageal sphincter pressure, permitting gastroesophageal reflux.¹⁵ Although studies have repeatedly shown that caffeine itself is not responsible for GERD, some evidence does indicate that decaffeination of coffee significantly reduces reflux.^16,17 In addition, other compounds in coffee may trigger reflux.¹⁸

Avoiding alcohol. Compared with nondrinkers, alcohol consumers have at least double the risk of gastroesophageal reflux disease.¹⁹

Eating smaller meals. The total amount of food consumed during a meal appears to be related to reflux symptoms, perhaps because gastric distension triggers GERD symptoms.²⁰ Reducing meal size may therefore be a reasonable prevention strategy,^21,22 particularly for patients who frequently experience delayed gastric emptying.²³

Thickened feedings. Thickened feedings for children under 2 years of age reduce regurgitation severity and emesis frequency, although this does not lower the reflux index.²⁴

Orders

See Basic Diet Orders.

Avoid patient–specific food triggers, or eliminate potential triggers (as described above) prospectively.

Smoking cessation.

Alcohol restriction.

Stress reduction.

What to Tell the Family

Gastroesophageal reflux disease is a common disorder that may be preventable through maintaining a healthy weight, avoiding mealtime overeating, and avoiding caffeine and irritating foods. In chronic cases, treatment may also involve antacids, proton pump inhibitors, and even surgery to prevent erosive esophagitis and decrease the risk for esophageal cancer.