Looking for Nonpharmacologic Interventions for GERD? Try Diet

GERD patients are not following recommendations to avoid acid-triggering foods, according to a recent study.

Patients with gastroesophageal reflux disease (GERD) may need to pay more attention to what they eat. That’s the conclusion reached by researchers from Kaiser Permanente Division of Research, University of California, San Francisco, and the University of California, Berkeley, School of Public Health, in a new study published in BMC Gastroenterology on August 14, 2014.

GERD, the most common gastrointestinal diagnosis in Americans, is usually treated with medications including H2-receptor antagonists and proton pump inhibitors. These drugs are not without side effects and interactions, and in some patients, they are partially or completely ineffective. Our attention is shifting back to nonpharmacologic approaches that could decrease drug use and related side effects. A first step is dietary modification.

The National Institutes of Health and the American College of Gastroenterology recommend dietary and lifestyle changes when patients develop GERD. Reducing total fat, chocolate, alcohol, citrus and tomato product, coffee, and tea intake can reduce symptoms. Patients should also avoid large meals, quit smoking, and lose weight.

It is not clear if GERD patients follow these recommendations. The Kaiser Permanente researchers conducted a population-based cross-sectional study and compared 317 GERD patients with 182 asymptomatic population controls.

They found that GERD patients were as likely to consume tomato products and large portion meals as patients in the control group. Even GERD patients with moderate to severe symptoms or frequent symptoms were undeterred—they ate tomato products and large meals, too.

GERD patients were twice as likely to consume carbonated beverages and tea, fried foods, and a high-fat diet as patients in the control group. Citrus and beer were the only reflux-triggering foods that GERD patients were less likely to consume; they were more likely to drink hard liquor, however.

When the researchers excluded patients who were taking proton pump inhibitors, the associations still held.

GERD patients appear to disregard recommendations for dietary changes, and in fact, have diets more concentrated in acid-triggering foods than patients who do not have GERD. The authors indicate that further study on dietary modification is needed to gain a better understanding of the role of nonpharmacologic approaches in the treatment of GERD.