Individualized Dietary Management Best for Gastroesophageal Reflux Disease

Blanket dietary restrictions and lifestyle modifications may not be the most effective approach for managing GERD.

Gastroesophageal reflux disease should be managed with a long-term individualized diet that includes restrictions and/or additions, according to study findings in Clinical Nutrition ESPEN.

Researchers conducted a meta-analysis and systematic review to determine the efficacy of various dietary treatments (diet modifications, probiotics, and nutraceutical supplements) on GERD symptoms vs placebo, no intervention, or usual care.

Researchers sourced data from MEDLINE, CINHAL, Embase, and Central databases. From these 4 databases, 21 studies were included consisting of 6450 records; an additional 158 records were retrieved following a PubMed search update.

The studies were conducted in Europe or United Kingdom (n=9), Asia or the Middle East (n=7), and North (n=4) and South America (n=1) between 1999 and 2022.

Findings recommend the need to move away from the standardized practice of blanket dietary restrictions and lifestyle modifications, towards long-term individualized dietary management utilizing a toolkit consisting of both dietary restrictions and/or additions.

Study eligibility was based on the Participant, Intervention, Comparator, Outcomes, Study (PICOS) framework. Quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Study participants were aged 18 years and older, had a medical history of GERD or functional dyspepsia, displaying symptoms of reflux, heartburn, nausea, epigastric pain, and other gastrointestinal (GI) symptoms.

The primary outcome was GERD symptoms, and secondary outcomes included symptom elimination rate, exposure to esophageal acid, and Johnson-DeMeester scores.

GERD symptoms improved with restrictive diets, including a very low-carbohydrate diet (P =.0004), the food elimination diet (P =.001), low-nickel diet (P <.001), and low-fat and low-calorie diets (P <0.01).

Esophageal acid exposure was improved in the very low-carbohydrate diet (P =.022) and the low-fat and low-calorie diets (P <.01). Johnson DeMeester scores improved for the low-carbohydrate diet (P =.023) and the low-fat and low-calorie diets (P <.001).

Evidence of improvement of acid reflux symptoms from the use of biophenol nutraceuticals was assigned a GRADE level of high. Biophenol diets improved GERD symptoms in the subgroup with nonerosive reflux disease (P =.014) but not in the subgroup with esophagitis (P =.537).

Exposure to esophageal acid improved in diets with biophenol in the reflux esophagitis subgroup but was not clear in the nonerosive reflux group (P =.047).

Probiotic interventions improved GERD symptom scores, particularly the probiotic yogurt (P =.073). Probiotic yogurt improved symptom alleviation and effect size was moderate (P =.048).

Study limitations include using studies that examined orally consumed interventions and lifestyle changes, so findings may not inform clinical practice.

“The highly heterogenous nature of the evidence found in this review indicates that the effectiveness of singular dietary restrictions or additions will likely be dependent on the individual patient’s response following long-term individualized dietary counselling, as is the case with other gastrointestinal health conditions, such as irritable bowel syndrome,” the study authors noted.


Martin Z, Spry G, Hoult J, et al. What is the efficacy of dietary, nutraceutical, and probiotic interventions for the management of gastroesophageal reflux disease symptoms? A systematic literature review and meta-analysis. Clin Nutr ESPEN. Published online September 19, 2022. doi:10.1016/j.clnesp.2022.09.015