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The Effects of Modifying Amount and Type of Dietary Carbohydrates on Esophageal Acid Exposure Time and Esophageal Reflux Symptoms

Gu C, Olszewski T, King K, Vaezi M, Niswender K, Silver H (2022) The American Journal of Gastroenterology doi: 10.14309/ajg.0000000000001889  

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This is the first randomized controlled diet intervention trial to investigate both the amount and type of carbohydrate on symptomatic gastroesophageal reflux disease (GERD).


Ninety-eight Veterans with symptomatic GERD were randomly assigned to high total / high simple (HTHS control group), high total / low simple (HTLS), low total / high simple (LTHS) or low total / low simple (LTLS) carbohydrate diet for nine weeks. The primary outcomes were esophageal acid exposure time (AET) and total number of reflux episodes derived from 24-hour ambulatory pH monitoring. Secondary outcomes were esophageal reflux symptoms rated using the Gastroesophageal Reflux Disease Questionnaire (GERDQ) and GERD Symptom Assessment Scale (GSAS).


Half of subjects were Caucasian and half African American (mean age, 60.0 ± 12.5 years; mean BMI, 32.7 ± 5.4 kg/m2). There was a significant main effect of diet treatment on AET (P = 0.001) and on total number of reflux episodes (P = 0.003). The change in AET in the HTLS group (-4.3 ± 3.8%) differed significantly from the HTHS control group (+3.1 ± 3.7%), P = 0.04. The reduction in simple sugars intake averaged 62 grams less per day. Subjects’ ratings of symptom improved in all carbohydrate modification groups, including significant reductions in heartburn frequency, heartburn severity, acid taste in the mouth, lump/pain in the throat or chest, and sleep disturbance.


A modification of dietary carbohydrate intake that targeted a substantial reduction in the intakes of simple sugars improved pH monitoring outcomes and symptoms of GERD that profoundly affect daily life. These findings provide a feasible and clinically applicable contribution to the limited objective data existing for efficacious dietary recommendations in the routine treatment and management of GERD.


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