Dietary patterns and gastroesophageal reflux disease in Sri Lanka: A regional food culture perspective

Table 1 Proposed mechanisms and clinical manifestations of dietary factors and eating habits associated with gastroesophageal reflux disease

Dietary factor or habit	Proposed mechanism	Primary pathway	Clinical manifestation(s)	Evidence boundary	Ref.
High-fat diet or high dietary fat load	May increase transient LES relaxations and delay gastric emptying	LES function; gastric emptying	Increased postprandial reflux and more severe retrosternal burning	Established mechanism	[15,16,19]
High-carbohydrate or high simple-sugar diet	May increase postprandial gastric load and prolong esophageal acid exposure	Gastric content load; acid exposure	Worsened reflux symptoms and greater postprandial discomfort	Inferred mechanism	[8,13,14,22,23]
Wheat-based or high-FODMAP diet	May increase intestinal fermentation and gas production and raise the frequency of transient LES relaxations	Intestinal fermentation; intra-abdominal pressure; TLESR	More bloating, acid regurgitation, and belching	Hypothetical mechanism	[14,20,21]
Spicy foods or capsaicin	May increase sensory sensitivity in the esophagus and stomach	Mucosal sensation; neural sensitivity	More prominent heartburn, irritation, and related symptoms	Inferred mechanism	[8,9,12,18]
Carbonated beverages	May increase intragastric gas and reduce LES pressure	Intragastric pressure; LES function	More belching and greater susceptibility to reflux	Inferred mechanism	[9,12]
Coffee or caffeinated beverages	May stimulate gastric acid secretion and alter LES tone	Gastric acid secretion; LES function	Possible worsening of acid regurgitation and heartburn	Inferred mechanism	[9,12,14,17,18]
Acidic foods or vinegar-based foods	May directly intensify esophageal mucosal irritation and symptom perception	Mucosal irritation; acid sensitivity	More prominent heartburn and retrosternal discomfort	Inferred mechanism	[9,14]
Short interval between dinner and sleep, or nighttime eating	May increase esophageal acid exposure in the supine position	Nocturnal acid exposure; position-related reflux	Nocturnal heartburn, sleep disturbance, and morning discomfort	Inferred mechanism	[25-28]
Irregular eating, midnight snacks, or skipping breakfast	May disrupt eating rhythm and increase opportunities for nocturnal or postprandial reflux	Meal timing; GI motility	Greater symptom fluctuation and more obvious nighttime or post-fasting discomfort	Inferred mechanism	[14,25-27]
Rapid eating or binge eating	May rapidly distend the stomach and increase intragastric pressure	Gastric distension; intragastric pressure	More postprandial reflux, belching, and upper abdominal fullness	Inferred mechanism	[8,14,25]
High-fiber diet or supplementation with soluble dietary fiber	May increase resting LES pressure and reduce the number of reflux episodes	LES function; gastrointestinal motility	Fewer episodes of heartburn and reflux	Inferred protective mechanism	[8,10]
Diet rich in vegetables, fruits, and fish	May reduce symptoms by improving overall dietary quality and lowering the intake of high-fat and highly processed foods	Overall dietary pattern; inflammation; gastrointestinal function	Potentially lower risk of GERD symptoms	Inferred association	[8,10,11]
Mediterranean dietary pattern	May exert protective effects through the combined actions of unsaturated fatty acids, dietary fiber, and antioxidant components	Overall dietary pattern; inflammatory regulation; gastrointestinal function	Potentially lower reflux symptom burden and GERD risk	Inferred protective association	[11]
Fried foods	Often combine high fat, high energy density, and strong irritation, which may promote postprandial reflux	Gastric emptying; LES function; intragastric pressure	Worsened heartburn, acid regurgitation, and postprandial heaviness	Inferred mechanism	[9,12,14,18]
Alcohol	May reduce LES pressure and irritate the esophageal and gastric mucosa	LES function; mucosal irritation	More acid regurgitation, heartburn, and retrosternal discomfort	Established/inferred mechanism	[9,12,17,18]

LES: Lower esophageal sphincter; FODMAP: Fermentable oligosaccharides, disaccharides, monosaccharides and polyols; GI: Gastrointestinal; TLESR: Transient lower esophageal sphincter relaxation; GERD: Gastroesophageal reflux disease.