Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2291
Peer-review started: March 27, 2018
First decision: April 11, 2018
Revised: April 27, 2018
Accepted: May 11, 2018
Article in press: May 11, 2018
Published online: June 7, 2018
To investigate the effect of dietary fiber on symptoms and esophageal function testing parameters in non-erosive gastroesophageal reflux disease (GERD) (NERD) patients.
Thirty-six NERD patients with low (< 20 g/d) dietary fiber intake were enrolled in the study. They were examined with the use of symptom questionnaire (GERD-Q), high-resolution esophageal manometry, 24-h esophageal pH-impedance examinations, and food frequency questionnaire before and after 10 d of usual diet supplemented by psyllium 5.0 g TID. Complete data of 30 patients were available to the final analysis. The obtained results were analyzed with the use of non-parametric statistics (Wilcoxon matched pairs test).
The number of patients experiencing heartburn was less (93.3% at baseline vs 40% at the end of the study, P < 0.001) and the GERD-Q score decreased (mean ± SD: 10.9 ± 1.7 vs 6.0 ± 2.3, P < 0.001) after the treatment period. Minimal resting lower esophageal sphincter (LES) pressure increased from 5.41 ± 10.1 to 11.3 ± 9.4 mmHg (P = 0.023), but no change in residual LES pressure and mean resting pressure was found. Total number of gastroesophageal refluxes (GER) decreased from 67.9 ± 17.7 to 42.4 ± 13.5 (P < 0.001) predominantly by acid and weak acid types of GERs. No significant change in mean esophageal pH and % of time pH < 4 was registered. Maximal reflux time decreased from 10.6 ± 12.0 min to 5.3 ± 3.7 min (P < 0.05).
Fiber-enriched diet led to a significant increase of minimal lower esophageal sphincter resting pressure, a decrease of number of gastroesophageal refluxes, and a decrease of heartburn frequency per week in NERD.
Core tip: Low dietary fiber intake is associated with decreased stomach and gut motility and delayed gastric emptying, which may contribute to the risk of gastroesophageal reflux and gastroesophageal reflux disease (GERD) symptom frequency. The ability of dietary fibers to bind nitric oxide contained in food may diminish its negative effect on lower esophageal sphincter pressure. Our study is the first prospective trial demonstrating that increasing dietary fiber intake results in an increase of minimal esophageal resting pressure, a decrease in the number of gastroesophageal refluxes, and a decrease in heartburn episodes per week in patients with non-erosive GERD.