Clinical Trials Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2018; 24(21): 2291-2299
Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2291
Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease
Sergey Morozov, Vasily Isakov, Mariya Konovalova
Sergey Morozov, Vasily Isakov, Mariya Konovalova, Department of Gastroenterology and Hepatology, Federal Research Center of Nutrition, Biotechnology, and Food Safety, Moscow 115446, Russia
Author contributions: Morozov S, Isakov V, and Konovalova M contributed to the design and practical implementation of the study; Morozov S and Isakov V designed the research and wrote the paper; Morozov S and Konovalova M conducted research and analyzed data; all authors critically revised the manuscript; the authors had complete access to the data that support the publication; all authors have approved the final version of the manuscript.
Supported by (partly) Federal Agency for Scientific Organizations of Russia, No. 0529-2017-0057.
Institutional review board statement: Study design, protocol, and patients’ informed consent form were approved by the Institute of Nutrition IRB (Moscow, Russia), (protocol #12, 25APR2012).
Clinical trial registration statement: This study registered at, and clinical trial registry number: NCT01882088.
Informed consent statement: All participants signed the informed consent form.
Conflict-of-interest statement: Sergey Morozov, Vasily Isakov, Mariya Konovalova are the employee of Federal Research Center of Nutrition and Biotechnology, and have received research funding from Federal Agency for Scientific Organizations of Russia.
CONSORT 2010 statement: Aligned with CONSORT 2010 (TREND statement for non-randomized studies).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sergey Morozov, MD, PhD, Doctor, Senior Researcher, Gastroenterology and Hepatology, Federal Research Center of Nutrition, Biotechnology and Food Safety, Kashirskoye shosse 21, Moscow 115446, Russia.
Telephone: +7-499-6131091 Fax: +7-499-6131091
Received: March 26, 2018
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.

Keywords: Gastroesophageal reflux disease, Psyllium, Gastroesophageal reflux, Lower esophageal sphincter relaxation, Esophageal motility, Dietary fiber, Heartburn, Non-erosive gastroesophageal reflux disease

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.