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
Frequency of heartburn is negatively correlated with the amount of dietary fiber consumed according to epidemiological studies. 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. The ability of dietary fibers to bind nitric oxide contained in food may diminish its negative effect onto low esophageal sphincter pressure, but it has not been clinically proven yet. This is the first prospective trial demonstrating that an increase of dietary fiber consumed results in a significant increase of minimal esophageal resting pressure a decrease of the number of gastroesophageal refluxes and frequency of heartburn per week in patients with non-erosive gastroesophageal reflux disease (GERD) (NERD).
Reflux disease symptoms are associated with low consumption of dietary fiber, according to epidemiological studies. However, no studies were available to date that evaluated the effect of dietary fibers on esophageal motility and reflux pattern and there were no interventional studies demonstrating the effect of dietary fibers on GERD symptoms. For the first time, we showed that additional daily consumption of 12.5 g of soluble dietary fiber is associated with an increase in minimal lower esophageal sphincter resting pressure and a decrease in the number of gastroesophageal refluxes and frequency of heartburn per week in NERD.
The main objective of the study was to evaluate the effect of increased dietary fiber consumption on the number of gastroesophageal refluxes, esophageal acidity, the lower esophageal sphincter pressure, and clinical manifestations of NERD in patients with low dietary fiber intake.
The study was conducted as a pilot single-center prospective trial with very strict inclusion criteria aimed to support the diagnosis and to exclude other reasons able to affect esophageal motility and NERD symptoms. Change in GERD-Q questionnaire score, lower esophageal sphincter function by high resolution esophageal manometry, number of different types of gastroesophageal refluxes, and acid exposure time were assessed before and after patient diet modification (increased intake of dietary fiber). Data were analyzed using non-parametric statistics.
Our study is the first prospective trial demonstrating that increasing the amount of dietary fiber consumed results in an increase of minimal esophageal resting pressure and a decrease of the number of gastroesophageal refluxes and frequency of heartburn per week in patients with non-erosive GERD. Diet modification with additional psyllium (5.0 g TID) was well tolerated by non-erosive GERD patients with low dietary fiber intake.
Our results are consistent with epidemiological studies that found an inverse correlation between the amount of dietary fibers consumed and symptoms of GERD. We demonstrated that diet modification with an addition of 12.5 of soluble fiber a day led to a decrease of GERD symptom frequency, an increase in lower esophageal sphincter resting pressure, and a decrease in the number of gastroesophageal refluxes. These findings are promising and suggest that nutritional interventions may be effective in GERD management.
Well-planned trials are needed to examine further novel potential mechanisms of nutritional support for patients with esophageal disorders. Moreover, multicenter, placebo-controlled, dose-escalating trials are necessary to confirm our results, to establish the dose necessary to reach the optimal effect on esophageal motility and NERD symptoms, and to evaluate the effect of different types of dietary fibers.