Original article
The Effects of Dietary Fat and Calorie Density on Esophageal Acid Exposure and Reflux Symptoms

https://doi.org/10.1016/j.cgh.2006.12.013Get rights and content

Background & Aims: The effects of diet on gastroesophageal reflux disease are not well understood. This study assessed the effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms in patients with reflux symptoms. Methods: Patients referred for the investigation of reflux symptoms were recruited (most with nonerosive disease). A catheter-free system provided esophageal pH monitoring over 4 days in 4 dietary conditions. A high-fat (50%) vs low-fat (25%) diet (calorie-controlled), and a high-calorie (1000 kcal) vs low-calorie (500 kcal) diet (fat-controlled) were provided in randomized order, and meal volume was controlled. The effects of meal consistency also were studied. Results: Complete data were available for 15 patients (6 men, 9 women; age, 48 y; range, 26–70 y; body mass index, 26 kg/m2; body mass index range, 21–35 kg/m2). Demographic variables and meal sequence had no effect on reflux parameters. Dietary composition had effects on esophageal acid exposure (F statistic [analysis of variance] = 7.4, P < .005) and symptoms (Friedman test = 24.2, P < .001). No effect of meal consistency was present. Esophageal acid exposure was greater during the high-calorie than the low-calorie diet (mean, 8.6% ± 2.0% vs 5.2% ± 1.4% time pH < 4/24 h; P < .01). No difference was observed between the high-fat and low-fat diets (mean, 8.6% ± 2.0% vs 8.2% ± 1.6% time pH < 4/24 h; P = NS). In contrast, the frequency of reflux symptoms was not affected by calorie density (median, 6; range, 2–12 vs median, 8; range, 2–13; P = NS) but was increased by the high-fat compared with the low-fat diet (median, 11; range, 5–18 vs median, 6; range, 2–12; P < .05). Conclusions: Calorie density determines the severity of esophageal acid exposure in gastroesophageal reflux disease after a meal; however, the percentage fat content of the diet has important effects on the frequency of reflux symptoms.

Section snippets

Subjects

Patients with typical reflux symptoms referred for Bravo pH monitoring were invited to participate in the study. Exclusion criteria included previous upper-gastrointestinal surgery (or interventions), gastrointestinal symptoms other than reflux, ingestion of medication that affects either gastrointestinal function (acid suppression was stopped 4 days before the study), special dietary requirements (eg, diabetes) or behavior (eg, vegetarian), and pregnancy. Subjects provided written informed

Study Progress

Forty-six patients with reflux symptoms waiting for Bravo pH monitoring were contacted between May and September 2005, 22 patients accepted an invitation for screening. One patient was excluded because of dietary restrictions and 2 patients withdrew consent before the study began. Endoscopy was performed in 19 patients, 4 had mild erosive esophagitis and 2 had a small hiatus hernia (acid suppression was stopped only 4 days before the study began). The Bravo capsule failed to deploy in 1 patient

Discussion

Prolonged pH recordings by wireless ambulatory pH measurements provided novel information about the effects of diet in patients with GERD, both in terms of objective esophageal acid exposure and subjective reflux symptoms. This study also provided information about the effects of food consistency on gastroesophageal reflux. The protocol allowed the effects of calorie density, percentage fat content, and food consistency on GERD to be assessed independently. Other factors that may have effects

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