Non-pharmacological approaches in gastroesophageal reflux disease: Evidence-based dietary and lifestyle interventions

Gastroesophageal reflux disease (GERD) affects 18-28 % of Western populations, with 10-40 % experiencing refractory symptoms despite proton pump inhibitor therapy. We conducted a comprehensive narrative review of dietary interventions in GERD, analyzing studies that measured clinical efficacy through validated symptom scores (GERD-Q, RDQ) and objective reflux parameters (24-h pH-impedance monitoring, acid exposure time). We examined pathophysiological mechanisms, intervention efficacy, and clinical implementation strategies across diverse patient populations. Structured dietary interventions demonstrate clinically meaningful outcomes with robust mechanistic rationale. Low-carbohydrate approaches achieved significant reductions in esophageal acid exposure time (mean difference -2.83 %, 95 % CI: -4.554 to -1.114, p < 0.001), while systematic trigger food elimination protocols achieved 23 % improvement in GERD-Q scores, enabling 45 % of patients to discontinue pharmacological therapy. Plant-based dietary patterns showed remarkable protective effects with 50 % reduction in GERD prevalence (OR = 1.96, 95 % CI 1.22-3.17 for animal food consumption). Weight management interventions demonstrated exceptional efficacy in overweight patients, with GERD prevalence decreasing from 37 % to 15 % (p < 0.01) and 65 % achieving complete symptom resolution. Individual dietary trigger identification achieved high success rates with standardized protocols. Evidence-based dietary interventions offer clinically meaningful alternatives or adjuncts to pharmacological therapy. However, significant study heterogeneity and predominance of short-term trials limit definitive clinical recommendations. Future research should prioritize developing validated precision medicine algorithms integrating clinical phenotyping, genetic markers, and microbiome profiling to optimize personalized dietary prescriptions and investigate long-term sustainability of dietary modifications.