A low-acid diet rarely normalizes pathologic gastroesophageal reflux disease

A 96-hour ambulatory pH testing is a practical tool for diagnosing gastroesophageal reflux disease (GERD) and for concurrently evaluating two conditions: dietary variation and its effect on measured acid exposure time (AET) and reported symptoms. To date, it is unknown how consuming a diet of either low or high acidity can influence pathologic GERD. This study aimed to assess the effects of high- and low-acid diets on AET and the occurrence of laryngopharyngeal symptoms (LPS) during prolonged wireless pH monitoring. A retrospective review of 208 patients who underwent 96-hour wireless pH monitoring for GERD evaluation was completed. Patients consumed a primarily high-acid diet on 1 day and a primarily low-acid diet on a separate day during the 96-hour period. Patients were considered to have pathologic GERD if esophageal AET was >6% for the time with pH <4, and were considered normal on an individual day if the AET was <4%. Pathologic GERD was found in 78 patients (37.5%), of whom the majority (55%) recorded their lowest AET during the study on their low-acid day. Only 24.7% achieved normal AET on a low-acid diet day. Mean AET on a high-acid diet, compared with a low-acid diet, decreased by 41%, from 12.51 to 7.33, with a similarly proportional decrease in patients negative for GERD. There was no significant difference between patients with and without LPS with regard to esophageal acid exposure on high- and low-acid diet days (P = 0.73, P = 0.81). A low-acid diet may be a viable lifestyle modification when used as monotherapy or adjunctively with proton pump inhibitor in patients with or without pathologic GERD.