DOES STANDARDIZED DIET IMPROVE PROTON PUMP INHIBITOR RESPONSE IN GERD PATIENTS?

Background and aim: Proton pump inhibitors (PPIs) are considered the gold standard therapy for gastroesophageal reflux disease (GERD). The additional role of dietary habits to improve symptoms relief remains to be established. Our aim is to evaluate the effect of a standardized diet added to PPIs’ therapy on symptoms’ improvement in GERD patients. Material and methods: We enrolled 16 patients (7M and 9F; Age range 18–65, BMI 27.2±4.44) with symptoms ofGERD. All subjects received 20mg of pantoprazole twice a day for twelve weeks. Each patient underwent a 24h pH-impedance monitoring (pH-MII) both off- and on-therapy at baseline and during the last week of treatment, respectively. Patients were randomly divided into two groups: 7 were treated both with PPIs and a standardized dietary regimen (D+ patients: 4M and 3F; BMI 29.89±3.91); 9 were treated only with PPIs (D- patients: 3M and 6F; BMI 25.83±4.18). D+ patients were instructed to follow a standardized nutrients’ balanced diet (protein 16–18%, fat 27%, CHO 55–57%), energetically adapted to each subject, and to avoid “refluxogen” food consumption. Symptoms (heartburn, pain and regurgitation) were scored by using Visual Analogue Scale (VAS), while diet adherence was evaluated by food frequency questionnaire. Data were analyzed using t-test for paired and unpaired samples. Results:We found a significant decrease of BMI in D+ group respect of D- (D+ T0-T12= 3.00±2.13 and D- T0-T12= 0.22±0.70; p<0.05). Improvement of heartburn and pH-MII parameters was observed in both groups. Patients on diet reported a significantly higher improvement of heartburn if compared to subjects receiving only PPIs (VAS: 36.06±25.70 mm; 25.83±24.21; p<0.05). We also observed a significantly higher decrease of distal (38.00±19.98 vs 14.56±16.29; p<0.05); and proximal (21.00±5.07 vs 7.67±12.95; p<0.05) acid refluxes in subjects D+and D-, respectively. Conclusions: A standardized diet further improves GERD outcome of patients already treated with PPIs. However it remains to be established whether the symptoms and pH-MII parameters improvement depends on BMI decrease or qualitative characteristics of diet.