Low-FODMAPs diet does not improve PPI-refractory GERD

An open-label study from France showed that a low-FODMAPs diet did not have any benefit over a standard diet to improve symptoms in patients with PPI-refractory gastro-oesophageal reflux disease (GERD).

An open-label study from France showed that a low-FODMAPs (Fermentable Oligo-, Di-, Mono-saccharides and Polyols) diet did not have any benefit over a standard diet to improve symptoms in patients with proton pump inhibitors (PPI)-refractory gastro-oesophageal reflux disease (GERD).

Dietary advice is often proposed for patients with GERD. Previous studies demonstrated that a low-FODMAPs diet improved lower gastrointestinal symptoms. Colonic fermentation of alimentary carbohydrates has been shown to impact gastric and oesophageal motility and the occurrence of reflux episodes.

The current multicentre, randomised, open-label study from France compared the efficacy of a 4-week low-FODMAPs diet with a standard diet in 31 patients (55% female, median age 45 years) with symptomatic PPI-refractory GERD, defined by a Reflux Disease Questionnaire (RDQ) score >3 and abnormal pH-impedance monitoring on PPIs.

Adherence to the assigned diet was good. There was a significant difference in the amount of FODMAPS consumed per day between the low-FODMAPs diet (2.5 g) and the standard diet group (13 g), (P<0.001). Furthermore, the caloric intake decreased in both groups (from 1,600 to 1,400 on average, P<0.001) without significant differences between the 2 groups. There was also no significant difference in response rates (RDQ score ≤3) between the low-FODMAPs diet and standard-diet groups (37.5% vs 20%, P=0.20).

The primary endpoint was the percentage of responder patients (RDQ ≤3) at the end of the 4-week period. Total RDQ score and dyspepsia subscore decreased significantly over time in both groups (P=0.002) These was no difference according to the assigned diet group (P=0.85).

The secondary endpoints evaluated the effect of the diet on pH-impedance parameters and associated functional symptoms (dyspepsia, irritable bowel syndrome), using different scores, including the Gastrointestinal Quality of Life Index (GIQLI) and the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS).

The IBS-SSS decreased in both groups, but this was only significant for the FODMAPS group (P=0.04). There was no difference in the GIQLI score. Moreover, there was no significant difference in the pH-impedance parameters between the low-FODMAPs diet and standard diet.

This study demonstrated that a low-FODMAPs diet did not show any benefit over a standard diet to improve symptoms in patients with PPI-refractory GERD.

1. Zerbib F. Low-FODMAPS diet for the treatment of refractory gastroesophageal reflux disease. A randomized controlled trial. UEG Week Virtual Symposium 2020, abstract OP194.

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