Decrease in Dietary Sugar Reduces GERD Symptoms and Esophageal Acid Exposure

Prateek Sharma, MD, FASGE, reviewing Gu C, et al. Am J Gastroenterol 2022 Jun 21.

Although dietary changes are recommended for patients with gastroesophageal reflux disease (GERD), randomized controlled trials (RCTs) supporting these management strategies are lacking. This RCT evaluated the effects of the amount and type of carbohydrates in the diets of patients with symptomatic GERD. 

For a period of 9 weeks, 98 veterans (53% White, 47% Black; mean age, 60±12.5 years; mean body mass index, 32.7±5.4 kg/m2) with symptomatic GERD were randomized to one of 4 carbohydrate diet intervention groups: high total/high simple (control group), high total/low simple, low total/high simple, and low total/low simple. The primary outcomes were esophageal acid exposure time and the total number of reflux episodes using baseline and follow-up data from 24-hour ambulatory pH monitoring. Secondary outcomes included the impact on GERD symptoms, rated with the Gastroesophageal Reflux Disease Questionnaire (GERDQ) and GERD Symptom Assessment Scale. 

Total acid exposure time significantly decreased in the high total/low simple carbohydrate group compared with the control group (-4.3±3.8% vs 3.1±3.7%, respectively; P=.4). The high total/low simple carbohydrate group also demonstrated a reduction in the total number of reflux episodes and a significant reduction in GERD symptoms, with the average GERDQ score decreasing by 50%. Simple sugar intake decreased by an average of 62 grams per day.

Prateek Sharma, MD, FASGE


A moderate modification in dietary carbohydrates by reducing intake of simple sugars leads to a reduction in esophageal acid exposure time and the total number of reflux episodes, as well as significant improvement in GERD symptoms. Patients with GERD should be instructed to reduce sugar intake as a management strategy.



Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Gu C, Olszewski T, King KL, Vaezi MF, Niswender KD, Silver HJ. The effects of modifying amount and type of dietary carbohydrates on esophageal acid exposure time and esophageal reflux symptoms: a randomized controlled trial. Am J Gastroenterol 2022 Jun 21. (Epub ahead of print) (

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