Can We Use Diet to Effectively Treat Esophageal Disease? A Review of the Current Literature
Purpose of Review
Esophageal diseases represent a wide variety of conditions affecting esophageal anatomy, physiology, and motility. Therapy focuses on pharmacotherapy and endoscopic or surgical management. Dietary therapy can be considered in management algorithms for specific esophageal diseases. This review focuses on outlining the literature related to dietary therapy in gastroesophageal reflux disease, eosinophilic esophagitis, Barrett’s esophagus, and esophageal adenocarcinoma.
Currently, data are strongest for dietary manipulation in eosinophilic esophagitis, specifically the six-food elimination diet. Dietary effects on gastroesophageal reflux disease are less clear, though newer research indicates that increased fiber with reduction in simple sugar intake may improve symptoms. In terms of Barrett’s esophagus and esophageal adenocarcinoma, antioxidant intake may affect carcinogenesis, though to an unknown degree.
Outcomes data regarding dietary manipulation for the management of esophageal diseases is heterogeneous. Given the rising interest in non-pharmacological treatment options for these patients, continued research is warranted.
KeywordsEsophageal diseases GERD Eosinophilic esophagitis Barrett’s esophagus Esophageal adenocarcinoma Dietary therapy
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: ••Of major importance
- 6.Roman S, Kahrilas PJ. Overview of gastroesophageal reflux disease treatments. Practical Manual of Gastroesophageal Reflux Dis. 2013:53–68.Google Scholar
- 7.Du X, Hu Z, Yan C, Zhang C, Wang Z, Wu J. A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults. BMC Gastroenterol. 2016;16(1).Google Scholar
- 8.•• Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2016;14(2):175–82. Most recently published overview of lifestyle modifications in the treatment of GERD including dietary manipulation. CrossRefPubMedGoogle Scholar
- 20.Kaltehbach T, Crockett S, Gerson L. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Gastrointest Endosc. 2005;61(5).Google Scholar
- 25.Fox M, Barr C, Nolan S, Lomer M, Anggiansah A, Wong T. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Clin Gastroenterol Hepatol. 2007;5(4).Google Scholar
- 27.•• Pointer SD, Rickstrew J, Slaughter JC, Vaezi MF, Silver HJ. Dietary carbohydrate intake, insulin resistance and gastro-oesophageal reflux disease: a pilot study in European- and African-American obese women. Alimentary Pharmacology & Therapeutics. 2016;44(9):976. Largest pragmatic trial of patients placed on a low carbohydrate diet showing this may be an effective tool in management of mild to moderate GERD symptoms. CrossRefGoogle Scholar
- 28.Nam SY, Park BJ, Cho Y-A, Ryu KH, Choi IJ, Park S, et al. Different effects of dietary factors on reflux esophagitis and non-erosive reflux disease in 11,690 Korean subjects. J Gastroenterol. 2016.Google Scholar
- 31.Lanzon-Miller S, Pounder RE, Mcisaac RL, Wood JR. The timing of the evening meal affects the pattern of 24-hour intragastric acidity. Aliment Pharmacol Therapeutics. 2007;4, 547(5):–53.Google Scholar
- 32.Pophali P, Halland M. Barrett’s oesophagus: diagnosis and management. Bmj. 2016;:i2373.Google Scholar
- 38.Dawsey SM, Fagundes RB, Jacobson BC, Kresty LA, Mallery SR, Paski S, et al. Diet and esophageal disease. Ann N Y Acad Sci. 2014Sep;1325(1):127–37.Google Scholar
- 43.•• Jeurnink S, Buchner F, Bueno-de-Mesquita H, Siersema PD, Boshuizen HZ, Numans NE. Variety in vegetable and fruit consumption and the risk of gastric and esophageal cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2012;131(6):E963–73. Largest prospective trial of cancer incidence as related to nutrition investigating over 450,000 patients across 10 European countries. CrossRefPubMedGoogle Scholar
- 52.Mcgowan EC, Platts-Mills TA. Eosinophilic esophagitis from an allergy perspective: how to optimally pursue allergy testing & dietary modification in the adult population. Curr Gastroenterol Reps. 2016;18(11).Google Scholar
- 56.•• Arias C, González-Cervera J, Tenias JM, Lucendo AJ. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology. 2014;146(7):1639–48. Review and meta-analysis of dietary intervention tactics in patients with eosinophilic esophagitisCrossRefPubMedGoogle Scholar
- 58.Lucendo AJ. Meta-analysis-based guidance for dietary management in eosinophilic esophagitis. Curr Gastroenterol Reps. 2015;17(10).Google Scholar
- 62.Lucendo AJ, Arias Á, González-Cervera J, Yagüe-Compadre JL, Guagnozzi D, Angueira T, et al. Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease. J Allergy Clin Immunol. 2013;131(3):797–804.CrossRefPubMedGoogle Scholar
- 63.Molina-Infante J, Arias A, Barrio J, Rodríguez-Sánchez J, Sanchez-Cazalilla M, Lucendo AJ. Four-food group elimination diet for adult eosinophilic esophagitis: a prospective multicenter study. J Allergy Clin Immunol. 2014;134(5).Google Scholar
- 64.Cotton CC, Erim D, Eluri S, Palmer SH, Green DJ, Wolf WA, et al. Cost utility analysis of topical steroids compared to dietary elimination for treatment of eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2016.Google Scholar