Diet and lifestyle in GERD management: a comparative guidelines review

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders and often requires long-term management. While PPI remains the main pharmaceutical therapy, many patients seek non-pharmacological strategies and require individualized support to improve symptom control and quality of life. This comparative review examines international guidelines from Europe, US, Asia and UK to clarify how dietary and lifestyle measures are framed within patient management, with particular attention to the involvement of dietitians.

Guidelines were identified through targeted searches of major gastroenterology societies and public health institutions and were analyzed for methodology, strength of recommendations, practical advice, and clarity regarding patient education. Overall, documents consistently recognize the value of weight reduction, meal timing, and individualized assessment of symptom triggers, but the level of detail varies across regions. Strong dietary prescriptions are uncommon, largely due to limited high-quality evidence, whereas guidance on structured patient counseling is often insufficient. The ASGE guideline stands out for explicitly explaining the methodological reasons behind the scarcity of robust lifestyle recommendations. European guidelines, particularly German and Italian documents, offer more practical cues for patient management than UK equivalents, yet gaps remain: limited epidemiological data for several populations, uneven guidance, and lack of dedicated recommendations for dietitians.

This review highlights the need for harmonized, evidence-informed dietary pathways and for greater integration of dietitians to support personalized symptom management, behavioral change, and shared decision-making. Future research should prioritize randomized trials on dietary patterns, meal timing, and patient-centered outcomes to strengthen non-pharmacological care in GERD.