Nutraceutical and probiotic interventions for the management of gastroesophageal reflux disease symptoms

Skye Marshall, Zoe Martin, Georgia Spry, Jen Hoult, Isabella Maimone, Xueying Tang, Megan Crichton

Research output: Contribution to journalMeeting AbstractResearchpeer-review

Abstract

Background and Aim:
Guidelines for managing gastroesophageal reflux disease (GERD) symptoms include pharmaceutical, surgical, dietary, and lifestyle strategies. However, emerging research suggests nutraceutical and probiotic interventions may have an adjuvant therapeutic effect. This study aimed to determine the effect of nutraceutical and probiotic interventions, with or without pharmaceutical therapy, on GERD symptoms in adults with a history of GERD or functional dyspepsia, compared with no intervention, placebo, or usual care.

Methods:
A systematic review and meta-analysis was conducted. We searched for eligible studies across MEDLINE, CINAHL, Central, and Embase databases. Intervention studies were eligible if they evaluated the effect of a nutraceutical (nutrient, herbal, or polyphenol-rich supplement) or probiotic intervention in adults with GERD or functional dyspepsia. Outcomes were GERD symptoms (using a validated symptom questionnaire) or incidence of reflux. Included studies were critically appraised using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Meta-analysis was performed using Review Manager, and certainty in the body of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results:
Ten studies with 11 intervention arms (eight nutraceutical intervention arms and three probiotic intervention arms) were included. Intervention duration varied from a single meal to 3 months. Most studies were parallel (n = 7) or crossover (n = 2) randomized trials, with one pre-test–post-test study. Nutraceutical studies evaluated a functional liquid meal (n = 1), ginger ± artichoke leaf extract (n = 2), antioxidant-enriched olive oil (n = 1), psyllium husk (n = 1), zinc (n = 1), prickly pear and olive leaf extract (n = 1), and a melatonin, amino acid, and B-group vitamin mix (n = 1). Probiotic studies evaluated probiotic-enriched olive oil (n = 1), Lactobacillus gasseri-enriched yoghurt (n = 1), and a Bacillus subtilis and Enterococcus faecium capsule (n = 1). Effects of enriched olive oil studies were excluded from evidence synthesis due to negative study quality. The remaining studies were of positive (n = 5) or neutral (n = 4) quality. GERD symptoms were clinically and statistically reduced by probiotic yoghurt (one study), psyllium husk (one study), prickly pear and olive leaf extract supplement (one study), melatonin, amino acid and B-group vitamin supplement (one study), and ginger-containing supplements (two studies), according to qualitative synthesis. Meta-analysis found that, compared with placebo, ginger-containing supplements increased the incidence of reflux improvement (odds ratio, 7.50 [95% CI, 3.62–15.54]; I2 = 36%; P < 0.00001; GRADE, high; Fig. 1). No clinically or statistically significant effects were found for the remaining interventions.

Conclusion:
Evidence supporting adjuvant nutraceutical and probiotic treatment for GERD symptoms is limited in scope, and most findings have not been reproduced. Ginger-containing supplements may reduce GERD symptoms if taken twice daily before meals for 4 weeks. High-quality clinical trials are required to increase confidence in the findings.
Original languageEnglish
Article number46
Pages (from-to)227-227
Number of pages1
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume38
Issue numberS2
DOIs
Publication statusPublished - 27 Aug 2023
EventAustralia's premier gastroenterology and hepatology conference 2023 - Brisbane Convention and Exhibition Centre , Brisbane, Australia
Duration: 2 Sept 20235 Sept 2023
https://agw.gesa.org.au/2023-agw-program-overview/

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