S485 The Effects of Intermittent Fasting on Gastroesophageal Reflux Disease

Abstract

Introduction: The role of diet in gastroesophageal reflux disease (GERD) is not clear. Intermittent fasting has been popularized in the media and has demonstrated potential benefits with weight loss and inflammatory conditions, as well as alterations in GI hormones. We aim to evaluate the impact of intermittent fasting on esophageal acid exposure time (AET) and GERD symptoms. Methods: Patients referred for 96-hour wireless pH monitoring off PPI for diagnostic evaluation of GERD symptoms were screened for eligibility. Consented patients were instructed to maintain their baseline diet for the first 2 days of pH monitoring and switch to an intermittent fasting regimen (consisting of a 16-hour consecutive fast with 8-hour eating window) for the second 2 days. A mixed effects model was used to analyze the impact of intermittent fasting on AET and GERD symptom severity (adapted from GERD-HRQL survey, up to 25 points each for regurgitation and heartburn). Results: A total of 25 participants were analyzed, averaging 43.5 years of age and about equally split among men and women. 9/25 (36%) fully adhered to the intermittent fasting regimen, with 21/25 (84%) demonstrating at least partial compliance (1 out of last 2 days). A total of 35 successful intermittent fasting days were identified and was associated with 6 additional hours of fasting before first meal and 0.6 less meals per day than days without intermittent fasting (p < 0.05 between groups for both). Mean AET on fasting days was 3.5% vs 4.3% on non-fasting days. Intermittent fasting was associated with a 0.64 reduction in AET (95% CI -2.32, 1.05). Post prandial acid exposure and reflux events were not increased in those who underwent intermittent fasting. Stratified analysis of those with at least borderline reflux at baseline demonstrated a stronger trend toward benefit with intermittent fasting. There was a reduction in GERD symptom scores of heartburn and regurgitation during periods of intermittent fasting (14.3 vs 9.9; difference of -4.46, 95% CI -7.6, -1.32). Conclusion: Initial adherence to time restricted eating may be difficult for patients. There is weak statistical evidence to suggest that intermittent fasting reduces esophageal acid exposure. Our data suggests that intermittent fasting can improve symptoms of both regurgitation and heartburn. Randomized controlled trials with larger sample sizes and longer follow up times will be needed to determine if intermittent fasting has a role in the non-pharmacologic management of GERD.Figure 1.: (A) Change in AET by intermittent fasting status. (B) Change in GERD symptom severity score following day 2 (baseline diet) and day 4 (intermittent fasting) of pH monitoring.Table 1.: Intermittent Fasting Adherence and Characteristics