Effectiveness of dietary interventions in managing pediatric gastroesophageal reflux disease: a comprehensive systematic review

Abstract

Background

Pediatric gastroesophageal reflux disease (GERD) is a common chronic digestive disorder that significantly impacts children’s growth, development, and quality of life. Traditional management of GERD often involves pharmacological interventions, such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), which raise concerns about side effects and long-term safety. Recently, interest has shifted toward dietary interventions as complementary or alternative approaches to managing GERD symptoms.

Objective

This systematic review aims to evaluate the efficacy of various dietary interventions, including low-fat diets, plant-based diets, exclusion diets, and nutraceuticals such as probiotics, in managing pediatric GERD symptoms and promoting overall digestive health.

Methods

A comprehensive search was conducted across PubMed, MEDLINE (Ovid), Embase, Web of Science, and Cochrane databases up to March 2024. Studies investigating dietary interventions for pediatric GERD published in English were selected. Risk of bias was assessed using the modified ROBVIS2 tool, and results were synthesized through narrative and thematic analysis.

Results

Eleven studies were included in the review. Evidence on low-fat versus full-fat dairy diets showed mixed results, with no clear consensus on their impact on GERD symptoms. Plant-based and exclusion diets demonstrated significant improvements in GERD symptoms, likely due to their anti-inflammatory properties and the elimination of dietary triggers. Probiotics emerged as a promising intervention, reducing GERD symptoms by enhancing gut barrier function and modulating inflammation. However, the studies varied in design, and adherence to dietary interventions was identified as a key challenge, particularly in pediatric populations.

Conclusion

Although current evidence remains limited, this review highlights promising dietary strategies—especially plant-based diets and probiotics—for managing pediatric GERD. Future research should focus on personalized nutrition and long-term effectiveness to validate these non-pharmacological interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40001-025-02784-0.

Introduction

Gastroesophageal reflux disease (GERD) is a chronic digestive disorder characterized by the abnormal backflow of stomach contents into the esophagus, leading to various symptoms and potential complications [1, 2]. This condition is prevalent across all age groups, including pediatric populations, where it can significantly impact a child's growth, development, and overall quality of life [3].

The etiology of pediatric GERD is multifactorial, involving a complex interplay of anatomical, physiological, and dietary factors [4]. Anatomically, the immaturity of the lower esophageal sphincter (LES) and the shorter length of the esophagus in children can contribute to increased reflux episodes [5, 6]. Physiologically, delayed gastric emptying, impaired esophageal motility, and altered gastric acid production can exacerbate reflux symptoms [7].

Dietary factors play a crucial role in the management of pediatric GERD, as certain foods and eating habits can either trigger or alleviate reflux symptoms [8]. The traditional approach to managing GERD in children has primarily relied on pharmacological interventions, such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), which aim to reduce gastric acid production [9–11]. However, these medications have limitations, including potential side effects, incomplete symptom resolution, and the risk of developing tolerance or dependence [12, 13].

In recent years, there has been growing interest in exploring non-pharmacological approaches, particularly dietary interventions, as adjuncts or alternatives to conventional medical therapies [14, 15]. Dietary modifications have gained attention due to their potential to address the underlying causes of GERD, improve symptom management, and promote overall digestive health without the risks associated with long-term medication use [16, 17].

One dietary strategy that has been extensively studied is the implementation of an alkaline diet, which involves consuming foods and beverages with a higher pH to neutralize gastric acid and reduce reflux episodes [18–20]. Additionally, the elimination of specific dietary triggers, such as acidic, spicy, or fatty foods, has been proposed to alleviate GERD symptoms in children [21]. Another dietary approach that has garnered significant interest is the use of functional foods and nutraceuticals, which are foods or food components that provide potential health benefits beyond their nutritional value [22–24]. For example, studies have investigated the efficacy of probiotics in modulating gut microbiota, promoting gut barrier function, and reducing inflammation associated with GERD [25–27].

Furthermore, lifestyle modifications, including eating habits and portion control, have been explored as complementary interventions for managing pediatric GERD [28, 29]. Strategies such as avoiding large meals, maintaining an upright position after eating, and practicing relaxation techniques to reduce stress have been suggested to mitigate reflux symptoms [30].

Despite the growing interest in dietary interventions for pediatric GERD, the evidence surrounding their efficacy remains limited and inconsistent [31]. While some studies have reported promising results, others have failed to demonstrate significant improvements in symptom management or disease progression [32, 33]. This inconsistency may be attributed to factors such as the heterogeneity of study designs, small sample sizes, variations in dietary interventions, and differences in patient populations and baseline characteristics [34].

Additionally, compliance with dietary interventions can be challenging, particularly in pediatric populations, where food preferences, behavioral factors, and parental involvement play crucial roles [35]. Ensuring adherence to dietary recommendations and monitoring potential nutritional deficiencies or adverse effects are important considerations when implementing dietary interventions in children [36].

In light of these challenges, there is a need for well-designed, large-scale clinical trials to provide robust evidence on the efficacy of dietary interventions in managing pediatric GERD [37]. Interdisciplinary collaborations involving gastroenterologists, nutritionists, and behavioral specialists may be beneficial in developing comprehensive and tailored dietary approaches that address the unique needs and challenges of pediatric patients [38, 39].

Furthermore, ongoing research efforts should aim to elucidate the underlying mechanisms by which dietary factors influence GERD pathophysiology, such as their effects on gut motility, acid production, and mucosal integrity [40]. Understanding these mechanisms can inform the development of more targeted and personalized dietary interventions for pediatric GERD management [41].

Dietary interventions have emerged as a promising complementary or alternative approach to conventional pharmacological therapies in managing pediatric GERD. While preliminary findings suggest potential benefits, further research is needed to establish the efficacy, safety, and optimal implementation strategies for various dietary interventions [42, 43]. Addressing the gaps in knowledge and leveraging interdisciplinary collaborations will be crucial in advancing the field and improving the overall management of pediatric GERD through dietary means [44].

Aim of the study

The primary aim of this systematic review is to synthesize the current evidence on the efficacy of various dietary interventions in managing pediatric gastroesophageal reflux disease (GERD). Specifically, the review seeks to evaluate and compare the effectiveness of different dietary strategies, such as low-fat diets, plant-based diets, exclusion diets, and nutraceuticals (including probiotics), in terms of their impact on symptom reduction and overall digestive health. By synthesizing findings across multiple studies, this review aims to provide insights into which interventions hold the most promise and identify gaps for future research.

Research question

How effective are different dietary interventions—such as low-fat diets, plant-based diets, exclusion diets, and nutraceuticals—in managing pediatric GERD, compared to conventional pharmacological treatments, in terms of symptom relief and long-term digestive health?

Materials and methods

Search strategy and selection criteria

This systematic review was rigorously structured in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), emphasizing a commitment to thoroughness and transparency. Adhering to the protocol outlined in the PRISMA Protocols (PRISMA-P) statement, we developed a detailed research protocol, which was then duly registered with PROSPERO (CRD42024548333). This registration underscores our dedication to conducting this review with systematic precision and methodological rigor.

Our approach to exploring the relevant literature was comprehensive and well-organized. We conducted in-depth searches across several reputable databases, including PubMed, MEDLINE (Ovid), Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials (Wiley), and Google Scholar. Our latest search, carried out on March 1, 2024, was designed to capture the most recent and pertinent studies in the field. The search strategy was intricately formulated, merging medical subject headings (MeSH) and a set of carefully chosen keywords that are relevant to the dietary interventions for managing pediatric gastroesophageal reflux disease (GERD) (Table 1). This strategy was crafted to encompass various dimensions of the topic, such as symptom management, dietary modifications, and overall digestive health, aiming for an all-encompassing review of the subject matter.

Table 1.

Search strategy

Database	Search terms	Items found
PubMed	("Gastroesophageal Reflux Disease"[Mesh] OR"GERD"OR"Acid Reflux") AND ("Dietary Interventions"OR"Diet Modification"OR"Nutraceuticals")	1252
MEDLINE (Ovid)	("Gastroesophageal Reflux Disease"OR"GERD"OR"Acid Reflux") AND ("Dietary Interventions"OR"Diet Modification"OR"Nutraceuticals")	745
Embase	'gastroesophageal reflux disease'/exp OR'GERD'OR'acid reflux'AND'dietary interventions'/exp OR'diet modification'OR'nutraceuticals'	998
Web of Science	TS = (gastroesophageal reflux disease OR GERD OR acid reflux) AND TS = (dietary interventions OR diet modification OR nutraceuticals)	621
Cochrane Library	"Gastroesophageal Reflux Disease"OR"GERD"OR"Acid Reflux"AND"Dietary Interventions"OR"Diet Modification"OR"Nutraceuticals"	333
Google Scholar	"Gastroesophageal Reflux Disease"OR"GERD"OR"Acid Reflux"AND"Dietary Interventions"OR"Diet Modification"OR"Nutraceuticals"	1,457

Eligibility screening

After removing duplicates, our review process commenced with an initial screening of titles and abstracts, followed by a comprehensive evaluation of full-text articles. We included original research articles, systematic reviews, meta-analyses, and clinical trials involving human subjects that specifically addressed dietary interventions for managing pediatric gastroesophageal reflux disease (GERD). The focus of our review was on studies involving children diagnosed with GERD and assessing the impact of various dietary modifications, including alkaline diets, elimination of dietary triggers, and the use of functional foods and nutraceuticals. Studies comparing these dietary interventions with conventional pharmacological treatments, placebos, or standard care practices were also considered. Key outcomes of interest included the efficacy of dietary interventions in symptom reduction, improvement in disease outcomes, overall digestive health, and any associated adverse effects or complications.

Exclusion criteria comprised case reports, case series, abstracts, letters, editorials, and conference proceedings, as well as animal studies or in vitro research. Studies that did not specifically focus on pediatric GERD or dietary interventions were excluded. Additionally, research involving children with underlying gastrointestinal conditions that could confound the results, or those lacking detailed descriptions of the dietary interventions or methodologies, were not considered. Studies without appropriate comparison groups, insufficient data for meaningful analysis, or those not directly contributing to the understanding of dietary interventions in pediatric GERD were also excluded. Finally, non-English language studies without available translations were omitted. These criteria were rigorously applied to ensure that our review remained focused on dietary interventions for managing pediatric GERD, and they were refined as necessary to align with our research objectives and the scope of the available literature.

Data extraction

Data extraction was a crucial part of this systematic review, aimed at meticulously gathering relevant data from studies investigating dietary interventions for managing pediatric gastroesophageal reflux disease (GERD). The goal of this phase was to systematically extract key information to elucidate critical aspects of each study, detail the interventions employed, and accurately document the outcome measures pertinent to dietary interventions for GERD.

The extraction process involved a thorough analysis of each selected study, focusing on the following essential elements:

• Study Characteristics: Comprehensive details such as the study design, sample size, geographic location, publication date, and demographic characteristics of the participants were systematically recorded. This provided context for the findings and helped in evaluating the study's relevance to our review.

• Intervention Details: For studies exploring dietary interventions, precise descriptions of these interventions, including the types of diets, specific dietary modifications, and any comparative analysis with conventional treatments, were extracted. This included information on the nature of the dietary interventions, implementation methods, and any innovative approaches used.

• Outcome Measures: The extraction process also included identifying and recording specific outcome measures used to evaluate the effectiveness of the dietary interventions in managing pediatric GERD. These measures might include symptom reduction, improvement in disease outcomes, and overall digestive health, as well as any associated risks or benefits.

In instances where critical data were missing or unclear, we made concerted efforts to contact the study authors for clarification. This ensured that our review was based on the most complete and accurate data possible.

Additionally, we were vigilant in assessing any potential overlap or duplication in patient cohorts across studies. Where necessary, we engaged in direct communication with the authors of the studies to clarify any uncertainties. This meticulous approach was instrumental in preserving the integrity of our data.

Our initial search yielded 4521 documents. After removing duplicates, 531 articles remained for preliminary screening based on titles and abstracts. Of these, 106 articles were excluded at this stage, leaving 425 papers for further eligibility assessment. Following a thorough full-text review, 11 studies were ultimately selected for inclusion in this review [45–55]. The process of study selection is detailed in a flowchart, prepared in accordance with PRISMA guidelines, as shown in Fig. 1.

Fig. 1.

PRISMA Flow Diagram. This flowchart outlines the study selection process according to PRISMA 2020 guidelines, from identification to inclusion of eligible studies

Quality assessment

A rigorous and comprehensive assessment of the methodological quality and risk of bias in the included studies is a cornerstone of our systematic review on the efficacy of dietary interventions in managing pediatric gastroesophageal reflux disease (GERD). To ensure the reliability and validity of our findings, we meticulously evaluated the quality and bias of each study.

We employed a structured approach using a modified version of the ROBVIS2 tool. ROBVIS2, an advanced web application developed during the Evidence Synthesis Hackathon, is based on the well-established ROBVIS R package. This tool is widely respected in the systematic review community for its effectiveness in assessing study quality and bias.

Each study was independently evaluated, focusing on key aspects such as study design, participant selection, blinding, data collection methods, and the management of missing data. This thorough analysis was essential to ascertain the methodological rigor and identify potential biases within the studies.

Any discrepancies in the evaluation process were addressed with diligence and transparency. Disagreements or uncertainties regarding the methodological quality or risk of bias were resolved through a consensus-based approach, involving detailed discussions with fellow researchers to reach a unified decision on the study evaluations.

Data analysis

In our review of dietary interventions for pediatric GERD, we employed both narrative synthesis and thematic analysis to extract and interpret meaningful insights from the collected data.

Narrative Synthesis: This qualitative approach forms the backbone of our analysis. It involves a systematic interpretation of findings from the included studies, aiming to provide not just a summary but a critical synthesis of evidence. This synthesis highlights key insights, trends, and implications relevant to managing pediatric GERD through dietary interventions. It contextualizes the findings, offering a comprehensive understanding beneficial to healthcare practitioners and patients.

Thematic Analysis: Complementing the narrative synthesis, thematic analysis was used to uncover patterns and themes in the data. This qualitative technique focuses on identifying common themes, particularly regarding the effectiveness, adherence, and challenges of various dietary interventions in managing pediatric GERD. The thematic analysis helps in understanding the underlying relationships, variations, and trends within these themes, providing deeper insights into the efficacy and implementation challenges of dietary interventions.

Together, narrative synthesis and thematic analysis provide a multifaceted examination of the evidence. This approach allows us to transcend simple data aggregation and delve into a deeper understanding of the complexities of dietary interventions in managing pediatric GERD. Our systematic review aims to be a valuable resource for healthcare professionals, researchers, and patients interested in optimizing dietary management strategies for pediatric GERD.

Results

Quality assessment

The methodological integrity of the 11 studies included in this systematic review (Fig. 2) was scrutinized through a risk of bias assessment across several domains: the randomization process, adherence to intended interventions, management of missing outcome data, accuracy of outcome measurement, and the selection of reported results [45–55]. The majority of studies demonstrated a low risk of bias across these domains, indicating a strong commitment to methodological rigor, thereby reducing the potential for systemic errors or result bias. In particular, studies maintained a low risk of bias in almost every evaluated category, providing a solid foundation for the validity of their findings and contributing to the robust evidence base for this review. Conversely, a few studies indicated some concerns regarding specific domains. For instance, Fernando et al. [45] had some concerns in the randomization process and in the measurement of the outcome; Chao and Vandenplas [53] showed some concerns in the management of missing outcome data; Dziewitczarz et al. [49] presented some concerns in the adherence to intended interventions and the selection of the reported results; and Hadad et al. [48] indicated concerns in both the randomization process and adherence to intended interventions. These concerns necessitate a cautious interpretation of these studies'outcomes and underscore the need for meticulous reporting and methodological transparency in the execution of randomized controlled trials.

Fig. 2.

Summary of risk of bias

Main outcomes

The systematic review synthesized the findings from 11 studies that evaluated the efficacy of various dietary interventions in managing paediatric gastroesophageal reflux disease (GERD). Four major themes emerged from the analysis as shown in Supplementary Table S1 [45–55].

1. Efficacy of low-fat vs. full-fat dairy diets

One of the central questions addressed in the studies was whether the fat content in dairy products influences GERD symptoms in pediatric populations. Famouri et al. [51] conducted a randomized controlled trial comparing low-fat and full-fat dairy diets and found significant weight loss in the group consuming low-fat dairy, suggesting a potential benefit for pediatric patients with obesity. However, the relationship between dairy fat content and GERD symptoms remained unclear.

Salvatore et al. [46] and Fernando et al. [45], who also explored the role of low-fat versus full-fat dairy diets in pediatric GERD, reported no significant differences between the two interventions regarding symptom reduction. These studies suggest that while reducing dietary fat may be beneficial for weight management in children with GERD, dairy fat content itself does not appear to directly influence GERD symptom severity. These mixed results point to the complexity of GERD pathophysiology, where multiple factors, such as individual digestive responses and meal composition, may interact with dietary fat.

• 2.Plant-based and exclusion diets for GERD management

Several studies in the review focused on plant-based and exclusion diets as non-pharmacological interventions for GERD. Zalvan et al. [52] reported significant improvement in GERD symptoms with a plant-based diet, which was attributed to its anti-inflammatory properties and high fiber content. The diet, rich in vegetables, fruits, whole grains, and legumes, may help neutralize gastric acidity and improve overall digestive health. These findings highlight the potential for plant-based diets to serve as a sustainable alternative to conventional pharmacological treatments, especially for children who experience side effects from proton pump inhibitors (PPIs).

Similarly, Chao and Vandenplas [53] demonstrated that exclusion diets, which involve removing specific trigger foods (such as acidic, spicy, or fatty foods) from the diet, led to significant improvements in pediatric GERD symptoms. This approach is highly individualized, allowing for the identification and elimination of dietary triggers that exacerbate reflux. However, adherence to exclusion diets can be challenging, particularly in younger children, due to limited food options and parental compliance.

Both plant-based and exclusion diets underscore the importance of personalized nutrition in managing GERD. Tailoring dietary interventions to individual patient needs—by identifying specific food intolerances or leveraging the anti-inflammatory potential of plant-based foods—may lead to better symptom control and improved quality of life for pediatric patients with GERD.

• 3.Probiotics and nutraceuticals as adjuncts to GERD therapy

Another key outcome highlighted in the review was the role of probiotics and other nutraceuticals in managing GERD. Wenzl et al. [50] and Salvatore et al. [46] found that probiotics significantly reduced GERD symptoms in children, likely due to their ability to improve gut barrier function, regulate gut motility, and modulate inflammation. Probiotics, particularly strains like Lactobacillus and Bifidobacterium, were shown to support the gut microbiota, enhance mucosal integrity, and reduce gastric acidity, which may help mitigate the frequency and severity of reflux episodes.

The promise of probiotics as an adjunct therapy is further supported by the findings of Rao et al. [54] and Gu et al. [47], who examined the effects of dietary supplements in broader contexts, such as managing obesity and asthma, which are often comorbid with GERD. In these studies, nutraceuticals, including probiotics, were found to reduce both obesity-related symptoms and asthma exacerbations. Given the frequent association between GERD and respiratory disorders such as asthma, these findings suggest that probiotics may offer a dual benefit by addressing both gastrointestinal and respiratory symptoms in children with GERD.

However, the review also noted several challenges associated with the use of probiotics and nutraceuticals, including variability in probiotic strains, dosages, and study designs. Wenzl et al. [50], for example, emphasized the need for further research to identify the most effective probiotic strains for pediatric GERD. Additionally, long-term studies are required to assess the sustained efficacy and safety of probiotic use, particularly in younger populations with developing digestive systems.

• 4.Comprehensive dietary approaches for managing comorbidities

While GERD was the primary focus of this review, several studies also explored the impact of dietary interventions on related conditions such as obesity and asthma, which are common in pediatric patients with GERD. Hadad et al. [48] and Factor [55] demonstrated that low-calorie and low-carbohydrate diets were effective in promoting weight loss, which is a critical component of GERD management in obese children. As obesity is a well-known risk factor for GERD, dietary interventions that target weight reduction could offer dual benefits for managing both conditions.

In addition, Gu et al. [47] and Rao et al. [54] highlighted the potential for dietary supplements to improve asthma symptoms in children. Given the established link between GERD and asthma, where reflux of stomach contents into the esophagus can exacerbate respiratory symptoms, these studies suggest that comprehensive dietary strategies—combining GERD management with weight loss and asthma control—could lead to better overall health outcomes in pediatric patients.

Discussion

This systematic review aimed to evaluate the efficacy of dietary interventions in managing pediatric gastroesophageal reflux disease (GERD). The findings from the 11 included studies provide valuable insights into various dietary approaches and their potential benefits in alleviating GERD symptoms and improving overall digestive health in children. Our analysis revealed four key themes, which we will discuss in detail.

1. The role of fat content in dietary interventions for GERD

The impact of dietary fat content on GERD symptoms emerged as a significant theme in our review. Famouri et al. [51] demonstrated significant weight loss with a low-fat dairy diet in obese children, suggesting potential benefits for weight management in pediatric GERD patients. However, the studies by Salvatore et al. [46] and Fernando et al. [48] found no significant differences between low-fat and full-fat dairy diets in terms of GERD symptom management.

These mixed results indicate that while reducing overall dietary fat intake may be beneficial for weight management in children with GERD, the fat content of dairy products alone may not be a determining factor in symptom control. This aligns with previous research suggesting that the relationship between dietary fat and GERD symptoms is complex and may vary among individuals [56, 57].

The inconsistent findings highlight the need for more nuanced approaches to dietary fat recommendations in pediatric GERD management. Future research should explore whether specific types of fats (e.g., saturated vs. unsaturated) have differential effects on GERD symptoms and whether individual factors such as age, body composition, or genetic predisposition influence the response to dietary fat modifications [8].

• 2.Efficacy of plant-based and exclusion diets

The potential of plant-based and exclusion diets in managing GERD emerged as another significant theme. Zalvan et al. [52] reported a substantial reduction in GERD symptoms with a plant-based diet in adults, while Chao and Vandenplas [49] observed significant improvements in children's GERD symptoms following an exclusion diet. These findings support the growing body of evidence suggesting that dietary modifications, particularly those focusing on plant-based nutrients and eliminating potential trigger foods, may play a crucial role in GERD management [58].

The efficacy of these approaches may be attributed to their potential to reduce inflammation, improve gut microbiome composition, and enhance overall digestive function [59]. Plant-based diets, rich in fiber and antioxidants, may help reduce gastric acid production and improve gastric emptying, while exclusion diets can help identify and eliminate specific food triggers that exacerbate GERD symptoms in individual patients [60].

However, implementing these diets in pediatric populations presents unique challenges, including ensuring adequate nutrient intake for growth and development, and addressing issues of palatability and adherence. Future studies should focus on developing age-appropriate, nutritionally balanced plant-based and exclusion diet protocols specifically tailored for children with GERD [61].

• 3.The impact of nutritional supplements, particularly probiotics

The role of specific nutritional supplements, particularly probiotics, in managing GERD symptoms was a notable theme in our review. Wenzl et al. [50] and Salvatore et al. [51] both found that probiotic supplementation effectively reduced GERD symptoms. These results are consistent with emerging research on the gut-brain axis and the potential of probiotics to modulate gastrointestinal function and inflammation [62].

The beneficial effects of probiotics in GERD management may be related to their ability to enhance gut barrier function, reduce esophageal inflammation, and improve gastric emptying [63]. Additionally, probiotics may help restore balance to the gut microbiome, which has been implicated in the pathogenesis of GERD [64].

While these findings are promising, questions remain regarding the optimal strains, dosages, and duration of probiotic supplementation for pediatric GERD management [65]. Future research should aim to identify specific probiotic formulations that are most effective for different age groups and GERD severity levels, as well as investigate potential synergistic effects with other dietary interventions [66].

• 4.Comprehensive dietary approaches for related conditions

While our review focused primarily on GERD, several studies explored the impact of dietary interventions on related conditions such as obesity, asthma, and metabolic syndrome. This theme underscores the potential for comprehensive dietary approaches to address multiple aspects of children's health concurrently.

Hadad et al. [53] and Factor [50] demonstrated the effectiveness of low-calorie and low-carbohydrate diets in promoting weight loss, which is particularly relevant given the established link between obesity and GERD in pediatric populations [67]. These findings suggest that dietary interventions targeting weight management could have dual benefits for overweight or obese children with GERD.

Additionally, Gu et al. [47] and Rao et al. [54] reported positive effects of dietary supplements on asthma and obesity symptoms. Given the frequent comorbidity of GERD with conditions like asthma [68], these results highlight the potential for integrated dietary strategies that address multiple health concerns simultaneously.

Future research in this area should focus on developing and evaluating multifaceted dietary interventions that can effectively manage GERD while also addressing related health issues. Such comprehensive approaches could lead to more holistic and efficient treatment strategies for pediatric patients with complex health profiles.

Implications for clinical practice

The findings from this systematic review highlight the potential role of dietary interventions as complementary or alternative treatments for managing pediatric GERD. Specifically, plant-based and exclusion diets, along with probiotic supplementation, have demonstrated promising efficacy in reducing GERD symptoms in children. Clinicians should consider incorporating these non-pharmacological strategies into patient care, particularly for children who may not respond well to conventional pharmacological treatments or who experience adverse effects from long-term medication use. Furthermore, personalized nutrition plans tailored to individual patient needs and preferences can improve adherence and optimize outcomes. However, it is essential for healthcare providers to monitor for potential nutritional deficiencies, especially in growing children, and to ensure that dietary interventions are balanced and sustainable. Given the variability in the current evidence, further research is necessary to establish more precise clinical guidelines, but the integration of dietary strategies into holistic, patient-centered care appears to be a promising direction for improving pediatric GERD management.

Limitations of the study

This systematic review has several limitations that should be acknowledged to ensure accurate interpretation of the findings. First, there was substantial heterogeneity across the included studies in terms of design (randomized controlled trials, pilot studies, and observational designs), sample size, duration of interventions, and outcome assessment tools. These differences limit the comparability of results and hinder the ability to conduct a quantitative synthesis or meta-analysis. Second, most studies included small sample sizes and were underpowered to detect subtle but clinically relevant effects of dietary interventions. This limitation raises concerns about statistical validity and generalizability of the findings to broader pediatric populations with diverse clinical and sociodemographic profiles. Third, the dietary interventions examined varied widely in scope and implementation. While some studies focused narrowly on specific interventions (e.g., probiotic supplementation), others combined multiple dietary changes, making it difficult to isolate the effects of individual components. Moreover, adherence to dietary protocols was inconsistently reported and rarely monitored using validated tools, which may introduce bias related to self-reporting or caregiver compliance. Fourth, follow-up periods in most studies were short-term, limiting insights into the sustainability, safety, and long-term impact of dietary modifications—particularly important considerations in growing children. Potential nutritional deficiencies or unintended consequences of restrictive diets were not adequately assessed. Fifth, outcome measures used to evaluate GERD symptom changes lacked standardization across studies. This variability complicates comparisons and undermines efforts to establish consistent benchmarks for dietary efficacy. Additionally, some studies used surrogate or composite outcomes without clear definitions, which may affect interpretability. Finally, language and publication bias cannot be excluded, as only English-language studies were included, and gray literature was not comprehensively reviewed. The risk of selective reporting also remains, particularly in studies that did not pre-register protocols or publish full trial data. Future research should aim to overcome these limitations by employing larger, well-powered studies with standardized dietary interventions, validated outcome measures, longer follow-up periods, and robust adherence monitoring. Integrating multidisciplinary teams and considering patient and caregiver perspectives can also enhance the feasibility and impact of dietary approaches in pediatric GERD management.

Conclusions

This systematic review provides preliminary evidence suggesting that certain dietary interventions may be beneficial in managing pediatric gastroesophageal reflux disease (GERD). Among the approaches evaluated, plant-based diets, exclusion diets, and probiotic supplementation appear to show promise in reducing GERD-related symptoms and supporting digestive health. However, the current evidence base is characterized by considerable heterogeneity in study designs, intervention protocols, and outcome measures, which limits the generalizability and strength of these findings.

While plant-based and exclusion diets may offer anti-inflammatory benefits and symptom relief, and probiotics may enhance gut barrier function and modulate inflammation, these conclusions must be interpreted with caution. Many included studies had small sample sizes, short follow-up durations, and lacked standardized definitions or assessments of GERD symptoms. Additionally, adherence to dietary interventions, especially in pediatric populations, remains a challenge and was inconsistently reported.

Longitudinal, large-scale clinical trials with standardized methodologies are needed to confirm the efficacy, safety, and long-term impact of these dietary strategies. Moreover, exploring potential synergistic effects of combined interventions and integrating caregiver involvement and behavioral support may enhance adherence and outcomes.

Personalized nutrition—tailored to individual needs, preferences, and comorbidities—represents a promising direction for future research. Understanding the role of genetic, microbiome, and metabolic profiles in response to dietary interventions could contribute to more targeted and effective GERD management strategies for children.

Author contributions

A.A.A. conceptualized the study, led the design and methodology, and conducted the systematic review and data analysis. A.A.A. also wrote the first draft of the manuscript. All authors contributed to the interpretation of findings and critically revised the manuscript for important intellectual content. A.A.A. finalized the manuscript and approved the version submitted for publication. All authors have read and approved the final manuscript.

Funding

This work was Funded by the Deanship of Scientific Research at King Faisal University, Saudi Arabia (Grant: KFU252305)..

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable. This study is a systematic review and does not involve human or animal subjects.

Competing interests

The authors declare no competing interests.