A cohort study found that adherence to a strict antireflux diet and stress-reduction activities was associated with lower reflux symptom scores compared with antacid therapy and showed numerically higher response rates than all medication groups. However, the degree of symptom improvement over time did not differ significantly among treatment approaches. These findings suggest that dietary modifications and stress management may provide symptom relief comparable to or greater than conventional medical therapies within 3 months of treatment. Randomized clinical trials are needed to directly compare the effectiveness of these treatment strategies. The study was published in the JAMA Otolaryngology-Head & Neck Surgery by Jerome R. and colleagues.
The large number of patient inclusion period stretched over several years, from April 2018 to February 2024, with complete data analysis performed in November 2025. Importantly, to avoid misdiagnosis, all subjects had to be clinically diagnosed based on the gold standard test of 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH test for LPRD. This investigation included patients under four different therapeutic interventions, namely, a strict antireflux diet together with stress reduction exercises, alginates, magaldrates (antacids), or regular proton pump inhibitors (PPIs).
The researchers collected detailed baseline and post-treatment data, including patient age, gender, and clinical indices before treatment and after treatment in terms of Reflux Symptom Score (RSS) and objective Reflux Sign Assessment (RSA). Linear mixed models were used to assess the clinical progress of patients and calculate the therapeutic response rate of each of the four categories.
Key findings:
- The first study's sample consisted of 84 women (57.9%), having a median cohort age of 53 years, with an interquartile range ranging between 37.0 and 63.3 years.
- The entire group of participants had an equal representation among four treatment arms, where there were 48 participants under the strict diet regimen, 38 in the alginate arm, 32 in the proton pump inhibitor arm, and 27 in the antacid treatment arm.
- Significant time effects for both RSS and RSA were found in linear mixed model analysis (F1,274 = 19.82; P < .001 for RSS, F1,219 = 26.47; P < .001 for RSA), demonstrating improvement in symptom and sign.
- For RSS, there was a significant relationship between treatment group and RSS scores (F3,274 = 3.53; P = .02).
- The strict lifestyle modification group showed the highest percent of treatment success rate at 81.2% (39 out of 48).
- In sharp contrast to the diet group, the lowest rates of responder were noted among pharmaceutical agents where it was only 74.1% for antacids (20 out of 27), 57.9% for alginates (22 out of 38), and 56.3% for proton pump inhibitors (18 out of 32).
- The lifestyle track demonstrated a massive success margin, beating proton pump inhibitors by 24.9 percentage points (95% CI, 4.6-45.4), outperforming alginates by 23.4 percentage points (95% CI, 4.2-42.5), and outstripping antacids by 7.2 percentage points (95% CI, −12.7 to 27.1).
In summary, compliance with an antireflux diet and stress-relieving activities might lead to similar or better improvements in symptoms after 3 months from the start of the treatment than those offered by traditional treatments. Comparisons between the 4 treatment modalities through randomized clinical studies are warranted. These astounding real-life statistics offer a critically important scientific base for current otolaryngology practice, confirming that lifestyle changes need to be considered a legitimate medical treatment modality.
Reference:
Lechien JR. Comparison of Diet and Lifestyle Program With 3 Medication Approaches for Laryngopharyngeal Reflux Disease Management. JAMA Otolaryngol Head Neck Surg. Published online July 02, 2026. doi:10.1001/jamaoto.2026.0577
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