Gastroesophageal reflux disease (GERD) is defined as a condition that develops when gastric contents reflux into the esophagus, causing troublesome symptoms and/or mucosal injury [1]. GERD represents a global health challenge of increasing magnitude, affecting 18–28 % of Western populations with substantial regional variation [2]. GERD prevalence has surged 50 % since the 1990s across the US, Europe, and Southeast Asia, reflecting the influence of modern dietary patterns and lifestyle factors [2]. This epidemic translates to significant healthcare burden, with annual costs exceeding $10 billion in the United States alone and over 110,000 hospitalizations, while profoundly impairing patients' quality of life through sleep disruption, activity limitations, and psychological comorbidities [3].

The shift toward non-pharmacological GERD management reflects multiple clinical realities beyond mechanistic considerations [4]. Medication adherence challenges plague chronic PPI therapy, with nonadherence rates of 30–60 % stemming from inadequate patient education, complex dosing regimens (step-down protocols, on-demand therapy, cyclic treatments), and unrealistic therapeutic expectations [[5], [6], [7], [8]]. Additionally, 10–40 % of patients experience refractory symptoms despite optimal PPI therapy [1], while many with mild, meal-related symptoms actively prefer dietary and lifestyle modifications over pharmacological interventions. These factors collectively drive patient and provider interest in evidence-based non-pharmacological alternatives that address symptom triggers through modifiable behaviors rather than sustained medication dependence.

Contemporary guidelines increasingly emphasize lifestyle modifications as first-line interventions, recognizing that dietary approaches can address underlying pathophysiological mechanisms rather than merely suppressing acid production [9]. However, clinical practice often provides either insufficient guidance or impractical restriction lists that compromise patient adherence. This comprehensive review synthesizes current evidence for dietary and lifestyle interventions in GERD management, examining pathophysiological mechanisms, intervention efficacy, and clinical implementation strategies to provide evidence-based recommendations for precision dietary medicine approaches.