Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease?

Abstract

ifestyle modifications are first-line therapy for patients with gastroesophageal reflux disease (GERD). We applied an evidence-based approach to determine the efficacy of lifestyle measures for GERD management. We used PubMed and Ovid to perform a search of the literature published between 1975 and 2004 using the key words heartburn, GERD, smoking, alcohol, obesity, weight loss, caffeine or coffee, citrus, chocolate, spicy food, head of bed elevation, and late-evening meal. Each study was reviewed by 2 reviewers who assigned one of the following ratings: evidence A, randomized clinical trials; evidence B, cohort or case-control studies; evidence C, case reports or flawed clinical trials; evidence D, investigator experience; or evidence E, insufficient information. We screened 2039 studies and identified 100 that were relevant. Only 16 clinical trials examined the impact on GERD (by change in symptoms, esophageal pH variables, or lower esophageal sphincter pressure) of the lifestyle measure. Although there was physiologic evidence that exposure to tobacco, alcohol, chocolate, and high-fat meals decreases lower esophageal sphincter pressure, there was no published evidence of the efficacy of dietary measures. Neither tobacco nor alcohol cessation was associated with improvement in esophageal pH profiles or symptoms (evidence B). Head of bed elevation and left lateral decubitus position improved the overall time that the esophageal pH was less than 4.0 (evidence B). Weight loss improved pH profiles and symptoms (evidence B). Weight loss and head of bed elevation are effective lifestyle interventions for GERD. There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions.

Obesity predicts persistence of pain in children with functional gastrointestinal disorders

“…Adult studies have shown clinical improvement of FD and reflux after weight Childhood obesity and functional disorders S Bonilla et al loss, 28,29 but there is conflicting evidence for other FGIDs. 30 In summary, we found that obesity is associated with poor long-term outcome in children with FGIDs.…”

Two-year results of a feasibility study on antireflux transoral incisionless fundoplication using EsophyX

“…In addition, we assessed each patient's ability to consume foods and beverages commonly associated with triggering GERD symptoms, such as citrus, strawberries, tomatoes, chocolate, fatty foods, deep-fried foods, spicy foods, carbonated drinks, tea, coffee, caffeinated drinks, and alcohol [25]. Patients were asked whether they were able (''yes'') or unable (''no'') to consume each of the following foods and beverages without symptoms of GERD.…”

“…Patients (n = 14, 50% female) available at 2 years had a median age of 34 (range, 23-55) years and a median BMI of 22 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) kg/m 2 . Patients had suffered from GERD for a median of 10 (range, 3-15) years and were on continuous daily PPI therapy for a median of 6 (range, 2-13) years before undergoing TIF.…”

New algorithm for the treatment of gastro‐oesophageal reflux disease

“…Lifestyle factors include meal size and timing, as well as not lying down after a meal or lying down where the head is in a non-elevated position, not smoking, not consuming alcohol, and not eating heavily spiced or fatty foods. 21 From clinical experience, these factors appear to be triggers for GERD and heartburn; however, if monitored, can minimize the occurrence of sporadic or breakthrough symptoms. In addition, by providing advice on these lifestyle measures, pharmacists and physicians may be able to help ease the patient's milder symptoms of heartburn.…”