Lifestyle changes of little benefit in GERD

Journal of Family Practice, August, 2006 by T. Kaltenbach, S. Crockett, L.B. Gerson

* Clinical Question

What lifestyle changes are effective in patients with gastroesophageal reflux disease (GERD)?

* Bottom Line

Decreasing GERD symptoms with lifestyle changes requires an empirical approach; the research literature gives very little guidance regarding nondrug approaches. Neither smoking cessation, alcohol avoidance, nor any food avoidances have been shown to make, on average, a difference in symptoms, although existing studies are small and of poor quality. Elevating the head of the bed may be effective. Weight loss may also be effective. Of course, if patients find something that works, encourage them to continue doing it. (LOE=3a-)

Study Design

Systematic review

Funding

Foundation

Allocation

Concealed

Setting

Outpatient (any)

Synopsis

This systematic review assembled all English-language research on the value of lifestyle changes on the symptoms of GERD. Their search was severely flawed by limiting to only English-language articles and only searching I database back to the year 1975. Once the studies were identified, 2 authors independently reviewed every study--that is, they did not limit their review by quality of the study.

Although smoking was associated with an increase in GERD symptoms, short-term (1-2 days) smoking cessation was not shown to decreased GERD symptoms in 3 low-quality studies. Alcohol use may or may not be associated with reflux symptoms. There is insufficient research supporting recommendations to abstain from citrus juices, carbonated beverages, coffee and caffeine, chocolate, spicy foods, fatty foods, or late evening meals.

One study supports the effectiveness of raising the head of the bed, though other studies have not found a difference. Another study supported a wedge to elevate the head. Several studies have shown some association between weight loss or left lateral decubitus sleeping position and improved symptoms.

FAST TRACK

Research in not sufficient to recommend that GERD patients abstain from citrus juice, soda, coffee, chocolate, spicy foods, or late evening meals

Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? Arch Intern Med 2006; 166:965-971.