Lifestyle modifications, including weight loss, smoking cessation, avoiding late evening meals and elevation at the head-of-the-bed for patients with gastroesophageal reflux disease were shown to be beneficial in a recent systematic review. Researchers also found evidence that awareness of possible adverse effects associated with the use of proton pump inhibitors has increased.
Eivind Ness-Jensen, MD, of the upper gastrointestinal surgery, department of molecular medicine and surgery, Karolinska Institutet, Stockholm, Sweden and The Nord-Trøndelag Health Study Research Centre, department of public health and general practice, Norwegian University of Science and Technology, Levanger, Norway, and colleagues, performed searches of literature in PubMed, Embase and the Cochrane Library. The types of studies included to examine lifestyle interventions in the treatment of GERD were meta-analyses, systematic reviews, randomized clinical trials and prospective observational studies.
In two randomized clinical trials, researchers found that weight loss in patients with GERD decreased time with esophageal acid exposure from 5.6% to 3.7% in one study and from 8% to 5.5% in the other. In prospective observational studies, weight loss was found to lead to reduced reflux symptoms, while in a large prospective cohort study, reflux symptoms were reduced by tobacco smoking cessation in normal-weight individuals (OR = 5.67, 95% CI, 1.36-23.64).
Also found in randomized clinical trials, time with supine acid exposure was increased when patients had late evening meals rather than early meals (5.2% point change). Time with supine acid exposure decreased when patients were elevated at the head of the bed compared to being in a flat position (from 21% to 15%).
“We believe that patients suffering from GERD should be recommended to lose weight if they are obese, that tobacco smoking cessation and increased dietary fiber should be encouraged, and that late evening meals should be avoided and head-of-the-bed elevation recommended for patients with supine reflux,” the researchers wrote.
Disclosures: The researchers report no relevant financial disclosures.