Search resultsAre lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach
Title
Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach
Publication type
Journal Article
Year of Publication
2006
Authors
Journal
Archives of Internal Medicine
Volume
166
Issue
9
Pagination
965 - 971
Date published
2006
ISBN
00039926 (ISSN)
Keywords
alcohol consumption, Alcohol Drinking, Beverages, cacao, caffeine, carbonated beverage, Case-Control Studies, cigarette smoking, Citrus, citrus fruit, clinical trial, Clinical trials, coffee, diet restriction, Dietary Fats, eating habit, Esophagus, esophagus pH, evidence based medicine, Evidence-Based Medicine, Food Habits, gastroesophageal reflux, head position, human, Humans, Hydrogen-Ion Concentration, Life Style, lifestyle, lipid diet, lower esophagus sphincter pressure, MEDLINE, Mentha, obesity, Posture, priority journal, Randomized Controlled Trials, recumbency, Research Design, review, smoking, smoking cessation, Spices, systematic review, Time Factors, Treatment Outcome, Weight Loss, weight reduction
Abstract
Lifestyle 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.