Gastroesophageal Reflux Disease

Lifestyle modifications

NUTRITION

  • Avoid eating late at night if nocturnal GERD symptoms (1)
  • Specific food elimination if positive benefits: Chocolate, caffeine, alcohol, acidic foods, spices (1)
  • Chewing gum may increase saliva production thus improve neutralization of refluxed acid (2)

PHYSICAL ACTIVITY

  • Belly or abdominal breathing can strengthen the diaphragm and reduce esophageal disease and reflux (2)

SLEEP

  • Head of bed elevation, 6-8 inches (1)
  • Do not use additional pillows as this may cause pressure on the stomach and worsen reflux (2)

SMOKING

  • Smoking cessation if smoking (1)
  • Mechanisms of action: Smoking reduces saliva, which help to neutralize refluxed acid. Smoking lowers the pressure in the lower esophageal sphincter and provokes coughing which increases reflux. 
  • Quitting smoking may eliminate or reduce mild GERD symptoms (2)

STRESS

  • Relaxation strategies to disrupt the overstimulated gut-brain connection (2)

WEIGHT

  • Weight loss if overweight / obese (1)

OTHER

  • Avoid tight fitting clothes that may increase pressure on the abdomen and force content into the esophageous (2)

References

1) https://bestpractice.bmj.com/topics/en-us/82/management-approach

2) https://www.cghjournal.org/article/S1542-3565(22)00079-9/fulltext


Resources

EXPLANATION TO EVIDENCE PRESENTATION

Figure: Evidence pyramid

Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

Evidence based on observational / cohort studies is written in CURSIVE font