How to Minimize or Prevent GERD

Summarized by Robert W. Griffith, MD
July 28, 2006

Summary

GERD can be helped significantly by two simple lifestyle modifications - raising the head of the bed and losing weight. There's no evidence of the benefits of avoiding tobacco, alcohol, or dietary factors such as chocolate, spices, or mint.

Introduction

About 44% of all US adults experience heartburn at least once a month, but this isn't often enough to characterize them as GERD patients. True sufferers from GERD (gastroesophageal reflux disease) have symptoms much more frequently, and know about all the things done to try to stop it, before they resort to 'strong medicines', or even surgery. The list includes: smoking, alcohol, obesity, caffeine or coffee, chocolate, peppermint, spicy food, sodas, fatty foods, citrus drinks, a late evening meal, and lying too flat in bed. Now physicians from Stanford University have searched the medical literature for evidence of effectiveness of all or any of these lifestyle factors. They have published their findings in the Archives of Internal Medicine, and we summarize them here.

What was done

Review of medical English-language literature revealed over 2000 clinical trials that included the effect of a lifestyle intervention on GERD signs or symptoms. A well-accepted system was used to evaluate the quality of the evidence presented by such studies, which were grade A (best evidence) through E (totally inadequate data). Only those scoring A or B were considered further.

One hundred of the studies were relevant, and only 16 of these examined the effect of a particular lifestyle change on GERD, by a change in symptoms, a change in the acidity of the lower esophagus, or a change in the pressure of the lower esophageal muscle ring.

What was found

Smoking: While smoking has been clearly associated with GERD symptoms in questionnaires sent to smokers and non-smokers, there's no evidence that stopping smoking improves GERD physiological signs (esophagus acidity or muscle-ring pressure).

Alcohol: Although alcohol consumption can precipitate GERD, and there is an increased prevalence of GERD in drinkers, there was no improvement in esophageal acidity or muscle-ring pressure on stopping alcohol intake in the only well-conducted clinical study.

Obesity: In 5 studies, weight loss has shown beneficial effects on GERD symptoms, esophageal acidity, and lower esophageal muscle-ring pressure.

Citrus fruits and juices, sodas, coffee, caffeine, spicy foods, chocolate, fatty foods, peppermint: While there are plenty of anecdotal reports of associations between these factors and the occurrence of GERD, there are no adequate clinical studies showing that removal of one particular factor causes a measurable improvement in symptoms or esophageal physiological tests

Late evening meal: Although in might appear likely that late evening meals could provoke GERD, there is no evidence to recommend that suffers should avoid eating late.

Sleeping too flat: In one study, raising the head of the bed using 11-inch blocks resulted in significantly fewer GERD episodes. In another study, sleeping on a wedge resulted in reduced esophageal acidity and lower muscle-ring pressure.

Sleeping on one's right side: The amount of reflux, esophageal acidity and lower muscle-ring pressure are greater in people lying on their right side; however, it's not very practical to get GERD patients to avoid this - people change their sleeping posture quite often during the night.

What these results mean

Doctors continue to recommend lifestyle and dietary changes for patients with GERD symptoms, although, as summarized above, there are not good studies in support of most of these changes. There's reasonable evidence that these factors are associated with GERD symptoms and physiologic changes, there's little evidence from studies that removal of individual or a group of factors results in clinical improvement. Elevating the head of the bed (or using a wedge mattress) and weight loss have both been shown to improve GERD symptoms and signs, and can be safely recommended as first steps in treatment. Future studies may show similar benefits for avoiding the other listed factors. But in the meantime, ask you doctor about helpful medications.

Source

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

Related Links
GERD or GORD - It's Still a Pain
GERD Is More Common If You're Overweight
Don't Bolt Your Food

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