Perspectives in clinical gastroenterology and hepatologyLifestyle Intervention in Gastroesophageal Reflux Disease
Section snippets
Methods
Systematic literature searches on lifestyle interventions for patients with GERD were performed in MEDLINE using PubMed from 1946 and EMBASE using OvidSP from 1980 to October 1, 2014. In addition, the Cochrane Library was searched (last search was performed on October 1, 2014). The searches included the thesaurus terms (MeSH in MEDLINE and EMTREE in EMBASE): “gastroesophageal reflux,” “heartburn,” “peptic esophagitis” (EMBASE)/”esophagitis, peptic” (MEDLINE) and “non-erosive reflux disease”
Literature Searches
Literature searches on lifestyle intervention identified 15 original studies that met the inclusion criteria (Table 1 and Supplementary Table 1). In addition, 1 previous systematic review on lifestyle intervention and 1 previous systematic review on conservative and surgical treatment for obesity in GERD were identified.32, 33 No relevant Cochrane reviews were identified. Three management guidelines were assessed: the Canadian Association of Gastroenterology consensus (2005),24 the American
Discussion
RCTs have shown reduced reflux symptoms and esophageal acid exposure with weight loss,37, 38, 39, 40 findings supported by well-designed observational studies showing a dose-dependent decreased presence of reflux symptoms after weight reduction. A large prospective observational study showed reduced reflux symptoms with tobacco smoking cessation in normal-weight individuals.47 RCTs also showed that early evening meals48 and head-of-the-bed elevation51 decreased the esophageal acid exposure
Conclusions
Recent evidence supports lifestyle intervention in the treatment of GERD. These include weight loss, tobacco smoking cessation, avoiding late evening meals, and head-of-the-bed elevation. Meanwhile, the awareness of adverse effects of medical treatment has increased, questioning long-term and continuous PPI therapy, at least in mild GERD.
References (52)
- et al.
The role of delayed gastric emptying and impaired oesophageal body motility
Best Pract Res Clin Gastroenterol
(2010) - et al.
Obesity: a challenge to esophagogastric junction integrity
Gastroenterology
(2006) - et al.
Clinical esophageal pH recording: a technical review for practice guideline development
Gastroenterology
(1996) - et al.
Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial
Obesity
(2013) - et al.
Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review
Gut
(2014) - et al.
Gastro-oesophageal reflux symptoms and health-related quality of life in the adult general population–the Kalixanda study
Aliment Pharmacol Ther
(2006) - et al.
Systematic review: the impact of gastro-oesophageal reflux disease on work productivity
Aliment Pharmacol Ther
(2006) - et al.
Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma
N Engl J Med
(1999) - et al.
A global assessment of the oesophageal adenocarcinoma epidemic
Gut
(2013) - et al.
Review article: gastro-oesophageal reflux disease–the health economic implications
Aliment Pharmacol Ther
(2005)
The esophagogastric junction
N Engl J Med
The lower esophageal sphincter
Neurogastroenterol Motil
Review article: the clinical relevance of transient lower oesophageal sphincter relaxations in gastro-oesophageal reflux disease
Aliment Pharmacol Ther
Pathophysiology of gastroesophageal reflux disease
J Clin Gastroenterol
The effect of cigarette smoking on salivation and esophageal acid clearance
J Lab Clin Med
Inhibitory effect of smoking on the lower esophageal sphincter
N Engl J Med
Epidemiology of gastro-oesophageal reflux disease: a systematic review
Gut
Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications
Ann Intern Med
Obesity and estrogen as risk factors for gastroesophageal reflux symptoms
JAMA
Lifestyle related risk factors in the aetiology of gastro-oesophageal reflux
Gut
A systematic review and meta-analysis of the sex ratio for Barrett's esophagus, erosive reflux disease, and nonerosive reflux disease
Am J Epidemiol
Systematic review: ageing and gastro-oesophageal reflux disease symptoms, oesophageal function and reflux oesophagitis
Aliment Pharmacol Ther
Prevalence and trends in obesity among US adults, 1999-2008
JAMA
Central adiposity is associated with increased risk of esophageal inflammation, metaplasia, and adenocarcinoma: a systematic review and meta-analysis
Clin Gastroenterol Hepatol
The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus
Am J Gastroenterol
Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults - update 2004
Can J Gastroenterol
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This article has an accompanying continuing medical education activity on page e19. Learning Objective–Upon completion of this activity, successful learners should be able to identify lifestyle interventions with documented effect on gastroesophageal reflux disease.
Conflicts of interest The authors disclose no conflicts.
Funding Supported by the Norwegian and Swedish Research Councils (E.N.-J.); by National Institutes of Health grant K24 DK04-107 and the Houston VA Health Services Research and Development Center of Excellence (HFP90-020) (H.E.-S.); and by grants from the Swedish Research Council (J.L.).