The role of such measures in GORD management in the era of potent acid suppressant therapy is discussed.Ī Medline search was conducted from 2005 to 20 March 2014, limited to original articles in the English language, using the following keywords: gastro-oesophageal reflux disease, gastroesophageal reflux disease, oesophagitis, esophagitis, heartburn, reflux, lifestyle modification, smoking, alcohol, obesity, weight loss, caffeine, coffee, citrus, chocolate, mint, carbonated beverages, spicy foods, fatty foods, head of bed elevation, late-evening meal, nocturnal symptoms, regurgitation, posture, postural, sleep, body position, left lateral decubitus, fat, low fat, curry, antacid, proton-pump inhibitors, omeprazole, lansoprazole, rabeprazole, esomeprazole, cimetidine, H2 antagonist, ranitidine and Gaviscon ®. We separately considered the effect of these factors and their modification on symptoms, physiological parameters of reflux as well as endoscopic appearances, since these different indices may be discordant for individual patients. We have performed a systematic review of the literature from 2005 to the present relating to lifestyle measures against GORD. In 2006, Kaltenbach and colleagues reviewed the evidence base relating to lifestyle measures against gastro-oesophageal reflux and concluded that, while weight loss and head of bed elevation were effective interventions for GORD, evidence was lacking to support tobacco or alcohol cessation or other dietary measures.
Medication for gord trial#
To date there is no trial evidence that directly compares drug therapy with lifestyle interventions. However, 65% of 130 consecutive patients with GORD presenting to an English district general hospital had no knowledge of lifestyle interventions and only 28% had been informed of such measures by their general practitioners. An expert committee did not even consider them to be sufficiently effective to justify a trial as initial or long-term therapy, citing a ‘remarkable lack of data in this area’ and suggesting that ‘many patients seeking medical advice have already tried lifestyle measures and antacids and found them ineffective’. However, the introduction of potent acid suppressants has rendered lifestyle measures unfashionable. GORD is traditionally managed in a stepwise fashion, beginning with modification of lifestyle factors and use of over-the-counter medications such as antacids, stepping up to potent pharmacological agents and antireflux surgery. However, recent increases in prevalence have been reported in Asian populations, suggesting that lifestyle factors may contribute to GORD development. In the Western world, GORD, defined here as at least weekly heartburn and/or acid regurgitation, has a higher prevalence of 10–20% compared with less than 5% in Asia. It is a risk factor for adenocarcinoma of the oesophagus, an increasingly prevalent malignancy in Western populations.
Frequent or severe GORD symptoms are associated with work loss and impaired health-related quality of life. Typical symptoms include heartburn and acid regurgitation.
Gastro-oesophageal reflux disease (GORD) is characterized by symptoms and/or mucosal damage produced by the abnormal reflux of gastric contents into the oesophagus.
However, there is limited evidence for the role of avoiding alcohol and certain dietary ingredients including carbonated drinks, caffeine, fat, spicy foods, chocolate and mint. Clinical and physiological studies also suggest that some physical measures as well as modification of meal size and timing can also be beneficial. There is recent good evidence that weight reduction and smoking cessation are beneficial in reducing GORD symptoms. These equivocal findings are partly due to methodology problems. Conflicting results existed for the association between smoking, alcohol and various dietary factors in the development of GORD. We performed a systematic review of the literature from 2005 to the present relating to the effect of these factors and their modification on GORD symptoms, physiological parameters of reflux as well as endoscopic appearances.
Several lifestyle and dietary factors are commonly cited as risk factors for gastro-oesophageal reflux disease (GORD) and modification of these factors has been advocated as first-line measures for the management of GORD.
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