Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For patients with gastroesophageal reflux disease (GERD), you should recommend several lifestyle modifications, which encourage self-management and may offer general health benefits, although evidence for symptom reduction is limited NICE CKS.
- Weight Management: Encourage patients to lose weight if they are overweight or obese, as there is good evidence that weight reduction is beneficial for GERD symptoms NICE CKS.
- Dietary Adjustments: Advise patients to eat smaller meals and to eat their evening meal 3–4 hours before going to bed, if possible NICE CKS. They should also try to avoid any trigger foods such as coffee, chocolate, tomatoes, and fatty or spicy foods NICE CKS. Fatty foods can delay gastric emptying, and certain trigger foods like coffee, chocolate, and alcohol may transiently reduce the lower oesophageal sphincter (LOS) tone NICE CKS.
- Smoking Cessation: Patients should be encouraged to stop smoking, if appropriate, as there is good evidence that smoking cessation is beneficial NICE CKS. Smoking increases gastric acid production and delays gastric emptying NICE CKS.
- Alcohol Consumption: Advise patients to reduce alcohol consumption to recommended limits, if appropriate NICE CKS.
- Sleep Position: Recommend sleeping with the head of the bed raised, for example, by placing wood or bricks under the bed head to raise it by 10–20 cm, if practical NICE CKS. This may be particularly helpful for those with nocturnal symptoms, as lying flat can increase reflux episodes NICE CKS. Patients should be advised not to use additional pillows, as this may increase intra-abdominal pressure and worsen symptoms NICE CKS.
- Stress and Anxiety Management: Assess for stress and anxiety, which can worsen symptoms, and encourage relaxation strategies if needed NICE CKS. Psychological treatments may reduce symptoms in the short-term NICE CKS.
- Medication Review: Review the patient's current medications and consider reducing or stopping any drugs that may cause or exacerbate symptoms, if possible and appropriate NICE CKS. Examples include alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, theophyllines, and tricyclic antidepressants NICE CKS.
- Over-the-Counter Medications: Ask patients about any over-the-counter medications they have tried for symptom relief, such as antacids and/or alginates NICE CKS.
It is also important to offer written information and advice on the symptoms, self-care, and management options for GERD NICE CKS. If symptoms persist or recur despite initial management, reinforce lifestyle advice NICE CKS.