What are the recommended lifestyle modifications for patients with gastroesophageal reflux disease (GERD)?

Recommended lifestyle modifications for patients with gastroesophageal reflux disease (GERD) include:

• Encouraging weight loss if the patient is overweight or obese, as obesity can worsen GERD symptoms.
• Avoiding known trigger foods such as coffee, chocolate, tomatoes, fatty foods, and spicy foods, which may transiently reduce lower oesophageal sphincter tone or delay gastric emptying.
• Eating smaller, more frequent meals and avoiding eating the evening meal within 3–4 hours before going to bed.
• Stopping smoking, as smoking increases gastric acid production and delays gastric emptying.
• Reducing alcohol consumption to within recommended limits, since alcohol can exacerbate symptoms.
• Raising the head of the bed by 10–20 cm to reduce nocturnal reflux, while advising against using extra pillows which may increase intra-abdominal pressure and worsen symptoms.
• Assessing and managing stress and anxiety, as these may worsen symptoms; relaxation strategies may be beneficial.
• Reviewing medications that may exacerbate symptoms (e.g., alpha-blockers, anticholinergics, calcium-channel blockers, corticosteroids, nitrates, theophyllines, tricyclic antidepressants) and considering dose reduction or cessation if appropriate.

These lifestyle measures are recommended primarily based on expert opinion and consensus, as evidence from clinical trials is limited or inconclusive, but they encourage self-management and may provide general health benefits.

Patients should be offered written information and advised to seek follow-up if symptoms are refractory or recurrent despite initial management.

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