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Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach.

Abstract

Lifestyle modifications are first-line therapy for patients with gastroesophageal reflux disease (GERD). We applied an evidence-based approach to determine the efficacy of lifestyle measures for GERD management. We used PubMed and Ovid to perform a search of the literature published between 1975 and 2004 using the key words heartburn, GERD, smoking, alcohol, obesity, weight loss, caffeine or coffee, citrus, chocolate, spicy food, head of bed elevation, and late-evening meal. Each study was reviewed by 2 reviewers who assigned one of the following ratings: evidence A, randomized clinical trials; evidence B, cohort or case-control studies; evidence C, case reports or flawed clinical trials; evidence D, investigator experience; or evidence E, insufficient information. We screened 2039 studies and identified 100 that were relevant. Only 16 clinical trials examined the impact on GERD (by change in symptoms, esophageal pH variables, or lower esophageal sphincter pressure) of the lifestyle measure. Although there was physiologic evidence that exposure to tobacco, alcohol, chocolate, and high-fat meals decreases lower esophageal sphincter pressure, there was no published evidence of the efficacy of dietary measures. Neither tobacco nor alcohol cessation was associated with improvement in esophageal pH profiles or symptoms (evidence B). Head of bed elevation and left lateral decubitus position improved the overall time that the esophageal pH was less than 4.0 (evidence B). Weight loss improved pH profiles and symptoms (evidence B). Weight loss and head of bed elevation are effective lifestyle interventions for GERD. There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA.

    ,

    Source

    Archives of internal medicine 166:9 2006 May 08 pg 965-71

    MeSH

    Alcohol Drinking
    Beverages
    Case-Control Studies
    Citrus
    Clinical Trials as Topic
    Dietary Fats
    Esophagus
    Evidence-Based Medicine
    Feeding Behavior
    Gastroesophageal Reflux
    Humans
    Hydrogen-Ion Concentration
    Life Style
    Mentha
    Obesity
    Posture
    Randomized Controlled Trials as Topic
    Research Design
    Smoking
    Spices
    Time Factors
    Treatment Outcome
    Weight Loss

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    16682569

    Citation

    Kaltenbach, Tonya, et al. "Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease? an Evidence-based Approach." Archives of Internal Medicine, vol. 166, no. 9, 2006, pp. 965-71.
    Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166(9):965-71.
    Kaltenbach, T., Crockett, S., & Gerson, L. B. (2006). Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Archives of Internal Medicine, 166(9), pp. 965-71.
    Kaltenbach T, Crockett S, Gerson LB. Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease? an Evidence-based Approach. Arch Intern Med. 2006 May 8;166(9):965-71. PubMed PMID: 16682569.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. AU - Kaltenbach,Tonya, AU - Crockett,Seth, AU - Gerson,Lauren B, PY - 2006/5/10/pubmed PY - 2006/5/24/medline PY - 2006/5/10/entrez SP - 965 EP - 71 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 166 IS - 9 N2 - Lifestyle modifications are first-line therapy for patients with gastroesophageal reflux disease (GERD). We applied an evidence-based approach to determine the efficacy of lifestyle measures for GERD management. We used PubMed and Ovid to perform a search of the literature published between 1975 and 2004 using the key words heartburn, GERD, smoking, alcohol, obesity, weight loss, caffeine or coffee, citrus, chocolate, spicy food, head of bed elevation, and late-evening meal. Each study was reviewed by 2 reviewers who assigned one of the following ratings: evidence A, randomized clinical trials; evidence B, cohort or case-control studies; evidence C, case reports or flawed clinical trials; evidence D, investigator experience; or evidence E, insufficient information. We screened 2039 studies and identified 100 that were relevant. Only 16 clinical trials examined the impact on GERD (by change in symptoms, esophageal pH variables, or lower esophageal sphincter pressure) of the lifestyle measure. Although there was physiologic evidence that exposure to tobacco, alcohol, chocolate, and high-fat meals decreases lower esophageal sphincter pressure, there was no published evidence of the efficacy of dietary measures. Neither tobacco nor alcohol cessation was associated with improvement in esophageal pH profiles or symptoms (evidence B). Head of bed elevation and left lateral decubitus position improved the overall time that the esophageal pH was less than 4.0 (evidence B). Weight loss improved pH profiles and symptoms (evidence B). Weight loss and head of bed elevation are effective lifestyle interventions for GERD. There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/16682569/full_citation L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.166.9.965 DB - PRIME DP - Unbound Medicine ER -