Lifestyle Factors and Efficacy of Lifestyle Interventions in Gastroesophageal Reflux Disease Patients with Functional Dyspepsia: Primary Care Perspectives from the LEGEND Study

Abstract

Objective Although gastroesophageal reflux disease (GERD), a very common disorder worldwide, is considered to be a lifestyle disease, the pathogenic role of lifestyle factors and consequently the efficacy of lifestyle interventions, remains controversial. Lifestyle factors associated with GERD and the beneficial effect of specific recommended lifestyle interventions in the primary care setting were evaluated as a post-hoc analysis of the LEGEND study which investigated the effect of lansoprazole in patients with GERD who reported dyspeptic symptoms. Methods GERD patients with dyspepsia were treated with lansoprazole 15 mg or 30 mg daily for four weeks. Reflux and dyspeptic symptoms were evaluated using patient-reported questionnaires before and four weeks after the administration of lansoprazole. Results Among 12,653 patients, "feelings of continued stress" was the most common lifestyle factor (45.6% of patients), and >30% of the patients reported "eating sweet foods at least once every two to three days," "eating greasy foods at least once every two to three days" and "drinking coffee almost daily." Introducing lifestyle interventions had a significant effect on both reflux and dyspeptic symptoms. Conclusion Lifestyle interventions are thus considered to be important in GERD patients with dyspepsia who receive a proton pump inhibitor.

Omeprazole vs Lansoprazole in the Management of Gastroesophageal Reflux Disease: A Systematic Literature Review

“…The effect of these interventions is, however, limited [5]. There is significant evidence that change in lifestyle can improve GERD symptoms [25] and that combining lifestyle interventions with PPIs provide better results [8]. In addition to this, combining omeprazole with other drugs like Baclofen is a more effective treatment for heartburn and regurgitation than omeprazole alone [26].…”

“…In addition to these, maintaining a correct posture and avoid wearing tight clothes helps to improve the symptoms. Losing weight helps to resolve GERD symptoms in addition to reducing the risk of several other medical conditions like diabetes, hypertension and cardiovascular diseases [8].…”

Effect of lifestyle modification sessions on knowledge, self- management and physical symptoms of patient with Gastro-esophageal Reflux Disease

“…Patient answers each question about symptoms frequency during last week using a Likert like scale from 0 to 3 for positive predictors and from 3 to 0 for negative predictors. The maximum score that can be obtained is 18 divided as follows mild (0-6), moderate (7)(8)(9)(10)(11)(12) and sever (13)(14)(15)(16)(17)(18). Internal consistency reliability levels were high, with alpha coefficients ranging from (0.80 to 0.85).…”

“…[13].Recommendations for lifestyle modifications are based on the presumption that types foods, pattern of sleep, smoking and obesity contribute to a dysfunction in the body's anti-reflux defense system. [14,15]. The American College of Gasrtroenterology and [16] recommends the use of lifestyle changes as the part of medical management which including elevates head of the bed; decrease fatty meals & spicy food; decrease coffee drinking; prevent smoking and avoiding recumbence at least 3 hours postprandial.…”

Stress and Gastroesophageal Reflux Disease

“…Another large-scale study from Japan interviewed 12,653 patients with GERD who were on proton pump inhibitor therapy with a validated questionnaire. The study found that «feelings of continued stress» was the most common lifestyle factor (45.6% of patients) associated with GERD related symptoms (10). In a Gallup survey, 64% of the GERD patients reported that stress exacerbates their symptoms (11).…”