Lifestyle measures in the management of gastro-oesophageal reflux disease: clinical and pathophysiological considerations

Abstract

Several lifestyle and dietary factors are commonly cited as risk factors for gastrooesophageal reflux disease (GORD) and modification of these factors has been advocated as first-line measures for the management 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. Conflicting results existed for the association between smoking, alcohol and various dietary factors in the development of GORD. These equivocal findings are partly due to methodology problems. There is recent good evidence that weight reduction and smoking cessation are beneficial in reducing GORD symptoms. Clinical and physiological studies also suggest that some physical measures as well as modification of meal size and timing can also be beneficial. 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.

Inducing and Aggravating Factors of Gastroesophageal Reflux Symptoms

“…48 The systematic review conducted by Kang et al suggests that studies on acid and spicy foods are not as many as studies on fatty foods and the results varry. 42 Some studies supported the abovementioned statement; while others suggest that there is no correlation between GERD complaints and the consumption of acid or spicy foods. 6,9,46,[48][49][50][51] Coffee Similar to studies on alcohol, varied results have also been found in studies which evaluate the correlation between coffee consumption and GERD complaints.…”

“…The mechanism of smoking which leads to the development of re u symptom is correlated to reduced pressure of lower esophageal sphincter during smoking, reduced bicarbonate from the saliva and increased intra-abdominal pressure when coughing or having deep inspiration. 6,42 Studies conducted by Diaz-Rubio et al and Bhatia et al have reported that there is no signi cant correlation between smoking habit and GERD complaints. 7,9 Meanwhile, a study conducted by Sharma et al has found that GERD complaints are more frequently found in active smokers.…”

“…42,46 However, studies that have been conducted so far indicate that alcohol consumption is not always correlated to GERD symptoms.…”

“…These foods and drinks induce GERD symptoms by reducing lower esophageal sphincter pressure, stimulating sensory receptors in esophagus, inducing gastric acid secretion or by inhibiting gastric emptying. 29,42,48 …”

“…whether it is taken with an empty stomach or after meal and whether the coffee is consumed with other foods. 42 Bhatia et al and Song et al have reported that GERD symptoms are aggravated by coffee consumption; while Sharma et al, Nilsson et al and Asl et al have reported that there is no correlation between both of them. 6,9,12,47,50 …”