Lifestyle Modification Counseling in Patients With Gastroesophageal Reflux Disease

Abstract

The purpose of this study was to determine the rate of documented counseling on lifestyle modifications in patients presenting to the primary care setting with a diagnosis of gastroesophageal reflux disease. Retrospective chart review was conducted for 502 active patients with a primary or secondary diagnosis of gastroesophageal reflux disease from two internal medicine clinics at the University of Kansas School of Medicine-Wichita. Charts were reviewed for documented counseling on four specific lifestyle modifications: (a) smoking and alcohol cessation, (b) dietary changes, (c) head of bed elevation, and (e) postprandial avoidance of recumbency. Only 12% of patients in this sample received documented counseling on lifestyle modifications. Of those patients receiving documented counseling, 71% were counseled on dietary changes, 41% smoking or alcohol cessation, 28% head of bed elevation, and 21% postprandial avoidance of recumbency. Documentation indicated that patients with gastroesophageal reflux disease are not adequately counseled regarding recommended lifestyle modifications.

The Quality of Care for Gastroesophageal Reflux Disease

“…Although these management strategies are low cost and effective, prior studies have demonstrated that provider adherence to delivering recommendations is suboptimal. 10,11 …”

“…6 However, there is limited data on the prognostic utility of impedance monitoring in patients undergoing evaluation for anti-reflux surgery. 7–10 Wireless pH monitoring facilitates prolonged monitoring for up to 96 hours without a transnasal catheter, and may increase the sensitivity of reflux detection. 11, 12 Currently the optimal diagnostic strategies utilizing pH monitoring remains an area of substantial controversy amongst clinicians.…”

Food for Thought Should Lead to Food for Therapy

“…As Vemulapalli 1 reports in this issue of Nutrition in Clinical Practice (NCP), only 12% of patients with gastroesophageal reflux disease (GERD) who were surveyed in one study received dietary advice from their doctor. 2 Patients assume that diet is a factor in the disease process and generation of symptoms. In a survey of patients with irritable bowel syndrome (IBS), 65% indicated that food clearly triggered their symptoms.…”

The Reflux Improvement and Monitoring (TRIM) Program Is Associated With Symptom Improvement and Weight Reduction for Patients With Obesity and Gastroesophageal Reflux Disease

“…Although effective weight management in the care of GERD is a national priority, implementing clinically feasible and effective interventions is challenging 9 . A multitude of factors influence the effectiveness of weight loss interventions.…”

“…A multitude of factors influence the effectiveness of weight loss interventions. Health system barriers include provider time constraints, insufficient reimbursement, and inadequate provider training 9,10 . In addition, patient engagement is influenced by choices, attitudes, and beliefs; as such effective interventions need to focus on changeable behaviors and objectives 9–11 .…”