What lifestyle changes are recommended for acid reflux?

Find out more about the efficacy of lifestyle changes for GERD and acid reflux.

Recommendations

1. Weight loss is recommended for GERD patients who are overweight or have had recent weight gain. (Conditional recommendation, moderate level of evidence)

2. Head of the bed elevation and avoidance of meals 2-3 hours before bedtime should be recommended for patients with nocturnal GERD. (Conditional recommendation, low level
of evidence)

3. Routine global elimination of food that can trigger reflux (including chocolate, caffeine, alcohol, acidic and/or spicy foods) is not recommended in the treatment of GERD.
(Conditional recommendation, low level of evidence)

4. An 8-weck course of PPIs is the therapy of choice for symptom relief and healing of erosive esophagitis. There are no major differences in efficacy between the different PPIs.
(Strong recommendation, high level of evidence)

5. Traditional delayed release PPIs should be administered 30-60 min before meal for maximal pH control. (Strong recommendation, moderate level of evidence). Newer PPIs may offer dosing flexibility relative to meal timing (Conditional recommendation, moderate level of evidence)

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6. PPI therapy should be initiated once a day dosing, before the first meal of the day. (Strong recommendation, moderate level of evidence). For patients with partial response to once daily therapy, tailored therapy with adjustment of dose timing and/or twice daily dosing should be considered in patients with night-time symptoms, variable schedules, and/or sleep disturbance. (Strong recommendation, low level of evidence)

7. Non-responders to PPI should be referred for evaluation (Conditional recommendation, low level of evidence, see
refractory GERD section)

8. In patients with partial response to PPI therapy, increasing the dose to twice daily therapy or switching to a different PPI may provide additional symptom relief. (Conditional
recommendation, low level of evidence)

9. Maintenance PPA therapy should be administered for GERD patients who continue to have symptoms after PPI is discontinued and in patients with complications including erosive esophagitis and Barrett’s oesophagus. (Strong recommendation, moderate level of evidence). For patients who require long-term PPI therapy, it should be administered in the lowest effective dose, including on-demand or intermittent therapy. (Conditional recommendation, low level of evidence)

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10. H-receptor antagonist therapy can be used as a maintenance option in patients without erosive disease if patients experience heartburn relief. (Conditional recommendation, moderate level of evidence). Bedtime H, RA therapy can be added to daytime PPI therapy in selected patients with objective evidence of night-time reflux if needed but may be associated with the development of tachyphylaxis after several weeks of usage. (Conditional recommendation, low level of evidence)

11. Therapy for GERD other than acid suppression, including prokinetic therapy and/or baclofen, should not be used in GERD patients without diagnostic evaluation. Conditional
recommendation, moderate level of evidence)

12. There is no role for sucralfate in the non-pregnant GERD patient. (Conditional recommendation, moderate level of evidence)

13. PPIs are safe in pregnant patients if clinically indicated.
(Conditional recommendation, moderate level of evidence).

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Lifestyle InterventionEffect of intervention on GERDSources of dataRecommendation
Weight lossImprovement of GERD Symptoms and oesophagalCase Control.Strong recommendation for patients with BMI 25 or patients with recent weight gain.
Head of the bed elevationImproved oesophagal pH and symptomsRandomized controlled trial,Head of bed elevation with foam wedge or blocks in patients with nocturnal GERD.
Avoidance of late evening mealsImproved nocturnal gastric acidity but not symptoms,Case control.Avoid eating meals with high fat content within 2-3 hours of reclining.
Tobacco and alcohol cessationNo change in Symptoms or oesophagal pHCase control.Not recommended to improve GERD symptoms
Cessation of chocolate, caffeine, spicy foods citrus carbonated beverages.No studies were performed.No evidence.Not routinely recommended for GERO patients. Selective elimination could be considered if patients note a correlation between GERD symptoms and improvement with elimination.

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