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Bitesize evidence: Lifestyle changes have little impact on GORD

Q What lifestyle changes are effective in patients with gastro-oesophageal reflux disease?

Synopsis

This systematic review assembled all

English-language research on the value of lifestyle changes on the symptoms of GORD. The search was severely flawed because it was limited to only English-language articles and only searching one database back to the year 1975.

Once the studies were identified, two

authors independently reviewed every study ­ that is, they did not limit their review by quality of the study. Although smoking was associated with an increase in GORD symptoms, short-term (one to two days) smoking cessation was not shown to decrease GORD symptoms in three low-quality studies.

Alcohol use may or may not be associated with reflux symptoms. There is insufficient research supporting recommendations to abstain from citrus juices, carbonated beverages, coffee and caffeine, chocolate, spicy foods, fatty foods, or late-evening meals.

One study supports the effectiveness of raising the head of the bed, though other studies have not found a difference. Another study supported a wedge to elevate the head. Several studies have shown some association between weight loss or left lateral decubitus sleeping position and improved symptoms.

Level of evidence

3a- (see www.infopoems.com/levels.html)

Reference

Kaltenbach T et al. Are lifestyle measures

effective in patients with gastro-

oesophageal reflux disease? Arch Intern Med 2006;166:965-971.

Bottom line

Reducing GORD symptoms with lifestyle changes requires an empirical approach.

The research literature gives very little

guidance regarding non-drug approaches. Neither smoking cessation, alcohol avoidance, nor any food avoidances have been shown to make, on average, a difference in symptoms, although existing studies are small and of poor quality.

Elevating the head of the bed may be effective. Weight loss may also be effective. Of course, if patients find something that works, encourage them to continue doing it.

This Patient Oriented Evidence that Matters (POEMs ) is taken from InfoPOEMS/ Inforetriever, a point of care evidence-based medicine tool, published by John Wiley.

For more information, e-mail: freynold@wiley.co.uk

or visit www.infopoems.com

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