Lifestyle modification for patients with GERD

Gastroesophageal reflux disease (GERD) is one of the most common disorders in medical practice. A population based study done in US showed that the prevalence of the condition in adults is about 40%. The condition occurs when muscles of the lower oesophagus do not function properly resulting in backward flow of food and acid from the stomach to the oesophagus. This can result in damage to the inner wall of the oesophagus.

The most common presentation of patients with GERD includes a long-standing history of heartburn and a shorter history of regurgitation. Heartburn, when typical, is a reliable symptom. Heartburn is confined to the upper abdomen and central chest areas. It is identified as a caustic or stinging sensation

The presence of regurgitation indicates progression of the disease. Some patients will be unable to bend over without experiencing the unpleasant event. The mainstay of treatment is medical with drugs to suppress acidity of the stomach (Proton pump inhibitors- PPI and prokinetics.) Resistant cases and those who do not wish to take medication lifelong will be offered surgery.

Heartburn, the principal symptom of GERD — can be aggravated by foods, certain medications, and other factors. Lifestyle modifications play a major role in controlling symptoms and reducing the need for medication, thus the cost of treatment.

Here are some suggestions to improve your heartburn symptoms

Dietary

Don’t go to bed with a full stomach. Eat meals at least two to three hours before lying down. This will give time to digest and empty your stomach, and gives acid levels a chance to decrease before putting your body in a position where heartburn is more likely to occur.

Don’t eat large meals – Decrease the size of portions at meal times, or try eating four to five small meals instead of three large ones.

Avoid foods which can trigger heartburn- Stay away from foods and beverages that trigger your heartburn symptoms (chocolate, coffee or caffeine included beverages, citrus juices, high-fat foods, spicy foods). Some of the chemicals in these foods can cause inappropriate relaxation of the lower oesophageal muscle and promote backward flow of acid to the oesophagus.

Reduction of body weight if overweight or obese

this is associated with improvement of symptoms

Stop smoking

Nicotine, one of the main active ingredients in cigarettes, can weaken the lower oesophageal sphincter, allowing the acid-containing contents of the stomach to easily enter the oesophagus.

Avoid alcohol

Alcohol can work as a gastric irritant as well as promote reflux

If Heartburn Is Worse When Lying Down

Raise the head of your bed so that your head and chest are higher than your feet.

Wear loose-fitting clothes

Keep a diary or heartburn log. Keep track of when heartburn hits and the specific activities that seem to trigger the incidents.

These simple modifications can significantly reduce symptoms in certain individuals. They can be adopted while a patient is already on medical therapy for GERD. Prolonged reflux can cause damage to the lower oesophageal wall lining and might lead to complications. Therefore assessment by a relevant medical practitioner is essential.

Dr Udaya Samarajeewa MBBS, MD- Surgery, MRCS (Eng.)

Consultant General Surgeon