Lifestyle

Many lifestyle-associated factors are implicated in GORD. The implementation of simple modifications to lifestyle (Table 1) can considerably reduce the symptoms of mild-to-moderate GORD.[Kitchin & Castell, 1991].

TABLE 1 – Lifestyle modifications to reduce the symptoms of GORD

Reduce weight
Stop smoking
Elevate bed head
Avoid large meals
No food or drink within 3–4 hours of bedtime
Avoid food or drink that provoke symptoms (see Diet)
Avoid chewing gum
Avoid clothing that is too tight, particularly around the abdomen
Avoid stooping manoeuvres that involve increasing abdominal pressure (eg, lifting weights)
Avoid drugs that have the potential to aggravate the disease (eg, NSAIDs)

Quality of life and lifestyle modifications

Although weight loss in clinically obese patients may be expected to offer some significant advantages by reducing abdominal pressure, other lifestyle modifications, while offering potential benefits, are often only associated with minimal reduction in symptoms and are difficult for some patients to follow.[Dent, 1992]

In some circumstances, lifestyle changes can impair quality of life significantly, resulting in low compliance with recommended lifestyle modifications. Therefore, in such cases, lifestyle changes should be combined with pharmacological treatment, such as antacids or reflux suppressants.

Diet

It is important to identify what foods and/or events cause or worsen the symptoms of GORD, and asking your patients to keep a food and events diary can be helpful.

Table 2 provides a checklist of foods and drinks that can cause problems in GORD. The list is not fully inclusive, but may help patients identify some causative substances.

TABLE 2 – Foods and drinks that can aggravate GORD

Caffeine Coffee
Tea Colas
Carbonated drinks Onions
Peppers Seasonings
Alcohol Citrus juices
Tomato products Chocolate
Spearmint or peppermint Spicy foods
Fatty/greasy foods Vinegar

Changing diet

Changes in diet that can be recommended to patients may be helpful in treating mild or infrequent GORD or heartburn by improving the constriction of the lower oesophageal sphincter (LOS), decreasing irritation in the oesophagus, and reducing the frequency and volume of reflux:

Improving LOS competence

  • Increasing protein intake
  • Decreasing intake of fat (≶45 g/day) avoiding particularly fatty or greasy foods
  • Avoiding food and drink flavoured naturally or artificially with peppermint or spearmint
  • Avoiding alcohol, coffee, chocolate, and strong tea, which can all decrease LOS pressure

Decreasing irritation in the oesophagus

  • Avoiding intake of potential irritants, such as alcohol, caffeinated drinks (coffee,chocolate milk, hot chocolate, colas, tea), carbonated drinks, citrus juices, tomato-based products, and spicy foods
  • Selecting foods that are easy to digest, such as gelatines, puddings, and yoghurts.

Reducing the frequency and volume of reflux

  • Eating smaller, more-frequent meals (every 2–3 hours)
  • Eating slowly and chewing food well
  • Drinking liquids 1 hour before or after meals instead of with meals
  • Reducing weight if the patient is overweight
  • Including enough fibre in the diet to avoid constipation, which can lead to an increase in intra-abdominal pressure

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