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GASTROESOPHAGEAL REFLUX DISEASE
Gastroesophageal reflux disease is a disorder in which gastric contents recurrently reflux into the esophagus, causing troublesome symptoms and/or complications.
It is produced by various mechanisms such as frequent occurrence of transient relaxation of the lower esophageal sphincter or pressure abnormalities in the lower esophageal sphincter (which can be caused by hormonal and neural mediators, food, drugs and patient lifestyle).
Typical symptoms are acid regurgitation and heartburn.
Regurgitation is the perception of flow of refluxed gastric contents into the mouth or hypopharynx.
Heartburn is defined as burning sensation in the retrosternal region.

Lifestyle Modification

  • All patients should be educated regarding factors that may worsen their gastroesophageal reflux disease (GERD) symptoms but lifestyle modifications alone typically do not provide adequate relief for most GERD patients
  • Considered the first line of treatment
    • Pregnant women who have GERD should also be offered lifestyle modification as 1st-line therapy
  • Advice should be tailored to the circumstances of the individual patient
Lifestyle Modifications
  • Avoidance of foods/drinks that may precipitate heartburn (eg spicy foods, onion, tomato-based products, citrus, carbonated drinks) and/or reflux (eg alcohol, coffee, chocolate, peppermint, fatty foods)
  • Avoidance of medications that lower lower esophageal sphincter (LES) pressure (eg calcium channel blockers, beta-agonists, alpha-adrenergic agonists, Theophylline, nitrates, PDE-5 inhibitors) or irritate the esophagus (eg Ferrous sulfate, nonsteroidal anti-inflammatory drugs [NSAIDs], bisphosphonates)
  • Adoption of behaviors that will help reduce esophageal acid exposure
    • Weight loss should be advised for obese or overweight patients
    • Smoking cessation
    • Elevation of the head of the bed for patients who are troubled with heartburn or regurgitation when recumbent
    • Avoiding recumbency for 2-3 hours postprandial
    • Avoiding large meals and decreasing fat intake
    • Avoiding late meals or skipping meals
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