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      Effectiveness of Lifestyle Measures in the Treatment of Gastroesophageal Reflux Disease — A Case Series

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          Abstract

          Aim

          To assess the effectiveness of lifestyle measures in the treatment of gastroesophageal reflux disease (GERD) among adults attending a dietetic practice.

          Methods

          A retrospective case series of adult patients presenting with GERD to a dietetic practice over a three year period. The routine lifestyle counselling for treatment of symptoms of GERD included: not reclining within two to three hours of eating; a diet low in fat; small frequent meals; avoiding dietary components considered to relax the lower esophageal sphincter; and avoiding local irritants.

          Results

          Twenty three cases were included (12 male). Eighteen, (9 female) were referred by their doctor, 7 (6 female) presented for GERD alone, 7 (4 female) presented for GERD together with comorbidities, and 9 (1 female) incidentally mentioned GERD during a dietary consultation for another disorder. Thirteen participants (9 female) had previously undergone endoscopies, 18 (11 female) were taking medication for GERD, and 19 (7 female) had comorbidities. Twenty two (10 female) reported an improvement in symptoms with 11/18 taking GERD medication at presentation reducing their medication following treatment.

          Conclusions

          These results suggest that a more thorough investigation of lifestyle modification in the treatment of GERD is warranted.

          Most cited references36

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          Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.

          J Lagergren, R. Bergstrom, A. Lindgren … (1999)
          The causes of adenocarcinomas of the esophagus and gastric cardia are poorly understood. We conducted an epidemiologic investigation of the possible association between gastroesophageal reflux and these tumors. We performed a nationwide, population-based, case-control study in Sweden. Case ascertainment was rapid, and all cases were classified uniformly. Information on the subjects' history of gastroesophageal reflux was collected in personal interviews. The odds ratios were calculated by logistic regression, with multivariate adjustment for potentially confounding variables. Of the patients interviewed, the 189 with esophageal adenocarcinoma and the 262 with adenocarcinoma of the cardia constituted 85 percent of the 529 patients in Sweden who were eligible for the study during the period from 1995 through 1997. For comparison, we interviewed 820 control subjects from the general population and 167 patients with esophageal squamous-cell carcinoma. Among persons with recurrent symptoms of reflux, as compared with persons without such symptoms, the odds ratios were 7.7 (95 percent confidence interval, 5.3 to 11.4) for esophageal adenocarcinoma and 2.0 (95 percent confidence interval, 1.4 to 2.9) for adenocarcinoma of the cardia. The more frequent, more severe, and longer-lasting the symptoms of reflux, the greater the risk. Among persons with long-standing and severe symptoms of reflux, the odds ratios were 43.5 (95 percent confidence interval, 18.3 to 103.5) for esophageal adenocarcinoma and 4.4 (95 percent confidence interval, 1.7 to 11.0) for adenocarcinoma of the cardia. The risk of esophageal squamous-cell carcinoma was not associated with reflux (odds ratio, 1.1; 95 percent confidence interval, 0.7 to 1.9). There is a strong and probably causal relation between gastroesophageal reflux and esophageal adenocarcinoma. The relation between reflux and adenocarcinoma of the gastric cardia is relatively weak.
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            Hypothesis: the changing relationships of Helicobacter pylori and humans: implications for health and disease.

            M Blaser (1999)
            Helicobacter pylori has apparently colonized the human stomach since time immemorial and is superbly adapted for persistence. Several genotypes, including cag+, are associated with increased risk of gastric and duodenal diseases. With modern life, for probably the first time in human history, there are large numbers of noncolonized persons. Duodenal ulceration has been present essentially for only 200 years; that its incidence rose just as H. pylori was waning is best explained by changes in gastric microecology. As H. pylori is disappearing, duodenal ulceration and gastric cancer rates are falling. However, more proximal diseases, gastroesophageal reflux (GERD), Barrett's esophagus, and adenocarcinomas of the gastric cardia and lower esophagus, are increasing; colonization with cag+ H. pylori strains appears protective against these diseases. Thus, in the 21st century, the continuing decline in H. pylori may lead to the disappearance of duodenal ulcers and distal gastric cancers and toward a marked increase in GERD, Barrett's esophagus, and esophageal adenocarcinoma.
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              Association of upper and lower gastrointestinal tract symptoms with body mass index in an Australian cohort.

              M Horowitz, Walton Jones, C Quan … (2004)
              Food modulates gastrointestinal (GI) function and GI symptoms could alter food intake, but it is not established whether or not obese people experience more or less GI symptoms. We aimed at evaluating the association between body mass index (BMI) and specific GI symptoms in the community. Population-based random samples from Sydney, Australia (n = 777) completed a validated questionnaire. The association of each GI symptom with BMI (kg m(-2)) categories was assessed using logistic regression analysis adjusting for potential confounders. The prevalence of obesity (BMI > or =30 kg m(-2)) was 22%. There were univariate associations (adjusting for age, sex, education level, alcohol and smoking) between increased BMI category and heartburn (OR = 1.9, 95% CI 1.4, 2.5), acid regurgitation (OR = 2.1, 95% CI 1.4, 2.9), increased bloating (OR = 1.3, 95%CI 1.1, 1.6), increased stool frequency (OR = 1.4, 95% CI 1.1, 1.7), loose and watery stools (OR = 1.5, 95% CI 1.1, 2.0) and upper abdominal pain (OR = 1.3, 95% CI 1.03, 1.6). Early satiety was associated with a lower BMI category but this was not significant after adjustment (OR = 0.8, 95% CI 0.6, 1.1). Lower abdominal pain, postprandial fullness, nausea and vomiting were not associated with BMI category. In a regression model adjusting for sex, education, smoking, alcohol and all GI symptoms, older age, less early satiety and increased stool frequency and heartburn were all independently associated with increasing BMI (all P < 0.01). Heartburn and diarrhoea were associated with increased BMI, while early satiety was associated with a lower BMI in this population.
              Article 0 comments Cited 33 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ther Clin Risk Manag
                Journal ID (publisher-id): Therapeutics and Clinical Risk Management
                Title: Therapeutics and Clinical Risk Management
                Publisher: Dove Medical Press
                ISSN (Print): 1176-6336
                ISSN (Electronic): 1178-203X
                Publication date (Print): September 2006
                Publication date (Electronic): September 2006
                Volume: 2
                Issue: 3
                Pages: 329-334
                Affiliations
                [1 ]School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University Townsville, Australia
                [2 ]School of Medicine, North Queensland Centre for Cancer Research within the Australian Institute of Tropical Medicine, James Cook University Townsville, Australia
                Author notes
                Correspondence: Madeleine Nowak, Skin Cancer Research Group, School of Public Health and Tropical Medicine, James Cook University, Townsville, QLD 4811 Australia Tel +61 7 4796 1748 Fax +61 7 4796 1767 Email Madeleine.Nowak@ 123456jcu.edu.au
                Article
                PMC ID: 1936270
                PubMed ID: 18360609
                SO-VID: 0ec31143-3edb-49bc-a71f-65cbc6d06d2c
                Copyright © © 2006 Dove Medical Press Limited. All rights reserved
                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Medicine
                Keywords: diet,gastroesophageal reflux disease,lifestyle modification,case series,symptom reduction
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: diet, gastroesophageal reflux disease, lifestyle modification, case series, symptom reduction

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