|LETTER TO EDITOR
|Year : 2023 | Volume
| Issue : 2 | Page : 92-93
The role of lifestyle in prevention and treatment of gastroesophageal reflux disease
Vindhya Vasini Lella1, Satwik Kuppili1, Tarun Kumar Suvvari2
1 Department of Medicine, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
2 Department of Medicine, Rangaraya Medical College, Kakinada, Andhra Pradesh; Founder and Executive Director, Squad Medicine and Research (SMR), India
|Date of Submission||26-Mar-2023|
|Date of Decision||30-Mar-2023|
|Date of Acceptance||01-Apr-2023|
|Date of Web Publication||24-Apr-2023|
Dr. Tarun Kumar Suvvari
RMC Mens Hostel, Rangaraya Medical College, Kakinada, Andhra Pradesh 533001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lella VV, Kuppili S, Suvvari TK. The role of lifestyle in prevention and treatment of gastroesophageal reflux disease. Adv Biomed Health Sci 2023;2:92-3
|How to cite this URL:|
Lella VV, Kuppili S, Suvvari TK. The role of lifestyle in prevention and treatment of gastroesophageal reflux disease. Adv Biomed Health Sci [serial online] 2023 [cited 2023 Jun 9];2:92-3. Available from: http://www.abhsjournal.net/text.asp?2023/2/2/92/374458
To the Editor,
The prevalence of gastroesophageal reflux disease (GERD) is increasing all over the world due to various lifestyle changes. Lifestyle particularly is described as the major contributing factor for the development of GERD. Such lifestyle factors including obesity or overweight (high body mass index [BMI]), exposure to tobacco, alcohol, chocolate, high-fat meals, hot beverages such as coffee and tea, fewer hours of sleep, lack of physical activity or intense exercise, food just before bedtime, and midnight snacking might be the major contributors . And hence, the first step in the management of GERD is considered to be a lifestyle modification with dietary changes to high-fiber and low-fat foods, weight loss, and smoking cessation etcetera .
Yuan et al. conducted a study on 1518 subjects, consisting of 832 GERD patients and 686 non-GERD patients from 6 hospitals. The study identified 21 potential risk lifestyle choices for GERD. The most frequent lifestyle habits found were fast eating habits, more preference for spicy foods, and overeating . A lower incidence of GERD in female gender could be associated with the presence of estrogen that is inactivating the inflammatory cells. GERD in overweight people could be explained by gastric overfilling which loosens up the lower esophageal sphincter, causing hiatal hernia. A major component of tea is theophylline, which eases the lower esophageal sphincter that could lead to GERD.
There are very limited articles out there referring to the exact role of these lifestyle changes in the symptomatic treatment of reflux disease. Relationship assessments between the risk factors and symptom relief have been performed, and only a few modifications were proven to relieve symptoms or lower the pH. Of those, weight loss and smoking cessation were the major contributors in patients whose BMI was above normal and smokers, respectively . These alleviated the heartburn and regurgitation associated with GERD and also the 24-h pH also was normalized to some extent. In two randomized control trials, weight loss has shown to decrease time the esophagus was exposed to acid from 5.6% to 3.7% and 8.0% to 5.5% and head elevation by decreasing supine acid exposure from 21% to 15% leading to the reduced symptoms in prospective studies .
On the contrary, other modifications like the dietary changes including not taking food 2–3 h prior to bedtime, reduced coffee, chocolate, spices, acidic food, and high-fat food intake did not seem to improve the symptoms of regurgitation and dyspepsia as much as they thought they would . But, elevating the head of the bed and sleeping on the left side were found to decrease symptoms of nocturnal dyspepsia among people with GERD. Moreover, some randomized trials also showed the effect of breathing exercises by assessing the quality of life, pH manometry, and usage of a proton-pump inhibitor. Hence, it is generally recommended for patients to avoid foods that trigger their symptoms based on their personal relationships with food .
Pharmacotherapy is, therefore, the first-line treatment of GERD. However, lifestyle changes, including the ones that were not proven to be effective, are also an important component of supportive treatment. Some trials have studied the positive roles of each lifestyle modification with a drug that is used using the Frequency Scale for the Symptoms of GERD scoring system. These studies showed correlation-standardized coefficient (β) of female gender (β = 0.198), inadequate sleep (β = 0.150), skipping breakfast (β = 0.146), dinner just before bedtime (β = 0.129), and antihypertensive nonusers (β = 0.134) with proton-pump inhibitors and inadequate sleep (β = 0.248), midnight snacking (β = 0.160), anticoagulant (β = 0.106), and antihypertensive nonusers (β = 0.095) with H2 receptor antagonists .
Upcoming approaches for GERD treatment include potassium-competitive acid blockers, reflux-reducing agents, bile-acid binders, and electric stimulation of the lower esophageal sphincter. However, the role of modifiable risk factors in managing dyspeptic symptoms, aside from dietary changes, such as the potential effects of adequate exercise, requires further research. Most patients might find it comfortable to use proton-pump inhibitors rather than losing weight or smoking cessation, but for those who want to have an alternative to daily medication and for cirrhotic patients without alarming symptoms of GERD, lifestyle variations could be a huge part of their regimen ,.
In conclusion, the bottom line is that lifestyle interventions amplify the efficacy of the medications used and more importantly lifestyle should be considered more like a preventive measure prior to the development of GERD. This combination of lifestyle interventions with medications has been reported to alleviate or even cure GERD. It is never too late to opt for lifestyle changes as the treatment option in adjunct to medications either.
Sincere thanks to Squad Medicine and Research (SMR) for their support and guidance of this project.
Financial support and sponsorship
Conflict of interests
No conflict of interests declared.
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Yamamichi N, Mochizuki S, Asada-Hirayama I, Mikami-Matsuda R, Shimamoto T, Konno-Shimizu M, et al
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