What lifestyle modifications should I recommend to patients with GERD?

For patients with gastroesophageal reflux disease (GERD), you should recommend several lifestyle modifications, which encourage self-management and may offer general health benefits, although evidence for symptom reduction is limited ¹.

• Weight Management: Encourage patients to lose weight if they are overweight or obese, as there is good evidence that weight reduction is beneficial for GERD symptoms ¹.
• Dietary Adjustments: Advise patients to eat smaller meals and to eat their evening meal 3–4 hours before going to bed, if possible ¹. They should also try to avoid any trigger foods such as coffee, chocolate, tomatoes, and fatty or spicy foods ¹. Fatty foods can delay gastric emptying, and certain trigger foods like coffee, chocolate, and alcohol may transiently reduce the lower oesophageal sphincter (LOS) tone ¹.
• Smoking Cessation: Patients should be encouraged to stop smoking, if appropriate, as there is good evidence that smoking cessation is beneficial ¹. Smoking increases gastric acid production and delays gastric emptying ¹.
• Alcohol Consumption: Advise patients to reduce alcohol consumption to recommended limits, if appropriate ¹.
• Sleep Position: Recommend sleeping with the head of the bed raised, for example, by placing wood or bricks under the bed head to raise it by 10–20 cm, if practical ¹. This may be particularly helpful for those with nocturnal symptoms, as lying flat can increase reflux episodes ¹. Patients should be advised not to use additional pillows, as this may increase intra-abdominal pressure and worsen symptoms ¹.
• Stress and Anxiety Management: Assess for stress and anxiety, which can worsen symptoms, and encourage relaxation strategies if needed ¹. Psychological treatments may reduce symptoms in the short-term ¹.
• Medication Review: Review the patient's current medications and consider reducing or stopping any drugs that may cause or exacerbate symptoms, if possible and appropriate ¹. Examples include alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, nitrates, theophyllines, and tricyclic antidepressants ¹.
• Over-the-Counter Medications: Ask patients about any over-the-counter medications they have tried for symptom relief, such as antacids and/or alginates ¹.

It is also important to offer written information and advice on the symptoms, self-care, and management options for GERD ¹. If symptoms persist or recur despite initial management, reinforce lifestyle advice ¹.