Symptom relief should be the primary concern when selecting a strategy to manage gastroesophageal reflux disease (GERD). Healing erosive esophagitis is another important outcome in GERD, since reversing esophageal injury can prevent long-term complications. Speed of symptom relief is also important, especially in patients who choose on-demand or intermittent therapy. Since many patients do not have complete relief of symptoms with therapy, the goal is long-term acceptable symptom control, with the least amount of treatment necessary.
Despite major advances in our understanding of gastroesophageal reflux disease (GERD), managing this disease remains a challenge. Data have shown that the degree of esophageal insult can be directly correlated to the length of time that the gastroesophageal mucosa is exposed to pH lower than 4.0. Therefore, all treatment strategies in patients with symptomatic GERD should attempt to prevent reflux of gastric contents into the esophagus and reduce the volume of reflux acid by decreasing gastric secretions.
Lifestyle changes are designed to decrease reflux by strengthening lower esophageal sphincter (LES) tone or reducing extrinsic gastric pressure. Clinical studies of lifestyle interventions in symptomatic gastroesophageal reflux disease (GERD) have produced a range of results. Avoiding particular foods or alcoholic beverages that may provoke reflux-induced symptoms produces a reduction in these symptoms. An important measure in the relief of nocturnal symptoms is elevating the head and upper body while sleeping. However, smoking cessation has shown minimal if any benefit in managing GERD. Weight reduction in obese patients also has failed to produce significant improvement.There is no evidence to support that lifestyle modifications are effective in healing esophagitis. Some also argue that aggressive lifestyle modifications can further decrease the patient’s quality of life. Despite limited clinical data, most experts believe that education about lifestyle interventions should be part of a treatment plan for most patients.