Non-Medication Treatment for GERD

The spectrum of GERD is enormously wide, varying from very mild or very intermittent symptoms to virtually daily continuous heartburn and acid regurgitation. Also, the symptom pattern is highly complex, varying from characteristic symptoms of heartburn and acid regurgitation to massive nighttime regurgitation and occasionally aspiration to very nonspecific symptoms like dyspepsia or other atypical symptoms such as hoarseness, retrosternal pain, nausea, and vomiting.

As symptoms are the driving force, symptom reduction is the dominant aim of medical therapy. In addition, regression of endoscopically seen mucosal damage and thereby prevention of complications is a secondary aim. Any approach to a patient with reflux disease begins with explanation of the disorder, inquiry about potentially correctable abnormalities, and advice for lifestyle modification whenever appropriate. Of those measures, early evening meal, low fat content of the diet, avoidance of chocolate, and raising the head of the bed are obviously the most important. Compliance with life-style changes is often poor.

Several modifications of habits are recommended for patients with GERD. The various lifestyle modifications for treating GERD are:

• Elevation of head of bed; avoid waterbed; use foam rubber wedge on top of mattress
• Dietary modifications
• Early-evening meal; no food prior to sleeping
• Low-calorie, low-fat evening meal
• Avoid specific irritants [citrus juices, tomato products, coffee, alcoholic beverages (e.g., white wine), chocolate]
• Weight loss, if overweight in presence of hiatal hernia
• Avoid potentially harmful medications
• Sedatives/tranquilizers, theophylline, prostaglandins, calcium channel blockers, Progesterone, anticholinergics
• Avoid lying down after meals
• Avoid bending and stooping
• Do not wear tight clothing
• Avoid excessive repetitive straining at stool
• Avoid smoking

None of these measures have been studied with sufficient quality so far. Certainly, some suggestions may have some limited value in an individual patient.

The other measures to reduce the symptoms of GERD are:

• Antireflux surgery: This increases the pressure between the esophagus and stomach thereby preventing acid reflux. Nissen’s fundoplication is the most popular among the surgeries for GERD.
• Endoscopic treatment: These include radiofrequency frequency ablation, endoscopic sewing technique and sphincter injection technique.
• Relaxation: Stress is known to worsen GERD. Relaxation by reducing stress relieves the symptoms of GERD.
• Biofeedback: This also helps in relieving the symptoms of GERD by reducing stress.