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Gastroesophageal reflux disease and heartburn - Prevention

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of GERD.

Alternative Names

Heartburn; GERD

Prevention:

People with heartburn should first try lifestyle and dietary changes. Some suggestions are:

Avoid or reduce consumption of foods and beverages that contain caffeine, chocolate, peppermint, spearmint, and alcohol. Both caffeinated and decaffeinated coffees increase acid secretion.
Avoid all carbonated drinks, because they increase the risk for GERD.
Although doctors often advise patients with GERD to cut down on fatty foods, many studies have found no evidence that a low-fat or high-fat meal worsens symptoms. Better studies are needed to confirm this, but it is always wise to avoid saturated fats (which are from animal products), and cut down on all fats if you are overweight.
Choose low-fat or skim dairy products, poultry, and fish. Increasing protein intake may help strengthen muscles in the esophagus.
Eat a diet rich in fruits and vegetables, although it's best to avoid acidic vegetables and fruits (such as oranges, lemons, grapefruit, pineapple, and tomatoes).
Patients who have trouble swallowing should avoid tough meats, vegetables with skins, doughy bread, and pasta.

Prevention of Nighttime GERD

Nearly three-quarters of patients with frequent GERD symptoms have them at night. Patients with nighttime GERD also tend to experience severe pain. It is very important to take preventive measures before going to sleep, such as:

After meals, take a walk or stay upright.
Avoid bedtime snacks. In general, do not eat for at least 2 hours before bedtime.
When going to bed, try lying on the left side rather than the right side. The stomach is located higher than the esophagus when you sleep on the right side, which can put pressure on the lower esophageal sphincter (LES), increasing the risk for fluid backup.
Sleep in a tilted position to help keep acid in the stomach at night. To do this, raise the bed at an angle using 4- to 6-inch blocks at the head of the bed. Use a wedge-support to elevate the top half of your body. (Extra pillows that only raise the head actually increase the risk for reflux.)

A reflux board is prescribed for use in children who have gastroesophageal reflux. A board tilts the child upward while he is lying in bed to prevent the stomach contents from going back into the esophagus and mouth, and possibly into the lungs.

Other Preventive Measures

Quitting smoking is essential.
People who are overweight should try to diet and exercise to lose weight.
People with GERD should avoid wearing tight clothing, particularly around the abdomen.
If possible, GERD patients should avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve). Tylenol (acetaminophen) is a good alternative pain reliever.

Although gum chewing is commonly believed to increase the risk for GERD symptoms, one study reported that it might be helpful. Because saliva helps neutralize acid and contains a number of other factors that protect the esophagus, chewing gum 30 minutes after a meal has been found to help relieve heartburn and even protect against damage caused by GERD. Chewing on anything can help, because it stimulates saliva production.

Resources

http://digestive.niddk.nih.gov -- National Digestive Diseases Information Clearinghouse
www.gastro.org -- American Gastroenterological Association
www.acg.gi.org -- American College of Gastroenterology
www.asge.org -- American Society for Gastrointestinal Endoscopy
www.ssat.com -- Society for Surgery of the Alimentary Tract
www.naspgn.org -- North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
www.reflux.org -- Pediatric/Adolescent Gastroesophageal Reflux Association
www.iffgd.org -- International Foundation for Functional Gastrointestinal Disorders

References

Brant K. Oelschlager BK, Eubanks TR, Pellegrini CA. Hiatal Hernia and Gastroesophageal Reflux Disease. In: Townsend: Sabiston Textbook of Surgery, 18th ed. Philadelphia, PA:WB Saunders; 2007:chap 42.

Chang EY, Morris CD, Seltman AK, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Ann Surg. 2007;246(1):11-21.

Friedenberg FK, Xanthopoulos M, Foster GD, Richter JE. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103:2111-2122.

Furnée EJ, Draaisma WA, Broeders IA, Smout AJ, Gooszen HG. Surgical reintervention after antireflux surgery for gastroesophageal reflux disease: a prospective cohort study in 130 patients. Arch Surg. 2008;143:267-274.

Gee DW, ANdreoli MT, Rattner DW. Measuring the effectiveness of laparoscopic antireflux surgery: long-term results. Arch Surg. 2008;143:482-487.

Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA. 2009;301:2120-2128.

Hirano I, Richter JE, and the Practice Parameters Committee of the American College of Gastroenterology. ACG practice guidelines: esophageal reflux testing. American Journal of Gastroenterology. 2007;102:668-685.

Islami F, Kamangar F. Helicobacter pylori and esophageal cancer risk: a meta-analysis. Cancer Prev Res. 2008;1:329-338.

Jeansonne LO, White BC, Nguyen V, Jafri SM, Swafford V, Katchooi M, et al. Endoluminal full-thickness plication and radiofrequency treatments for GERD: An outcomes comparison. Arch Surg. 2009;144:19-24.

Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-1391.

Jacobson BC, Moy B, Colditz GA, et al. Postmenopausal Hormone Use and Symptoms of Gastroesophageal Reflux. Arch Intern Med. 2008;168(16):1798-1804.

Mishkin DS, Chuttani R, Croffie J, et al. ASGE Technology Status Evaluation Report: wireless capsule endoscopy. Gastrointestinal Endoscopy. 2008;63(4): 539-545.

Orenstein S, Peters J, Khan S, et al. Gastroesophageal Reflux Disease (GERD). In: Kliegman: Nelson Textbook of Pediatrics, 18th ed. Philadelphia, PA: WB Saunders; 2007:chap 320.

Rodriguez LG, Ruigómez A, Martin-Merino E, Johansson S, Wallander MA. Relationship between gastroesophageal reflux disease and COPD in UK primary care. Chest. 2008;1223-1230.

Talley NJ, Locke GR 3rd, McNally M, Schleck CD, Zinsmeister AR, Melton LJ 3rd. Impact of gastroesophageal reflux on survival in the community. Am J Gastroenterol. 2008;103:12-19.

Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Lesie WD. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ. 2008;179:319-326.

Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3):788-97.

Wilson JF. In The Clinic: Gastroesophageal Reflux Disease. Ann Intern Med. 2008;149(3):ITC2-1-15.

Zhao Y, Encinosa W. Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005. Agency for Healthcare Research and Quality, January 2008.

Reviewed last on: 6/23/2009
Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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