title: Lifestyle Intervention in Gastroesophageal Reflux Disease.
abstract: OBJECTIVE
  Gastroesophageal reflux disease (GERD) affects up to 30% of adults in Western populations and is increasing in prevalence. GERD is associated with lifestyle factors, particularly obesity and tobacco smoking, which also threatens the patient's general health. GERD carries the risk of several adverse outcomes and there is widespread use of potent acid-inhibitors, which are associated with long-term adverse effects. The aim of this systematic review was to assess the role of lifestyle intervention in the treatment of GERD.
  
  
  METHODS
  Literature searches were performed in PubMed (from 1946), EMBASE (from 1980), and the Cochrane Library (no start date) to October 1, 2014. Meta-analyses, systematic reviews, randomized clinical trials (RCTs), and prospective observational studies were included.
  
  
  RESULTS
  Weight loss was followed by decreased time with esophageal acid exposure in 2 RCTs (from 5.6% to 3.7% and from 8.0% to 5.5%), and reduced reflux symptoms in prospective observational studies. Tobacco smoking cessation reduced reflux symptoms in normal-weight individuals in a large prospective cohort study (odds ratio, 5.67). In RCTs, late evening meals increased time with supine acid exposure compared with early meals (5.2% point change), and head-of-the-bed elevation decreased time with supine acid exposure compared with a flat position (from 21% to 15%).
  
  
  CONCLUSIONS
  Weight loss and tobacco smoking cessation should be recommended to GERD patients who are obese and smoke, respectively. Avoiding late evening meals and head-of-the-bed elevation is effective in nocturnal GERD.
authors.affiliation: Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; The Nord-Trøndelag Health Study Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway. Electronic address: eivind.ness-jensen@ki.se.
authors.forename: Eivind
authors.initials: E
authors.lastname: Ness-Jensen
authors.affiliation: The Nord-Trøndelag Health Study Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology, Levanger, Norway.
authors.forename: Kristian
authors.initials: K
authors.lastname: Hveem
authors.affiliation: Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas.
authors.forename: Hashem
authors.initials: H
authors.lastname: El-Serag
authors.affiliation: Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, United Kingdom.
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008019:Life Style; D009765:Obesity; D011446:Prospective Studies; D012907:Smoking
keywords: Acid Regurgitation; GERD; Heartburn; Therapy; Treatment