The American Gastroenterological Association has just issued a new position statement on treating GERD, otherwise known as gastroesophageal reflux disease, which some people refer to as acid reflux. And the guidelines discuss various remedies, including medication and lifestyle changes.

But let’s start with the National Institute of Diabetes and Digestive and Kidney Diseases, which suggests making one or more lifestyle changes, drugs, or surgery. Among the lifestyle changes: stop smoking; avoid foods and drinks that worsen symptoms (such as coffee, spicy stuff and alcohol); lose weight; eat small and frequent meals; wear loose-fitting clothes; avoid lying down for three hours after a meal, raise the head of one’s bed by several inches (read more here).

The AGA guidelines attempt to fine tune those by saying there is fair evidence to recommend losing weight, avoiding late meals and specific foods, and raising beds, depending upon the patient. But there is “insufficient evidence to recommend for or against broadly advocating lifestyle changes for all - as opposed to selected - patients.” The remarks are qualified, as you can see:

“The problem with these is that there are simply too many recommendations and each is too narrowly applicable to enforce the whole set on every patient. However, it is also clear that there are subsets of patients who may benefit from specific lifestyle modifications, and it is good practice to make those recommendations to those patients based on their specific history.” For instance, it may make sense to tell a patient to quit drinking booze if they consistently experience heartburn.

This seems reasonable, although the guidelines clearly recommend the use of drugs - and all three doctors who are responsible for the AGA recommendations have financial ties to AstraZeneca or TAP Pharmaceuticals, which make GERD meds, such as Nexium and Prevacid. And these companies are AGA partners. Which raises a question - where is the corresponding effort to generate evidence about lifestyle changes?

Hat tip to the Prescription Project for pointing this out