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Content Update

August 5, 2021

Lifestyle Changes that Reduce Symptoms of Gastroesophageal Reflux Disease (GERD): Lifestyle modifications are recommended to reduce the frequency and severity of heartburn symptoms and GERD when used prior to or combined with acid-suppressive medications. Until recently, there was no prospective evidence to substantiate the effectiveness of individual lifestyle changes. A publication from the Nurses’ Health Study II found that adhering to five specific modifications led to a 50% reduction in GERD symptoms: 1) not smoking; 2) drinking fewer than 2 cups daily of coffee, tea, or soda; 3) following a diet high in whole grains and low in red meat and added sugars; 4) getting 30 minutes or more of moderate to vigorous exercise daily; and 5) not being overweight (BMI <25 kg/m2). These lifestyle measures (especially weight loss when appropriate) should be included in comprehensive heartburn and GERD care plans.

Content Update

July 7, 2019

Updated Recommendation on the Long-Term Safety of Proton Pump Inhibitors (PPIs): In 2017, the American Gastroenterological Association (AGA) released best practice recommendations evaluating the risks and benefits of long-term proton pump inhibitor (PPI) therapy based on observational studies, including chronic kidney disease, dementia, bone fracture, myocardial infarction, Clostridioides difficile infection, other enteric infections, pneumonia, micronutrient deficiencies, and gastrointestinal cancer. This report stated that the risk of C. difficile infection was “modest” compared with traditional risk factors such as antibiotics. In the first and largest prospective, randomized trial examining the long-term safety of PPIs (specifically pantoprazole) published in 2019, after a median of three years of use, PPIs did not increase the risk of any of these adverse effects except for non-Clostridioides difficile enteric infections. The authors concluded that PPI therapy is safe for up to 3 years and that limiting prescription of PPI therapy because of concerns of long-term harm is not warranted.



Upon completion of the chapter, the reader will be able to:

  1. Explain the underlying causes of gastroesophageal reflux disease (GERD).

  2. Understand the difference between typical, atypical, and alarm symptoms.

  3. Determine when diagnostic tests should be recommended based on the clinical presentation.

  4. Identify the desired therapeutic outcomes for patients with GERD.

  5. Recommend appropriate nonpharmacologic and pharmacologic interventions for patients with GERD.

  6. Educate patients on appropriate lifestyle modifications and drug therapy issues including adherence, adverse effects, and drug interactions.

  7. Formulate a monitoring plan to assess the effectiveness and safety of pharmacotherapy for GERD.


Gastroesophageal reflux is the retrograde, effortless movement of stomach contents into the esophagus. When troublesome symptoms or mucosal damage occurs as a result of this process, this is defined as gastroesophageal reflux disease (GERD).1,2 Treatment is usually initiated based on symptom presentation rather than laboratory tests or invasive monitoring and consists of various ...

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