Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is increasingly prevalent and often not fully controlled by proton pump inhibitors alone, prompting renewed interest in evidence-based dietary and lifestyle management. This narrative review integrates contemporary guidelines with clinical, physiologic, and epidemiologic studies to formulate practical, patient-centered recommendations. Interventions with the most consistent support included the following: weight reduction, maintaining a two-to-three-hour interval between the final meal and bedtime, head-of-bed elevation and left-lateral sleep, smoking cessation, and light postprandial activity while avoiding high-intensity exercise immediately after meals. Eating slowly and consuming smaller portions are encouraged. Dietary triggers, such as high-fat foods, alcohol, carbonated beverages, coffee/caffeine, chocolate, and acidic items (e.g., tomato products and citrus), show heterogeneous associations across studies. Accordingly, individualized avoidance or substitution is preferable to universal prohibition. Pragmatic substitutions (e.g., decaffeinated coffee or low-fat latte; lean poultry or fish instead of fatty processed meats; less acidic fruits such as apple, pear, or banana) may enhance adherence. Emerging randomized evidence suggests that diaphragmatic breathing can reduce postprandial reflux events, increase inspiratory lower esophageal sphincter pressure, and improve symptoms and quality of life. On the other hand, the evidence base remains limited in scope and duration. Overall, tailored dietary and lifestyle modification constitutes a credible adjunct to pharmacotherapy and a practical framework for patient counseling in GERD.