[Non-pharmacological therapeutic possibilities in gastroesophageal reflux dyspepsia]

New knowledge concerning the pathophysiology of gastroesophageal reflux gives an opportunity for updating measures of conservative antireflux treatment. There are only few controlled trials, and it is uncertain whether the requirement for pharmacological treatment may hereby be diminished. General advice such as eating small meals, reducing the fat intake, avoiding food intake for three hours before bedtime are recommended to all, while advice on more specific foods should be individualized according to actual food related symptoms. Patients with annoying symptoms of reflux are advised not to consume alcohol every day, while the consumption of tobacco seems to be of minor importance. Advising weight loss isn't well founded, but ought to be given to obese patients. Elevation of the head of the bed is suggested to patients with nocturnal symptoms of reflux, which usually coincide with the presence of a hiatal hernia. If possible, revision of other current pharmacotherapy should be done. Theophylline, calcium channel blockers, benzodiazepines and nonsteroidal antiinflammatory drugs, seem in particular to be able to provoke or aggravate reflux. Patient support groups with medical supervision might be useful and reduce the number of consultations. The non-pharmacological measures should still be the basis of treatment and it might be sufficient in mild cases. It is recommended that the advise be individualized to each patient in such a way that no unfounded changes of life style are recommended that impair the quality of life. Gastroesophageal reflux, nonpharmacological treatment, food advices, alcohol, tobacco, overweight, hiatal hernia, drugs, patient education.