title: Gastric fullness, physical activity, and proximal extent of gastroesophageal reflux.
abstract: OBJECTIVE
  Proximal extent of gastroesophageal reflux (PER) is relevant for symptoms in GERD patients. It has been suggested that PER is determined by the volume of the refluxate that, in turn, might depend on the degree of gastric fullness. Abdominal straining, during ambulation, increases the likelihood of gastroesophageal reflux. We assessed the influence of gastric fullness and ambulation on proximal extent of reflux.
  
  
  METHODS
  PER was assessed in 37 patients with GERD undergoing ambulatory pH impedance monitoring. In 14 controls and 19 GERD patients, esophageal pH impedance and gastric emptying were also studied simultaneously in stationary conditions. We compared PER during fasting, early postprandial (before half emptying), and late postprandial periods in ambulatory and stationary conditions.
  
  
  RESULTS
  More reflux episodes reached the proximal esophagus in the postprandial period compared to fasting (60%+/-4 vs 29%+/-3, p<0.05). In stationary conditions, early postprandial reflux reached higher proximal extent than late postprandial reflux (15+/-3% vs 8+/-4%, p<0.05). The proportion of reflux events reaching the proximal esophagus was significantly higher in ambulatory than in stationary conditions (29+/-5% vs 15+/-3%, p<0.05).
  
  
  CONCLUSIONS
  Compared to fasting, reflux episodes occurring after the meals are more likely to reach higher proximal extent, particularly so during the early postprandial period. The highest proportion of postprandial proximal reflux occurred in ambulatory condition. These findings suggest that reducing meal volumes and early postprandial physical activity might contribute to decrease proximal extent of reflux and postprandial GERD symptoms.
authors.affiliation: Centre for Gastroenterological Research, Catholic University of Leuven, Belgium.
authors.forename: Sara
authors.initials: S
authors.lastname: Emerenziani
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Kathleen
authors.initials: K
authors.lastname: Blondeau
authors.forename: Jiri
authors.initials: J
authors.lastname: Silny
authors.forename: Jan
authors.initials: J
authors.lastname: Tack
authors.forename: Jozef
authors.initials: J
authors.lastname: Janssens
authors.forename: Daniel
authors.initials: D
authors.lastname: Sifrim
mesh_terms: D000328:Adult; D000368:Aged; D002940:Circadian Rhythm / Q000502:physiology; D004435:Eating / Q000502:physiology*; D017097:Electric Impedance; D005215:Fasting / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying / Q000502:physiology*; D005750:Gastric Juice / Q000378:metabolism; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007297:Inpatients; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D010045:Outpatients; D019518:Postprandial Period / Q000502:physiology; D013270:Stomach / Q000503:physiopathology*