Gastric fullness, physical activity, and proximal extent of gastroesophageal reflux.
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.
Emerenziani
Sara
S
Centre for Gastroenterological Research, Catholic University of Leuven, Belgium.
Zhang
Xin
X
Blondeau
Kathleen
K
Silny
Jiri
J
Tack
Jan
J
Janssens
Jozef
J
Sifrim
Daniel
D
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*