A systematic review of the definitions, prevalence, and response to treatment of nocturnal gastroesophageal reflux disease.
OBJECTIVE
More than half of patients with chronic gastroesophageal reflux (GERD) report nocturnal symptoms. We performed systematic literature review to define nocturnal heartburn and to determine potential causality between nocturnal reflux and extraesophageal manifestations.


METHODS
We performed a search of literature published from 1974-2007. Each study was examined by 2 reviewers and rated on the basis of study type and outcome.


RESULTS
Screening of 445 trials identified 59 (13%) studies relevant for analysis. Twenty-two (5%) of the trials described potential changes in sleep parameters resulting from treatment of heartburn. In most studies, nocturnal reflux was defined as heartburn symptoms that impacted sleep quality and duration. On the basis of 5 large population studies, the mean +/- standard deviation prevalence of nocturnal heartburn was 54% +/- 22%. Consequences of nocturnal reflux included poor sleep quality, daytime fatigue, difficulty initiating sleep or arousals from sleep, and impaired work productivity. The strength of the association between the occurrence of nocturnal reflux and late evening meals was flawed as a result of the confounding effect of the evening meal content. There was no evidence supporting causality between nocturnal heartburn and asthma or obstructive sleep apnea. Subjective, but not objective, measures of sleep improved with antireflux therapy. Head of bed elevation, proton pump inhibitor therapy, H(2)-receptor antagonists, and Nissen fundoplication alleviated nocturnal heartburn and associated sleep disturbances.


CONCLUSIONS
Nocturnal GERD is common and is associated with adverse sleep parameters. It can be effectively managed with medical and surgical therapy.
Gerson
Lauren B
LB
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA. lgersonmd@yahoo.com
Fass
Ronnie
R
D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012893:Sleep Wake Disorders / Q000209:etiology*; D016896:Treatment Outcome
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors