title: Effect of lateral positioning on gastroesophageal reflux (GER) and underlying mechanisms in GER disease (GERD) patients and healthy controls.
abstract: BACKGROUND
  Posture has been shown to influence the number of transient lower esophageal sphincter relaxation (TLESRs) and gastroesophageal reflux (GER), however, the physiology explaining the influence of right lateral position (RLP), and left lateral position (LLP) is not clear. The aim of this study was to determine the influence of RLP and LLP on TLESRs and GERD after a meal in GER disease (GERD) patients and healthy controls (HC) while monitoring gastric distension and emptying.
  
  
  METHODS
  Ten GERD patients and 10 HC were studied for 90 min (30 min test meal infusion, 30 min postprandial in either RLP or LLP (randomly assigned) and 30 min in alternate position). The study was repeated on a separate day in reverse position order. TLESRs, GER, and gastric emptying rate were recorded using manometry, multichannel intraluminal impedance, and (13) C-octanoate breath tests. Gastric distension was visualized by five serial gastric volume scintigraphy scans during the first 30 min.
  
  
  RESULTS
  Gastroesophageal reflux, (GER) disease patients had increased numbers of TLESRs in RLP compared to LLP in the first postprandial hour [5 (4-14) and 4.5 (2-6), respectively, P = 0.046] whereas the number of TLESRs was not different in RLP and LLP [4 (2-4) and 4 (3-6), respectively, P = 0.7] in HC. Numbers of GER increased similar to TLESRs in GERD patients. In GERD patients, gastric emptying reached peak (13)CO(2) excretion faster and proximal gastric distension was more pronounced.
  
  
  CONCLUSIONS
  In GERD patients, TLESRs, GER, distension of proximal stomach, and gastric emptying are increased in RLP compared to LLP. This effect is not seen in HC.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands. c.m.loots@amc.nl
authors.forename: C
authors.initials: C
authors.lastname: Loots
authors.forename: M
authors.initials: M
authors.lastname: Smits
authors.forename: T
authors.initials: T
authors.lastname: Omari
authors.forename: R
authors.initials: R
authors.lastname: Bennink
authors.forename: M
authors.initials: M
authors.lastname: Benninga
authors.forename: M
authors.initials: M
authors.lastname: van Wijk
mesh_terms: D000293:Adolescent; D000328:Adult; D018592:Cross-Over Studies; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D055815:Young Adult