Original Article
The American Journal of Gastroenterology (2005) 100, 1251–1256; doi:10.1111/j.1572-0241.2005.41695.x
Gastric Fullness, Physical Activity, and Proximal Extent of Gastroesophageal Reflux
Sara Emerenziani MD1, Xin Zhang MD1, Kathleen Blondeau MSc1, Jiri Silny PhD1, Jan Tack MD, PhD1, Jozef Janssens MD, PhD1 and Daniel Sifrim MD, Ph D1
1Centre for Gastroenterological Research, Catholic University of Leuven, Belgium; and femu – Research Center for Bioelectromagnetic Interaction, Aachen University Hospital, Germany
Correspondence: Daniel Sifrim, MD, PhD,, Faculty of Medicine K.U. Leuven, Lab G-I Physiopathology, O&N Gasthuisberg, 7th floor, Herestraat 49, 3000, Leuven, Belgium
Received 20 October 2004; Revised 0000; Accepted 28 December 2004.
Abstract
OBJECTIVES:
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).
CONCLUSION:
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.
