Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease

OBJECTIVE: Body position has been shown to influence postprandial and fasti ng gastroesophageal reflux (GER) in patients and normal volunteers when the y are assigned to lie in a prescribed position. No published studies have e valuated the effect of spontaneous sleeping positions on recumbent reflux i n patients with GER. METHODS: Ten patients, three female and seven male (mean age 47.6 yr, range 30-67 yr) with abnormal recumbent esophageal pH <4 on 24-h pH-metry partic ipated. A standardized high fat dinner (6 PM) and a bedtime snack (10 PM) w ere administered to all patients. GER during spontaneous sleep positions wa s assessed with a single channel pH probe placed 5 cm above the lower esoph ageal sphincter (LES) and with a position sensor taped to the sternum. Data were recorded with a portable digital data logger (Microdigitrapper-S, Syn ectics Medical) and analyzed for recumbent percent time pH <4 and esophagea l acid clearance time in each of four sleeping positions. Time elapsed betw een change in sleeping position and GER episodes was also calculated. RESULTS: Right lateral decubitus was associated with greater percent time p H <4 (p < 0.003) and longer esophageal acid clearance (p < 0.05) compared t o the left, supine, and prone. GER episodes were more frequent in the supin e position (p < 0.04) and occurred within 1 min after change in sleeping po sition 28% of the time. CONCLUSIONS: The left lateral decubitus position is preferred in patients w ith nocturnal GER. Measures to aid patients in sleeping in this position sh ould be developed. (Am J Gastroenterol 1999;94:2069-2073. (C) 1999 by Am. C ell. of Gastroenterology).