CHARACTERISTICS OF DAYTIME AND NIGHTTIME SUPINE REFLUX ASSESSED BY PHMONITORING SHOW LESS SEVERE REFLUX DURING DAYTIME RECUMBENT POSITION.
Filipe Pádua*1, Fernando A. Herbella1, Leonardo M. Del Grande1, Marco G. Patti2
1Surgery, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, SP, Brazil; 2University of Virginia, Charlottesville, VA
Introduction: Gastroesophageal reflux disease (GERD) may present with different patterns (upright, supine, or bipositional). Some studies suggested that supine reflux is clinically more severe. It is elusive; however, if there are differences between daytime versus nighttime supine reflux. Our study aims to compare the characteristics of daytime and nighttime supine reflux assessed by pHmonitoring.
Materials & Methods: We reviewed 472 consecutive patients that underwent esophageal manometry and pH monitoring. Patients were classified as GERD + per DeMeester score > 14.7. Upright acid exposure time (AET) was considered pathologic > 6% and supine AET > 2%. Acid reflux during daytime and nighttime recumbent position were compared. The number of episodes of reflux, AET, longest reflux (minutes), number of long refluxes (>5minutes), interval between last meal and recumbence, the interval between beginning of recumbence and the first episode of reflux and symptoms during recumbence were recorded.
Results: 250 (53%) patients were GERD + (12 (5%) upright, 156 (62%) supine and 41 (16%) bipositional pattern). Recumbence during daytime occurred in 212 (42%) patients, 27 twice and 1 thrice (107 (50%) were GERD+, 87 (41%) with supine pattern). One hundred and fifteen (52%) out of 222 patients that did not present with daytime recumbence were GERD +, 84 (38%) with supine pattern. There was no difference for the presence of GERD (p=0.8), supine pattern (p=0.1) or DeMeester score (p=0.2) between the patients that had a daytime recumbence or not. Table 1 shows the comparison between acid reflux during daytime versus nighttime of all patients. AET was not different between daytime or nighttime recumbence. All other parameters were lower during daytime recumbence. The interval between last meal and recumbence and the interval between from the beginning of recumbence and the first episode of reflux were lower for daytime recumbence. The report of symptoms during recumbence was similar between daytime and nighttime. A subanalysis comparing daytime versus nighttime reflux only among patients that had daytime recumbence (Table 2) showed similar results except for AET that were similar between periods (p=0.3).
Conclusions: Our results show that: (a) daytime recumbence is not a risk factor for GERD; (b) daytime recumbence is not a risk factor for supine reflux; (c) AET is not different from daytime and nighttime recumbence but all other parameters are lower for daytime recumbence even tough patients tend to have a shorter interval between meals and recumbence.
Table 1. Acid exposure parameters for daytime versus nighttime recumbence (all patients n=473).
Table 2. Acid exposure parameters for daytime versus nighttime recumbence (patients with daytime recumbence n=212).
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