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602 SUPERIOR EFFICACY OF THE PRONE ELEVATED POSITION IN TREATMENT OF POST-PRANDIAL GASTROESOPHAGEAL REFLUX

1981; Springer Nature; Volume: 15; Linguagem: Inglês

10.1203/00006450-198104001-00615

1530-0447

William F. Meyers, John J. Herbst, Stephen G. Jolley,

Eosinophilic Esophagitis

Positional therapy for gastroesophageal reflux was evaluated by extended pH monitoring of the esophagus during the post-prandial period in 28 normal and 45 reflux patients. Frequency of reflux (F), percent time the esophagus was pH<4 (%) and mean duration of reflux (MD) were determined while awake, asleep, supine, sitting, and prone on a board with the head elevated 30°. In normals, position or state of alertness did not affect reflux. Compared to normals, the increased % in reflux patients while awake (p<.001) was mainly related to increased F (p<.001) and normal MD; while asleep the increased % (p<.05) was related to normal F and prolonged MD (p<.05). Reflux patients have less % while on the board than while sitting or supine, both awake and asleep (p<.05). MD while asleep on the board was less than supine (p=.05), but F was unchanged; while awake, F was less on the board (p=.02) than supine, but MD was unchanged. These data demonstrate that alertness and position affect gastroesophageal reflux only in abnormal patients. The major determinant of increased acid exposure to the esophagus in reflux patients varies with the state of alertness, being mainly frequency of reflux while awake and prolonged duration while asleep. The prone elevated position effectively reduced these determinants in refluxers compared to supine positioning. The same effect could not be demonstrated for the sitting position.