Distribution of Oesophageal Acid Exposure Throughout the Sleep Period
Distribution of Oesophageal Acid Exposure Throughout the Sleep Period
Background: Nocturnal gastro-oesophageal reflux diseases (GERD) can lead to oesophageal mucosal injury and extra-oesophageal complications.
Aim: To compare distribution of oesophageal acid exposure during sleep time among patients with non-erosive reflux disease and abnormal pH test (NERD-positive), erosive oesophagitis (EO) and Barrett's oesophagus (BO).
Methods: Patients underwent endoscopy followed by 24-h oesophageal pH testing. Oesophageal acid exposure was assessed every 2 h of the sleep period (0-2, 2-4, 4-6 and 6-8 h). Each period of 2 h was evaluated for acid reflux parameters. All groups were matched by age, time from last meal and duration of sleep time.
Results: Thirty-eight patients were enrolled (NERD-positive, 16; EO, 1.4; and BO, 8). All GERD groups demonstrated higher oesophageal acid exposure in the first vs. second half of the sleep period as determined by percent time pH <4 (BO: 34.7 vs.11.6, EO: 13.5 vs. 6.9, NERD-positive: 8.8 vs. 2.5, all P < 0.01). In general, patients with BO had a significantly higher distribution of oesophageal acid exposure than those with NERD-positive and EO.
Conclusions: Oesophageal acid exposure generally declines throughout the sleep period regardless of GERD group, but BO patients demonstrated the greatest decline during the sleep period.
Gastro-oesophageal reflux disease (GERD) is a chronic and common medical problem. Population based studies have demonstrated that 44% of the adult US population report GERD-related symptoms (heartburn and acid regurgitation) at least once a month and 20% once a week.
In several nation-wide surveys of adults who suffer from GERD-related symptoms, nocturnal heartburn was reported by 74-79% of the respondents. Additionally, 34% of the GERD sufferers also reported nocturnal acid regurgitation. In a large prospective, cohort study of subjects from the general population, 24.9% reported having heartburn that awakens them from sleep during the night.
Physiologically, acid reflux events are distinctly different in the awake vs. the sleep period. During sleep, acid reflux events tend to be less frequent and of a longer duration as compared with acid reflux events during the awake period. This is due to the profound effect of sleep on oesophageal response to acid reflux events. During sleep, there is a significant reduction in voluntary swallowing and thus primary peristalsis. In addition, diminished saliva production during sleep results in delayed normalization of the distal oesophageal pH after an acid reflux event has occurred. Loss of gravitation effect as well as alteration in perception of acid reflux events and thus less symptom generation may all adversely affect physiological response to gastro-oesophageal reflux. Consequently, nocturnal gastro-oesophageal reflux has been demonstrated to be associated with oesophageal inflammation, GERD-related complications and extra-oesophageal manifestations of GERD.
Furthermore, recent reports have demonstrated that nocturnal GERD is commonly associated with reports of poor quality of sleep and a variety of sleep disturbances. In fact, patients with nocturnal heartburn report lower health-related quality of life when compared with GERD patients without nighttime GERD.
Thus far, there is no information about the distribution and physiological characteristics of oesophageal acid exposure during sleep among the different GERD groups, particularly between those with and those without oesophageal mucosal involvement. As a result, the aim of our study was to compare distribution of oesophageal acid exposure and reflux characteristics throughout the sleep period among patients with different phenotypic presentations of GERD [non-erosive reflux disease (NERD), erosive oesophagitis (EO) and Barrett's oesophagus (BO)].
Summary and Introduction
Summary
Background: Nocturnal gastro-oesophageal reflux diseases (GERD) can lead to oesophageal mucosal injury and extra-oesophageal complications.
Aim: To compare distribution of oesophageal acid exposure during sleep time among patients with non-erosive reflux disease and abnormal pH test (NERD-positive), erosive oesophagitis (EO) and Barrett's oesophagus (BO).
Methods: Patients underwent endoscopy followed by 24-h oesophageal pH testing. Oesophageal acid exposure was assessed every 2 h of the sleep period (0-2, 2-4, 4-6 and 6-8 h). Each period of 2 h was evaluated for acid reflux parameters. All groups were matched by age, time from last meal and duration of sleep time.
Results: Thirty-eight patients were enrolled (NERD-positive, 16; EO, 1.4; and BO, 8). All GERD groups demonstrated higher oesophageal acid exposure in the first vs. second half of the sleep period as determined by percent time pH <4 (BO: 34.7 vs.11.6, EO: 13.5 vs. 6.9, NERD-positive: 8.8 vs. 2.5, all P < 0.01). In general, patients with BO had a significantly higher distribution of oesophageal acid exposure than those with NERD-positive and EO.
Conclusions: Oesophageal acid exposure generally declines throughout the sleep period regardless of GERD group, but BO patients demonstrated the greatest decline during the sleep period.
Introduction
Gastro-oesophageal reflux disease (GERD) is a chronic and common medical problem. Population based studies have demonstrated that 44% of the adult US population report GERD-related symptoms (heartburn and acid regurgitation) at least once a month and 20% once a week.
In several nation-wide surveys of adults who suffer from GERD-related symptoms, nocturnal heartburn was reported by 74-79% of the respondents. Additionally, 34% of the GERD sufferers also reported nocturnal acid regurgitation. In a large prospective, cohort study of subjects from the general population, 24.9% reported having heartburn that awakens them from sleep during the night.
Physiologically, acid reflux events are distinctly different in the awake vs. the sleep period. During sleep, acid reflux events tend to be less frequent and of a longer duration as compared with acid reflux events during the awake period. This is due to the profound effect of sleep on oesophageal response to acid reflux events. During sleep, there is a significant reduction in voluntary swallowing and thus primary peristalsis. In addition, diminished saliva production during sleep results in delayed normalization of the distal oesophageal pH after an acid reflux event has occurred. Loss of gravitation effect as well as alteration in perception of acid reflux events and thus less symptom generation may all adversely affect physiological response to gastro-oesophageal reflux. Consequently, nocturnal gastro-oesophageal reflux has been demonstrated to be associated with oesophageal inflammation, GERD-related complications and extra-oesophageal manifestations of GERD.
Furthermore, recent reports have demonstrated that nocturnal GERD is commonly associated with reports of poor quality of sleep and a variety of sleep disturbances. In fact, patients with nocturnal heartburn report lower health-related quality of life when compared with GERD patients without nighttime GERD.
Thus far, there is no information about the distribution and physiological characteristics of oesophageal acid exposure during sleep among the different GERD groups, particularly between those with and those without oesophageal mucosal involvement. As a result, the aim of our study was to compare distribution of oesophageal acid exposure and reflux characteristics throughout the sleep period among patients with different phenotypic presentations of GERD [non-erosive reflux disease (NERD), erosive oesophagitis (EO) and Barrett's oesophagus (BO)].
Source...