The impact of the speed of food intake on gastroesophageal reflux events in obese female patients.

Obesity increases the risk of gastroesophageal reflux disease (GERD). The majority of the reflux attacks occur postprandially. The influence of the speed of food intake on gastroesophageal reflux events is unclear in obese patients. To determine the influence of the speed of food intake on intraesophageal reflux events in obese patients with and without GERD. A total of 26 obese female patients were recruited. The patients underwent esophageal manometry to evaluate the upper limit of the lower esophageal sphincter and subsequently placement of a Multichannel intraluminal impedance-pH (MII-pH) catheter. All patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g yogurt and 200 mL water; total energy value, 744 kcal; 37.6% carbohydrates, 21.2% proteins and 41.2% lipids) within 5 or 30 minutes under observation in a random order on two consecutive days. All reflux episodes over a 3-hour postprandial period were manually analyzed and compared. The mean age was 46 ± 12 (18-66) years. The mean body mass index (BMI) was 39.9 ± 8.4 kg/m2. There was no difference between the fast- and slow-eating group in the number of refluxes within the 3-postprandial hours. The patients were divided into 2 groups according to the 24-hour MII-pH monitoring results, that is, 16 subjects with normal MII-pH monitoring and 10 patients with pathologic MII-pH monitoring. There was no effect of the speed of food intake in either the patients with or without GERD. In contrast to the general belief, this study suggested that the speed of food intake does not influence the number of refluxes in obese female patients with or without GERD.

Relationship between history, laryngoscopy and esophagogastroduodenoscopy for diagnosis of laryngopharyngeal reflux in patients with typical GERD.

The techniques used in the diagnosis of gastroesophageal reflux disease (GERD) have insufficient specificity and sensitivity in diagnosing laryngopharyngeal reflux (LPR). The purpose of this study was to evaluate the role of esophagogastroduodenoscopy (EGD) and laryngological examination in the diagnosis of LPR. A total of 684 diagnosed GERD and suspected LPR patients were prospectively scored by the reflux finding score (RFS) which was suggested by Koufman. A total of 484 patients with GERD who had RFS ≥ 7 were accepted as having LPR. 248 patients with GERD plus LPR on whom an endoscopic examination was performed were evaluated. As a control group, results from 82 patients with GERD who had RFS <7 were available for comparison. The GERD symptom score (RSS) was counted according to the existence of symptoms (heartburn/regurgitation) and frequency, duration, and severity. The reflux symptom index (RSI) suggested by Belafsky et al. was also evaluated. The relationship between esophageal endoscopic findings, RSS, RFS and RSI was investigated. Mean age was 46 ± 12 (19-80). The mean values of RSS, RFS, and RSI were 18.9 ± 7.7, 10 ± 2.2, 16.6 ± 11.9, respectively. Erosive esophagitis was detected in 75 cases (30%). Hiatus hernia was observed in 32 patients (13%). There was no correlation between RSS and RFS, RSI. The severity of esophagitis did not correlate with the severity of the laryngeal findings. LPR should be suspected when the history and laryngoscopy findings are suggestive of the diagnosis. EGD has no role in the diagnosis of LPR.

The effect of the speed of eating on acid reflux and symptoms of patients with gastroesophageal reflux disease.

BACKGROUND/AIMS: There is a general belief that gastroesophageal reflux attacks appear more frequently after quick meal, which is without powerful scientific basis, and the general advise to patients is to eat slowly. We aimed to determine whether the speed of eating has an impact on reflux attacks and symptoms in gastroesophageal reflux disease patients. MATERIALS AND METHODS: 24-h intraesophageal pH monitoring was performed to 60 patients with frequent gastroesophageal reflux disease symptoms (39 women) in a tertiary referral center. One hour after placing the pH probe, the patients were asked to have the same meal (744 kcal: 37,6% of carbohydrate, 21,2% of protein, and 41,2% of fat) within 5 or 30 minutes in random order for two consecutive days without extubating. The number of reflux episodes, acid exposure time, and the symptoms of 3-h postprandial period were analyzed. RESULTS: Thirty-eight patients had normal and 22 patients had pathologic pH monitoring for a total of 28 hours of measurement period. The number of reflux episodes increased in the 2 nd hour. The fast eating group had less reflux attacks and lower total reflux time in the 1 st hour and an insignificant increase in the 2 nd and 3 rd hours. The number of symptoms was higher following slow eating (113 vs. 100) without reaching significance. CONCLUSION: Speed of food intake has no significant impact on acidic reflux attacks in patients with gastroesophageal reflux disease. The classical advice "eat slowly" may not have any scientific basis. However, a similar study on patients with gastroesophageal reflux disease should be performed by combined multichannel intraluminal impedance and pH to evaluate the place of nonacid or weak acid reflux.

The influence of the speed of food intake on multichannel impedance in patients with gastro-oesophageal reflux disease.

BACKGROUND: There is a general belief that gastro-oesophageal reflux increases after meals and especially following a rapid intake. OBJECTIVE: To evaluate the impact of rapid vs. slow food intake on gastro-oesophageal reflux disease (GORD) patients. MATERIALS AND METHODS: Forty-six GORD patients with heartburn and / or acid regurgitation once a week or more often common were included in this study. Participants were asked to eat the same standard meal within either 5 or 30 minutes under observation in a random order on 2 consecutive days. A total of 28 hours of recording were obtained by intraoesophageal impedance pH and number of liquid and mixed reflux episodes within 3 hours of the slow- and fast-eating postprandial periods were calculated. RESULTS: While all patients defined GORD symptoms, 10 (21.7%) had pathological 24-h intraoesophageal impedance measurement, 15 (32.6%) had pathological DeMeester and 21.7% had erosive oesophagitis. No difference has been shown according to the eating speed when all reflux episodes were taken together (754 vs. 733). Speed of food intake also did not have an impact on patients with normal vs. pathological 24-h intraoesophageal impedance or erosive vs. non-erosive. During the first postprandial hour, approximately half of the reflux events were non-acid, compared to 34.2% during the second hour and 26.8% during the third hour (p < 0.001). The number of acid reflux episodes was significantly higher than non-acid reflux especially during the second and third hours and in total for 3 hours. CONCLUSIONS: This first study addressing the effect of eating speed on reflux episodes in GORD patients did not support the general belief that reflux increases following fast eating. Acid and non-acid reflux were similar at the first postprandial hour, then acid reflux episodes were predominantly higher, which implicate the importance of acid pockets.

Low prevalence of erosive esophagitis and Barrett esophagus in a tertiary referral center in Turkey.

BACKGROUND/AIMS: The purpose of upper gastrointestinal endoscopy in gastroesophageal reflux disease is to detect the complications; both Barrett esophagus and erosive esophagitis are common in developed countries. We aimed to investigate the ratio of esophageal complications in gastroesophageal reflux disease and the relationship between reflux symptoms and erosive esophagitis. METHODS: Six hundred forty-five consecutive adult patients presenting to the Reflux Outpatient Clinic were evaluated prospectively. One hundred sixty patients who underwent upper gastrointestinal endoscopy and who complained of heartburn or regurgitation occurring at least weekly were selected. The complaints and general features of patients were queried via a detailed questionnaire. RESULTS: Twenty-seven patients (17%) had endoscopic evidence of erosive esophagitis. Barrett esophagus was found in 3 patients (2%). Neither esophageal stricture nor adenocarcinoma was found. Esophagitis was low grade (grades A and B) in 25 of the 27 (92%) with erosive esophagitis. Patients with erosive esophagitis consumed less alcohol than patients with non-erosive reflux disease. No difference was found between the severity of symptoms in patients with erosive esophagitis and non-erosive reflux disease. CONCLUSIONS: Barrett esophagus and erosive esophagitis were less common compared to the literature although the study was conducted in a tertiary reference center for gastroesophageal reflux disease. The presence of severe symptoms in gastroesophageal reflux disease is not an indication for upper gastrointestinal endoscopy. No impact of Helicobacter pylori on the severity of esophagitis or symptoms was shown.