Nocturnal Reflux Episodes Following the Administration of a Standardized Meal. Does Timing Matter?

OBJECTIVES: Prospective evidence supporting lifestyle modifications, including avoidance of late evening meals, for gastroesophageal reflux disease (GERD) sufferers is lacking. The aim of this study was to determine the difference of supine esophageal acid exposure in patients consuming an early or late standard meal relative to bedtime. METHODS: This is a prospective, randomized unblinded crossover trial. Thirty-two patients with typical reflux symptoms were enrolled and randomized to consume a standard meal either at 6 h or 2 h prior to going to bed for 2 consecutive nights. Acid exposure was measured for 48-h using a Bravo wireless pH system. Reflux symptom frequency and severity were recorded. RESULTS: Thirty patients successfully completed the study (63% male, 70% white, mean age 46 [24–74], mean body mass index [BMI] 28 kg/m2 [18–40]). EGD revealed esophagitis in 37% and hiatal hernia (HH) in 47% of patients. Following the late evening meal, there was significantly more supine reflux (P = 0.002) when compared to the early meal. Significantly more supine reflux was also noted following the late evening meal in patients with HH, in overweight individuals (25 ≤ BMI ≤ 29.9), and those reporting heartburn as their chief complaint. Patients with esophagitis had more supine reflux following both the late and early evening meals. There was no significant difference in total symptom score between the 2 days. CONCLUSIONS: GERD patients consuming a late-evening meal had significantly greater supine acid reflux compared to when they consumed an early meal, especially in overweight patients, and in patients with esophagitis or HH. These findings support the recommendations to our GERD patients to eat dinner early and to lose weight.