Gastroesophageal Reflux Disease (GERD) and Positional Therapy

Gastroesophageal reflux disease (GERD) is often treated with lifestyle modifications, acid-suppressive medication, and sometimes surgery, depending on the nature and severity of the disease. Nocturnal reflux symptoms, seen in 80% of GERD patients, can severely hamper sleep quality and are often difficult to treat with current treatments, including acid-suppressive medications.

A recent study was conducted by Jeroen M. Schuitenmaker and team, to evaluate the effect of an electronic positional therapy wearable device on nocturnal gastroesophageal reflux measured by pH-impedance reflux monitoring.

Study Overview

The prospective study published in Neurogastroenterology and Motility reveals that sleep positional therapy using an electronic wearable device was effective in promoting sleep. The wearable device alerted participants when in the right lateral decubitus position, and the number of nocturnal reflux episodes and median acid exposure time decreased. The device significantly increased the time spent in the left lateral decubitus position. The symptoms improved in 70% of the participants.

The study was a single-center, prospective, interventional study in 30 patients with nocturnal reflux symptoms and a nocturnal esophageal acid exposure time (AET) ≥1.5% measured off acid-suppressive medication by ambulatory pH-impedance reflux monitoring. Patients were treated with an electronic positional therapy wearable device for 2 weeks. The device vibrated in the right lateral decubitus position so it conditions patients to avoid that sleep position. After 2 weeks of treatment, the pH-impedance study was repeated. Primary outcome was the change in nocturnal AET. Secondary outcomes include change in number of reflux episodes and reflux symptoms.

Key Findings

• Researchers could get complete data for 27 patients (13 females, mean age 49.8 years).
• The median nocturnal AET decreased from 6.0% (IQR, 2.3–15.3) to 3.1% (0.1–10.8) after 2 weeks of treatment (p = 0.079).
• The number of reflux episodes was significantly reduced after 2 weeks of treatment (baseline: 8.0 (3.0–12.3) vs. end: 3.0 (1.0–8.0); p = 0.041).
• Treatment led to a statistically significant decrease in time spent in right lateral decubitus position (baseline: mean 36.9% ± 15.2% vs. end: 2.7% ± 8.2%; p < 0.001) and an increase in the left lateral decubitus position (baseline 29.2% ± 14.8% vs. end: 63.3% ± 21.9%; p < 0.001).
• Symptom improvement was reported by 70.4% of the patients.

Researchers concluded that “Sleep positional therapy using an electronic wearable device promotes sleeping in the left lateral decubitus position and improves reflux parameters measured by pH-impedance reflux monitoring.”

Reference: Jeroen M. Schuitenmaker, Thijs Kuipers, Marlies P. Schijven, André J. P. M. Smout, Paul Fockens, Albert J. Bredenoord; The effect of sleep positional therapy on nocturnal gastroesophageal reflux measured by esophageal pH-impedance monitoring, Neurogastroenterology & Motility; DOI: https://doi.org/10.1111/nmo.14614.