Effect of lateral positioning on gastroesophageal reflux (GER) and underlying mechanisms in GER disease (GERD) patients and healthy controls.
Level 2 - randomized trial
Randomized crossover physiological trial
PubMed 23190417 · doi:10.1111/nmo.12042
What was done
Ten patients with gastroesophageal reflux disease (GERD) and 10 healthy controls participated in a randomized crossover study across two separate test days. Participants received a 30-minute test meal infusion, followed by 30 minutes postprandial monitoring in either the right lateral position (RLP) or left lateral position (LLP) and then 30 minutes in the alternate position, reversed on the subsequent day. Transient lower esophageal sphincter relaxations (TLESRs), reflux episodes, and gastric emptying were measured using manometry, multichannel intraluminal impedance, and carbon-13 octanoate breath tests. Gastric distension was evaluated with serial scintigraphy scans during the first 30 minutes.
What was found
In GERD patients, TLESR frequency was significantly higher in RLP than in LLP during the first postprandial hour [5 (4-14) vs 4.5 (2-6), P = 0.046], with a corresponding increase in reflux episodes. In healthy controls, TLESR frequency did not differ significantly between positions [4 (2-4) in RLP vs 4 (3-6) in LLP, P = 0.7]. In GERD patients, gastric emptying reached peak carbon dioxide excretion faster and proximal gastric distension was more pronounced in RLP. Specific numerical values for reflux episodes, scintigraphy volumes, and breath test kinetics were not reported in the abstract.
Why it matters
This study provides physiological evidence that left lateral positioning reduces postprandial lower esophageal sphincter relaxations and reflux compared to right lateral positioning in GERD patients.
Limits
The sample size was very small (n = 20 total: 10 GERD patients and 10 controls). The observation window was limited to a brief 90-minute postprandial period following a liquid test meal infusion rather than normal solid food intake or overnight sleep. Clinical symptoms and long-term outcomes were not assessed.
Cited by
- supports Sleeping on the right side causes gastric juices to leak and triggers gastroesophageal reflux disease, whereas sleeping on the left side avoids this.