The effect of posture on esophageal pH in endoscopy normal reflux disease (ENRD) cases

Endoscopy Normal Reflux Disease (ENRD) is a common presentation of reflux disease. These patients are symptomatic but do not have abnormal endoscopy findings. They may have pathological intraesophageal reflux. Lifestyle modifications are the mainstay of management of these patients. Posture plays an important role in their management. It was felt that exact quantification of reflux pattern with different postures in ENRD cases should be studied to include it as a part of management of these cases.

Fifteen male patients were studied. 24 h ambulatory pH metry was done for all patients. Half an hour recording was studied for various postures: supine, supine with 30 degrees head end elevated, upright, right and left lateral recumbent position. The data of pH metry for half an hour of each of these postures was studied.

All fifteen patients were ENRD cases and were upright refluxers. None of them had an abnormal supine reflux pattern. The percentage time of reflux and the reflux episode duration was significantly low in supine (P<0.05) and supine with 30 degrees head end elevated (P<0.005).

In our study of 15 upright refluxers, supine with 30 degrees head end elevated and supine position were the postures associated with least reflux. Posture can help reduce the reflux significantly and can be used as an effective means in management.