NEW YORK, June 10 (Reuters) -- Eating just before sleep may encourage the development of gastroesophageal reflux disease (GERD), according to a report in the Medical Tribune. If true, this could explain why some people wake up with a cough, sore throat, or hoarseness.
GERD occurs when the sphincter at the top of the stomach becomes weakened, allowing highly acidic stomach matter to leak back into the esophagus, the hollow tube that connects the mouth to the stomach. While sitting or standing, gravity helps to keep partially digested material in the lower portions of the stomach; but on reclining, the stomach contents can wash back up the esophagus if the cardiac sphincter (the muscular guard where the esophagus meets the stomach) is weak. This is also why the "heartburn" associated with GERD is usually most acute during (or after) bending or lying down.
But now Dr. Stephen Sontag, a staff physician at Chicago's Hines Veterans Affairs Hospital, believes lying down after a meal may actually help promote the development of GERD in people with no symptoms of the disorder.
He monitored 24 individuals with no previous history of the condition. According to the report, "the patients all had 'normal' readings when given a 24-hour test for acid levels in the esophagus, but significantly higher levels of acidity when they laid down after eating breakfast."
The particular sleeping position seemed to have little effect on the amount of acid reflux. "These normal people had a huge amount of reflux in every position and no position was significantly better than any other position," Sontag reported. A slight ease of symptoms occurred when individuals lay on their backs or sat up in bed.
For many people, the results of nighttime reflux may be temporary and relatively harmless: some coughing, sore throat, or hoarseness upon waking. "Reflux is a problem only when it causes symptoms or complications," Sontag explained.
However, he believes nighttime reflux triggered by pre-slumber eating may sometimes progress to full-blown GERD. More research is needed to prove or disprove this theory, he said.
Sontag does caution that asthmatics should be especially wary about eating before bedtime. He believes that "for asthmatics, it may be a disaster." Nighttime reflux may exacerbate asthma symptoms, and vice-versa. When acidic material is refluxed into the back of the throat, it can be inhaled into the lungs. In asthmatics, this can trigger respiratory distress.
Sontag examined over 260 asthmatics and found that four out of five yielded abnormal esophageal acid levels upon testing, while 40% had identifiable chronic inflammation of the esophagus. "As many as one-third reported burning in the back of the throat or regurgitation of food during sleep," according to the Medical Tribune report.
Sontag reported his findings at last month's Digestive Disease Week conference in Washington, D.C., which was sponsored by the American Gastroenterological Association.
SOURCE: Medical Tribune (June 5, 1997, p.6)
