Left is right: The effect of sleep position on nocturnal gastroesophageal reflux

Gastroesophageal reflux, the movement of gastric content into the esophagus, is a physiological phenomenon that occurs multiple times a day. When it leads to esophageal mucosal damage and/or symptoms such as heartburn and regurgitation, it is referred to as gastroesophageal reflux disease (GERD). This thesis covers studies on GERD, mainly focusing on nocturnal gastroesophageal reflux. We evaluated current available treatment options, investigated the effect of sleep position on nocturnal reflux and explored sleep positional therapy as novel treatment strategy for nocturnal gastroesophageal reflux.
We observed that the left lateral decubitus position was associated with significantly shorter nocturnal esophageal acid exposure time and faster esophageal acid clearance compared with the supine and right lateral decubitus positions. These findings provide a rationale for interventions aiming to promote the left lateral decubitus sleep position for the treatment of nocturnal gastroesophageal reflux. Indeed, in patients with nocturnal gastroesophageal reflux symptoms, treatment with an electronic sleep positional wearable device promotes sleeping in the left lateral decubitus position, effectively alleviates nocturnal reflux symptoms and improves objective reflux parameters. Therefore, sleep positional therapy is a valuable addition to current GERD treatment strategies. GERD is a multifactorial disease and should be treated as such.