Jeannette Y. Wick, RPh, MBA, FASCP
A recent study indicates that eating meals quickly does not increase reflux episodes in gastroesophageal reflux disease patients.
Health care clinicians often suggest lifestyle modifications like smoking cessation, avoiding meals before bedtime, and choosing foods carefully when patients have gastroesophageal reflux. Small studies and patient surveys have suggested that eating too quickly may trigger more gastroesophageal reflux than eating at a more measured, leisurely pace. Thus, health care providers often suggest that patients pace themselves when they eat. Is the speed at which one eats a factor in gastroesophageal reflux?
In a study
published in a recent issue of the United European Gastroenterology Journal
, a team of researchers set out to evaluate the impact of rapid versus slow food intake on patients’ propensity to have gastroesophageal reflux. They enrolled 46 gastroesophageal reflux disease patients who reported heartburn and/or acid regurgitation at least once a week.
The researchers observed patients as they ate a standard meal in 5 or 30 minutes in a random order on 2 consecutive days at the same time of day. Using intraesophageal impedance pH, they measured acid reflux in each patient for about 28 hours (from 1 hour before the time the patient consumed the first meal until 3 hours after the second).
Among the 46 patients, 10 (21.7%) had a pathological 24-h intraesophageal impedance measurement, 15 (32.6%) had a pathological DeMeester score, and 10 (21.7%) had erosive esophagitis.
After eating fast, the group’s total number of reflux episodes was 754. After eating slowly, they experienced 733 episodes of gastroesophageal reflux. The difference is statistically insignificant.
Speed had no impact in patients with normal, pathological, erosive, or non-erosive 24-h intraesophageal impedance tests.
Half of the reflux events were non-acid during the first hour after eating, and non-acid events fell to 34.2% during the second hour and 26.8% during the third hour. Acid reflux events outnumbered non-acid reflux events, especially during the second and third hours; this finding was significant.
This first study did not support the general belief that reflux increases following fast eating. The fact that refluxes were predominantly acid in nature and lasted 3 hours supports the growing evidence of an “acid pocket
.” The authors suggest that acid pockets or acid that fails to mix homogeneously with a meal may cause postprandial reflux.