P0315 - Comparison of Acidic versus Weakly Acidic Reflux Distribution During Sleep Time in Patients with Refractory GERD

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

FS

Fahmi Shibli, MD

Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University
Nof HaGalil, HaZafon, Israel

Fahmi Shibli, MD¹, Ali El Mokahal, MD², Serge Baroud, MD², Gengqing Song, MD², Ronnie Fass, MD¹
¹Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; ²MetroHealth Medical Center, Cleveland, OH

Introduction: Nocturnal gastro-esophageal reflux (GERD) has been shown to be associated with severe GERD, GERD related complications and manifestations. Presently, there are no studies that have assessed the distribution of weakly acidic reflux during the sleep period. We aimed to determine the distribution of weakly acidic reflux during sleep time in GERD patients who failed once (OD) or twice (BID) daily PPI treatment.

Methods: A total of 242 GERD patients underwent ambulatory 24-hour esophageal pH-impedance monitoring were included in this study. Patients were divided into 2 groups based on PPI regimen, those who failed PPI OD or those who failed PPI BID. We divided the sleep time into 4 equal quartiles. We assessed the total number of reflux episodes per quartile, the number of acid and weakly acid reflux episodes per each quartile and compared those numbers among the different quartiles. Continuous variables were described through mean and standard deviations and were compared using Analysis of variance testing (ANOVA).

Results: Of the study sample, 79 (32.6%) patients were on once daily PPI dosing and 163 (67.4%) patients were on twice daily PPI dosing. The mean age of the study sample was 53 years. The two cohorts did not differ by gender, ethnicity, comorbidities, smoking, alcohol intake or surgical history. Both acidic and weakly acidic reflux events were highest in the first quartile of the sleep period, and subsequently decreased towards the fourth quartile (Figure 1). There was no statistically significant difference in mean weakly acidic reflux events between patients on once daily PPI dosing vs twice daily PPI dosing overall and in any quartile of sleep time. (Table 1) In addition, the distribution of weakly acidic reflux during sleep time was similar between the two PPI cohorts.

Discussion: The distribution of weakly acidic reflux during sleep time is similar to the distribution of acidic reflux. Weakly acidic reflux tends to be the highest during early hours of sleep and tends to decrease towards late stages of sleep

Figure: Figure 1: Variation of events per quartile of sleep (Mean ± SE)

Measure (N = 242)	Pts. on once PPI (Mean ± SD)	Pts. on twice PPI (Mean ± SD)	Total patients (Mean ± SD)	P value
Mean supine duration (minutes)	542 ± 119	519 ± 165	526 ± 152	0.268
Mean total number of weakly acidic reflux events while supine	8 ± 10	8 ± 11	8 ± 10	0.920
Mean weakly acidic reflux events during 1^st Quartile	4 ± 7	3 ± 5	3 ± 6	0.411
Mean weakly acidic reflux events during 2^nd Quartile	1.5 ± 2	1.6 ± 4	2 ± 3	0.807
Mean weakly acidic reflux events during 3^rd Quartile	1.2 ± 2	1.4 ± 3	1 ± 3	0.541
Mean weakly acidic reflux events during 4^th Quartile	1.4 ± 1.8	1.6 ± 2.5	2 ± 2	0.652

Table: Table 1 Distribution of weakly acidic reflux during sleep period

Disclosures:

Fahmi Shibli indicated no relevant financial relationships.

Ali El Mokahal indicated no relevant financial relationships.

Serge Baroud indicated no relevant financial relationships.

Gengqing Song indicated no relevant financial relationships.

Ronnie Fass indicated no relevant financial relationships.

Fahmi Shibli, MD¹, Ali El Mokahal, MD², Serge Baroud, MD², Gengqing Song, MD², Ronnie Fass, MD¹. P0315 - Comparison of Acidic versus Weakly Acidic Reflux Distribution During Sleep Time in Patients with Refractory GERD, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.