Riser's Reflux: An Eye-Opening Experience

Abstract

Background: Patients with GERD commonly report waking up in the morning with a sour or bitter taste in their mouth. Presently, it is assumed that these complaints are related to acid reflux that has occurred during sleep. Aim: To compare the prevalence and frequency of acid reflux events prior to and immediately after awakening from sleep using a novel technique that objectively determines sleep period during pH testing without confining patients to a sleep lab. Method: 17 patients (M/F - 8/9, mean age 57.06 ± 16.93yrs, age range 27-81) with heartburn at least 3 times weekly and abnormal pH test were included in this study. All patients were evaluated by demographic and symptom checklist questionnaires. Patients were not receiving antireflux treatment. Patients underwent pH testing concomitantly with actigraphy. The actigraph is a watch-like device worn on the nondominant wrist that records motions with accelerometers that are stored digitally within the device. Actigraphy is a validated technique that determines sleep and awake periods. Novel software (FRIM©) that simultaneously integrates actigraphy and pH raw data matched by time was utilized to determine patients' sleep and awake periods and arousal time. The computer pH data output integrates the old supine and upright analysis and the new sleep and awake analysis for all pH parameters. The presence, frequency, and characteristics of acid reflux events were calculated prior to (up to 1 hour) and immediately after (10 and 20 minutes). None of the subjects had any food consumption during this time period. Results: 47.1% (8/17) of the patients had an acid reflux event within the first 20 minutes of awakening from sleep in the morning. Around awakening (5 minutes prior) and within the first 10 as well as 20 minutes after awakening, patients had a total of 12 and 29 acid reflux events, respectively. The mean number of acid reflux events per patient was 1.2 and 2.9, respectively. The mean duration of these reflux events was 0.8 and 0.79 minutes, respectively. The mean time to first reflux after awakening was 6.55 minutes, with a range of 0.48 minutes to 14.92 minutes. Only 2 (11.8%) of all patients had acid reflux within an hour prior to awakening with a mean duration of 2.37 minutes per event (both P<0.05). Conclusion: Riser's reflux is very common among GERD patients and may explain their complaints of sour or bitter taste in the mouth when rising up in the morning.