Effect of liquid meals with different volumes on gastroesophageal reflux disease

Background and Aim: Patients with gastroesophageal reflux disease (GERD) are often advised to avoid large meals, based on their complaints of increased symptoms after eating too much, and epidemiological evidence of a link between high volume intake and the presence of GERD. However, the precise effects of meal volume on gastroesophageal reflux have not been well studied. We aimed to clarify the effect of meal volume on acid regurgitation and symptoms in patients with GERD. Methods: Fifteen patients (10 female, 5 male; mean 54±10 years old) with GERD were studied twice each in random order, during 24h ambulatory pH monitoring. On one day, they consumed a 600mL liquid test meal three times (breakfast, lunch, and dinner), and on the other, they consumed a 300mL test meal six times (breakfast, snack, lunch, snack, dinner, and snack). Gastric fundus and antral areas and antral contractions were measured by transabdominal ultrasound. Symptoms were recorded using questionnaires. Results: During the 600mL regimen, there were more reflux episodes (17±4 vs 10±2, P=0.03) and a greater total acid reflux time (12.5±5.9% vs 5.5±3.6%; P=0.045) than the 300mL regimen. Both the cross-sectional area of the gastric fundus (P=0.024) and the number of antral contractions (P=0.014) were greater for the 600mL regimen. Conclusions: Larger meals are associated with distension of the gastric fundus and an increase in gastroesophageal reflux when compared with smaller, more frequent meals.