Copyright © 2008 by Indian Society of Gastroenterology Original Article T he incidence of gastroesophageal reflux (GER) is increasing in developing countries and is highly prev- alent in developed countries with significant work loss due to associated symptoms and reduced quality of life. More- over, complications associated with GER especially Bar- rett’s epithelium and adenocarcinoma are a matter of concern. With advancement in technology and moderniza- tion, health awareness among populations has increased considerably and more and more people are resorting to exercise programs such as running, bicycling, yogic exercises, weight lifting and gymnastics. Factors associated with GER during transient increase in intra-abdominal pressure are not well understood. It has been thought previously that exercises which involve bending and stooping aggravate symptoms of reflux 1 and this may have serious implications when a patient’s occu- pation involves constant activity of this kind. Patients who have symptoms of GERD are advised to undergo lifestyle modification such as elevation of head end of the bed while sleeping. 2 Most earlier studies on exercise and reflux have been on healthy volunteers and the mode of exercise has been running and bicycling. These exercises, especially running, are known to precipitate reflux. 3-6 There are few studies which have evaluated the effect of bending exercises in patients of GERD. We aimed to objectively evaluate the effect of bending exercise in symptomatic patients of GERD by using continuous am- bulatory 24-hour esophageal pH test. Effect of bending exercise on gastroesophageal reflux in symptomatic patients Jaswinder Singh Sodhi, Showkat Ali Zargar, Gul Javid, Mushtaq A Khan, Bashir A Khan, G N Yattoo, Altaf Shah, G M Gulzar, Abid Shoukat Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India Background: Recumbency and bending are thought to provoke symptoms of reflux in patients with gastroesophageal reflux disease (GERD). The effect of exercise which involved bending and abdominal contractions was evaluated in symptomatic patients of GERD using continuous 24-hour ambulatory esophageal pH test. Methods: Twenty-five patients with GERD, confirmed by abnormal 24-hour esophageal pH study, performed exercise for 30 minutes consisting of 5 sessions of 6 minutes each. The exercise involved toe touching from supine, sitting and standing position of 2 minutes’ duration each. Each 2 minutes’ period included 8 repetitions of the same exercise of 15 seconds’ duration. 24-hour esophageal pHmetry was done on day 1 without exercise and on day 2 with 30-minute exercise. Reflux time percent (RT%) pH <4 was compared between days 1 and 2 and 30 minutes before and during exercise. Results: Fourteen patients were upright refluxers and 11 patients were combined refluxers, which included 4 patients with supine reflux and 7 patients who refluxed both in supine and upright positions. The median (range) 24-hour RT% on day 1 and day 2 was 7 (5-40) and 7 (4-46), respectively (p=0.15). RT% during 30 minutes exercise compared with 30 minutes before exercise was 6.6 (0-60) and 0.0 (0.0-80) (p = 0.02), respectively. In combined and upright refluxers, RT% during and before exercise was 13 (0-53) and 0.0 (0.0-42) (p=0.008), respectively and 0.0 (0-60) and 0.0 (0-80), (p=0.71), respectively. RT% between upright and combined refluxers during exercise was 0.0 (0-60) and 13 (0- 53), respectively (p=0.004). The mean (SD) LES pressure in mmHg in combined and upright refluxers was 7 (2.9) and 19.6 (6.8), respectively (p=0.008). Esophagitis in combined and upright refluxers was seen in 8 patients (72.7%) and 2 patients (14.3%), respectively. Two patients (8%) developed symptoms during exercise. Conclusion: Exercise which involves bending precipitates reflux in patients with moderate-to-severe GERD. Indian J Gastroenterol 2008 Nov-Dec; 27: 227-231.