The aim of this study was to investigate gastric accommodation to a meal in patients with reflux esophagitis using ultrasonography. Twenty consecutive patients with reflux esophagitis of grade I (14) or II (6) and 20 healthy subjects underwent ultrasonographic measurements of the stomach before and after ingestion of a 500 ml soup meal. Reflux esophagitis patients revealed a significantly larger sagittal area of the proximal stomach at 5 min (P = 0.002) and 15 min (P = 0.007) postprandially and experienced more epigastric fullness after the meal (P = 0.0006). Postprandial fullness and sagittal area of the proximal stomach correlated significantly (r = 0.69; P = 0.0007). We conclude that patients with mild or moderate reflux esophagitis have a larger sagittal area of the proximal stomach and more postprandial fullness in response to a soup meal than healthy subjects. Postprandial distension of the proximal stomach may be a pathogenetic factor in reflux esophagitis.