Effect of Head-of-Bed Elevation on Nocturnal Reflux Symptoms of Esophageal Cancer Patients With Esophagectomy and Reconstruction

Abstract

Background Studies revealed the symptom of gastroesophageal reflux (GE reflux) disturb patients following esophageal reconstruction. Objective To examine the effect of head-of-bed elevation by using the wedge-shaped pillow (WSP) on the reflux symptoms of patients with esophageal cancer following esophagectomy and reconstruction. Methods Fourteen patients with nocturnal reflux symptoms following esophagectomy and gastric tube reconstruction were enrolled and randomized into 2 groups. A 2-week crossover trial was performed using 2 sequences (drug only and drug plus WSP). The WSP was designed with a height of 20 cm, a length of 62 cm, and an elevation angle of 20 degrees and used with fabricated from memory foam. After 2 weeks, all of the patients received combined drug and WSP intervention for 3 months. Reflux symptoms were measured by Dysfunction After Upper Gastrointestinal Surgery for Cancer and examined by endoscopic observations prior to intervention and follow-up for 3 months. Result The average reflux symptom score for the combined drug and WSP treatment in the beginning 2 weeks was lower than that for the drug-only sequence. The severity of esophagitis was improved in 46.1%, and 38.5% showed a stabilization after 3 months. Conclusions Combined drug and WSP treatment may be beneficial in improving GE reflux symptoms. Implications for Practice Nursing care professionals would suggest patients find a similar WSP to elevate the head of the bed to reduce the severity of nocturnal reflux symptoms after esophagectomy and gastric tube reconstruction.

Systematic review: Clinical effectiveness of interventions for the treatment of nocturnal gastroesophageal reflux

“…In severe reflux esophagitis, treatment with 20‐cm bed blocks for six weeks reduced reflux symptoms, but the endoscopic appearance did not improve significantly 22 . Head of bed elevation also led to a significant reduction of reflux symptoms in patients that underwent esophagectomy with gastric tube reconstruction 20 . Unfortunately, these studies are hampered by severe methodological limitations with high risk of bias (Table 1).…”

“…We identified five randomized clinical trials and one non‐randomized clinical trial that investigated the effect of head of bed elevation on nocturnal reflux (Table 1 ). 19 , 20 , 21 , 22 , 23 …”

“… 22 Head of bed elevation also led to a significant reduction of reflux symptoms in patients that underwent esophagectomy with gastric tube reconstruction. 20 Unfortunately, these studies are hampered by severe methodological limitations with high risk of bias (Table 1 ). We identified one high‐quality clinical trial with 39 patients with nocturnal symptoms at least three nights a week and confirmed esophageal erosions.…”

“…We identified five randomized clinical trials and one non-randomized clinical trial that investigated the effect of head of bed elevation on nocturnal reflux (Table 1). [19][20][21][22][23] Two studies used esophageal pH parameters as outcome measure. In a cross-over study with 15 endoscopically proven reflux esophagitis patients, patients slept three consecutive nights, in random order, in a hospital bed with a wedge (22° angle), bed blocks (20 cm), or without elevation (one pillow).…”

“…22 Head of bed elevation also led to a significant reduction of reflux symptoms in patients that underwent esophagectomy with gastric tube reconstruction. 20 Unfortunately, these studies are hampered by severe methodological limitations with high risk of bias (Table 1).…”