Impact of head of bed elevation in symptoms of patients with gastroesophageal reflux disease: A randomized single-blind study (IBELGA)

Morales, Iván Mauricio Villamil; Ospina, Daniel Mauricio Gallego; Regino, William Otero

doi:10.1016/j.gastre.2020.01.007

Cited by 4 publications

(7 citation statements)

References 40 publications

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“…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 19 . In this cross‐over trial, patients were randomized to six weeks of lying flat followed by six weeks with a 20‐cm elevated head end of the bed (with a washout period of two weeks).…”

Section: Resultsmentioning

confidence: 99%

“…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 …”

Section: Resultsmentioning

confidence: 99%

“…We identified one high‐quality clinical trial with 39 patients with nocturnal symptoms at least three nights a week and confirmed esophageal erosions. 19 In this cross‐over trial, patients were randomized to six weeks of lying flat followed by six weeks with a 20‐cm elevated head end of the bed (with a washout period of two weeks). Treatment success, defined as change of ≥0.6 points in Reflux Disease Questionnaire score, was observed in 69.2% in the intervention group versus 33.3% in the control group (RR: 2.08; 95% CI: 1.19–3.61).…”

Section: Resultsmentioning

confidence: 99%

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

Schuitenmaker

Kuipers

Smout

et al. 2022

Neurogastroenterology Motil

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Background: Nocturnal gastroesophageal reflux symptoms have a major impact on sleep quality and are associated with complicated gastroesophageal reflux disease (GERD). We performed a systematic review to assess the data on the effectiveness of the currently available interventions for the treatment of nocturnal reflux symptoms. Methods:We searched PubMed, EMBASE, and the Cochrane Library. All prospective, controlled, and uncontrolled clinical trials in adult patients describing interventions (lifestyle modifications, surgical and pharmacological) for nocturnal gastroesophageal reflux symptoms were assessed for eligibility. A narrative descriptive summary of findings is presented together with summary tables for study characteristics and quality assessment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Schuitenmaker

Kuipers

Smout

et al. 2022

Neurogastroenterology Motil

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“…A study revealed that bed‐head elevation by 20 cm blocks reduced esophageal acid exposure and acid clearance time from baseline and led to some relief from heartburn and sleep disturbances 70 . In a recent study, head elevation significantly reduced reflux symptoms and night‐time symptoms of patients treated on an outpatient basis with PPI compared with those sleeping without the elevation 71 Statement 15: Alginates should be considered for empirical treatment of patients with mild‐to‐moderate symptoms of acid reflux disease Grade of recommendation: Strong Evidence level: High Consensus level: 100% (Strongly agree—80%; Agree with minor reservation—20%) …”

Section: Resultsmentioning

confidence: 99%

“…In the management of patients with GERD, it is important to recommend lifestyle measures as the first step. Although, evidence may not be convincing for some lifestyle measures, it is reasonable to advice patients on weight loss and timing and volume of meals and head of the bed elevation 58,60,61,71 . These are simple measures that can be easily adopted by patients.…”

Section: Discussionmentioning

confidence: 99%

Consensus statements and recommendations on the management of mild‐to‐moderate gastroesophageal reflux disease in the Southeast Asian region

et al. 2021

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This paper reports the proceedings from the first consensus meeting on the management of mild‐to‐moderate gastroesophageal reflux disease (GERD) in the Southeast Asian (SEA) region. Seventeen statements were drawn up by a steering committee that focused on epidemiology, mechanism of action, diagnostic investigations, and treatment. Voting on the recommendations used the Delphi method with two rounds of voting among the 10 panel members. The consensus panel agreed that GERD is mostly a mild disease in the SEA region with predominantly non‐erosive reflux disease (NERD). Complicated GERD and Barrett's esophagus are infrequently seen. The panel recommended endoscopy in patients with alarm or refractory symptoms but cautioned that the incidence of gastric cancer is higher in SEA. pH and impedance measurements were not recommended for routine assessment. The acid pocket is recognized as an important pathogenic factor in GERD. Lifestyle measures such as weight reduction, avoidance of smoking, reduction of alcohol intake, and elevation of the head of the bed were recommended but strict avoidance of specific foods or drinks was not. Alginates was recommended as the first‐line treatment for patients with mild‐to‐moderate GERD while recognizing that proton‐pump inhibitors (PPIs) remained the mainstay of treatment of GERD. The use of alginates was also recommended as adjunctive therapy when GERD symptoms were only partially responsive to PPIs.

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Assessment of Gastroesophageal Reflux Symptoms and Sleep Quality Among Women in the Nurses’ Health Study II

Mehta

Cao

et al. 2023

JAMA Netw Open

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ImportanceLimited data exist on the association of gastroesophageal reflux (GER) symptoms with sleep quality.ObjectiveTo prospectively investigate the association between GER symptoms and sleep quality.Design, Setting, and ParticipantsThis prospective cohort study included data from the Nurses’ Health Study II of female nurses in the US. Participants self-reported the frequency and duration of GER symptoms beginning June 2005, with updates every 4 years through June 2015. Follow-up was completed June 2019, and data were analyzed from November 15, 2022, to June 4, 2023.ExposuresFrequency and duration of GER symptoms.Main Outcomes and MeasuresPoor sleep quality was assessed in 2017 through a modified Pittsburgh Sleep Quality Index, which included difficulty in falling asleep, restlessness of sleep, daytime sleepiness, sleep disturbance, and sleep duration. Relative risk (RR) for poor sleep quality and individual components of poor sleep quality was estimated according to the frequency and duration of GER symptoms.ResultsAmong 48 536 women (median age, 59 years [range, 48-69 years]), 7929 (16.3%) developed poor sleep quality during 4 years of follow-up. Compared with those with GER symptoms less than once a month, the multivariable RR for poor sleep quality among women with GER symptoms more than once a week was 1.53 (95% CI, 1.45-1.62). Women who had GER symptoms once or more a week for more than 7 years had an RR of 1.36 (95% CI, 1.30-1.43) compared with women who had not had GER symptoms once or more a week. The frequency and duration of GER symptoms were significantly associated with each individual component of poor sleep quality; for example, the multivariable RRs for GER symptoms 2 or more times per week compared with no GER symptoms were 1.49 (95% CI, 1.39-1.58) for difficulty in falling asleep, 1.47 (95% CI, 1.39-1.56) for excessive daytime sleepiness, and 1.44 (95% CI, 1.36-1.53) for restlessness of sleep.Conclusions and RelevanceIn this prospective cohort study of female nurses in the Nurses’ Health Study II, the frequency and duration of GER symptoms were associated with subsequent risk of poor sleep quality. The findings suggest that effective treatment of GER disease may be important not only for improvement of symptoms but also for the reduction of comorbidities associated with poor sleep quality.

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Impact of head of bed elevation in symptoms of patients with gastroesophageal reflux disease: A randomized single-blind study (IBELGA)

Cited by 4 publications

References 40 publications

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

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

Consensus statements and recommendations on the management of mild‐to‐moderate gastroesophageal reflux disease in the Southeast Asian region

Assessment of Gastroesophageal Reflux Symptoms and Sleep Quality Among Women in the Nurses’ Health Study II

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