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. 2021 Jan 19;22(1):24.
doi: 10.1186/s12875-021-01369-0.

Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review

Loai Albarqouni  1 , Ray Moynihan  2 , Justin Clark  2 , Anna Mae Scott  2 , Anne Duggan  3 , Chris Del Mar  2
Affiliations

Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review

Loai Albarqouni et al. BMC Fam Pract. .

Abstract

Background: Overuse of proton pump inhibitors (PPIs) - frequently used for relieving symptoms of gastroesophageal reflux disease (GORD) - raises long-term safety concerns, warranting evidence-based non-drug interventions. We conducted a systematic review to evaluate the effect of head-of-bed elevation on relieving symptoms of GORD in adults.

Methods: We included controlled trials comparing the effect of head-of-bed elevation interventions to control in adults with GORD. Two independent reviewers screened articles, extracted data, and assessed quality of included studies. Primary outcomes were changes in GORD symptoms and use of PPIs.

Results: We screened 1206 records; and included five trials (four cross-over and one factorial) comprising 228 patients. All five included trials were judged to be at high-risk of performance bias and four of selection bias. Of five included trials, two used 'bed blocks' under the bed legs; one used 'sleeping on a wedge' pillow, and two used both. High heterogeneity in outcome measures and reported outcomes data precluded meta-analyses. The four studies that reported on GORD symptoms found an improvement among participants in the head-of-bed elevation; a high-quality crossover trial showed a clinical important reduction in symptom scores at 6 weeks (risk ratio of 2.1; 95% CI 1.2 to 3.6). These results are supported by the observed improvement in physiological intra-oesophageal pH measurements.

Conclusions: Methodological and reporting limitations in available literature preclude definitive recommendations. However, head-of-bed elevation could be still considered as a cheap and safe alternative to drug interventions with unfavourable safety profiles.

Protocol registration: Open Science Framework: http://osf.io/2hz3j.

Keywords: GORD; General practice; Non-pharmacological interventions; Proton pump inhibitors.

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Conflict of interest statement

No support from any organisation for the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of included articles
Fig. 2
Fig. 2
Risk of bias assessment in included studies both in individual studies and domains (left) and in summary (right)
See this image and copyright information in PMC

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