Effect of Bed Head Elevation During Sleep in Symptomatic Patients of Nocturnal Gastroesophageal Reflux

Bashir Ahmad Khan; Jaswinder Singh Sodhi; Showkat Ali Zargar; Gul Javid; Ghulam Nabi Yattoo; Altaf Shah; Ghulam Mohamad Gulzar; Mushtaq Ahmad Khan


J Gastroenterol Hepatol. 2012;27(6):1078-1082. 

In This Article

Abstract and Introduction


Background and Aim: Nocturnal gastro-esophageal reflux causes heartburn and sleep disturbances impairing quality of life. Lifestyle modifications, like bed head elevation during sleep, are thought to alleviate the symptoms of gastroesophageal reflux. We tested the hypothesis that bed head elevation might decrease recumbent acid exposure compared to sleeping in a flat bed.
Methods: Patients of symptomatic nocturnal reflux and documented recumbent (supine) reflux verified by esophageal pH test entered the trial. On day 1, baseline pH was measured while the patient slept on a flat bed. Then patients slept on a bed with the head end elevated by a 20-cm block for the next 6 consecutive days from day 2 to day 7. The pH test was repeated on day 2 and day 7. Each patient acted as his own control.
Results: Twenty of 24 (83.3%) patients with mean age of 36 ± 5.5 years completed the trial. The mean (± SD) supine reflux time %, acid clearance time, number of refluxes 5 min longer and symptom score on day 1 and day 7 were 15.0 ± 8.4 and 13.7 ± 7.2; P = 0.001, 3.8 ± 2.0 and 3.0 ± 1.6; P = 0.001, 3.3 ± 2.2 and 1.0 ± 1.2; P = 0.001, and 2.3 ± 0.6 and 1.5 ± 0.6; P = 0.04, respectively. The sleep disturbances improved in 13 (65%) patients.
Conclusions: Bed head elevation reduced esophageal acid exposure and acid clearance time in nocturnal (supine) refluxers and led to some relief from heartburn and sleep disturbance.


Nocturnal gastroesophageal reflux may cause severe gastroesophageal reflux disease (GERD) especially atypical/extra esophageal manifestations as well as complications of GERD, such as esophageal stricture, esophagitis, Barrett's epithelium and esophageal adenocarcinoma.[1] Heartburn is the dominant symptom in nocturnal GERD. Various studies have shown poor quality of sleep and variety of sleep disturbances with overall poor quality of life and work loss associated with nocturnal GERD. Acid reflux during upright time tends to be more frequent but of shorter duration, while acid reflux during sleep is generally less frequent but of significantly longer duration.[2–4] Patients who have symptoms of GERD are advised to undergo lifestyle modifications like bed head elevation while sleeping, and sleeping in a left lateral decubitus position, as these postures are thought to decrease esophageal acid exposure, and increase esophageal acid clearance. Effect of bed head elevation in symptomatic nocturnal reflux patients is not adequately studied and the reports are conflicting. Some studies show a beneficial effect in relieving symptoms and esophagitis[5–9] while other studies reveal no beneficial effect.[10] Despite some studies showing a beneficial effect, bed head elevation is not practiced widely among patients of GERD. We aimed to see objectively the effect of bed head elevation on symptoms and reflux in patients of nocturnal GERD by using a continuous ambulatory 24-h esophageal pH test.


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