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

Disclosures

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

In This Article

Results

Seventy-one patients of symptomatic nocturnal reflux were subjected to esophageal pH test. Thirty-four patients had upright reflux, 24 patients had supine reflux while 13 patients had combined reflux. Twenty-four patients of supine reflux entered into the trial. Four patients were excluded because they did not follow protocol of bed head elevation for 5 consecutive days at home (three patients) and continued to take proton pump inhibitor during the study period (one patient). Finally 20 patients completed the trial. The mean (SD) age of the study group was 36.2 (5.5) years and included 18 men. Fourteen of 20 patients (70%) had moderate reflux symptoms, five (25%) had moderate-to-severe reflux symptoms and one patient had severe reflux symptoms. Sixteen of 20 (80%) patients had normal endoscopy while 4/20 (20%) had esophagitis. Three patients had grade B esophagitis and one had grade A esophagitis.

Effect of Bed Head Elevation on Nocturnal GERD

The mean (SD) supine RT% on day 1 and day 7 was 15.0 (8.4) and 13.7 (7.2), respectively (P = 0.001). Mean (SD) ACT during the supine period between day 1 and day 7 was 3.8 (2.0) and 3.0 (1.6) min, respectively (P = 0.001) and number of refluxes 5 min longer on day 1 and day 7 was 3.3 (2.2) and 1.0 (1.2), respectively (P = 0.001) (Table 1). Effect of bed head elevation on RT% and acid clearance time in the 20 individual patients is shown in Figures 1 and 2.

Figure 1.

Bar chart showing effect of bed head elevation on supine RT% (no. of patients = 20). , Day 1 (sleep without bed head elevated); , Day 7 (sleep with bed head elevation).

Figure 2.

Bar chart showing effect of bed head elevation on acid clearance time (no. of patients = 20). , Day 1 (sleep without bed head elevated); , Day 7 (sleep with bed head elevation).

Effect of Bed Head Elevation on Symptoms of GERD

On day 7 of bed head elevation, only one patient reported complete resolution of the symptoms, 10 (50%) patients had mild reflux symptoms and the other nine (45%) patients had moderate reflux symptoms as shown in Table 2.

Effect on Sleep

Thirteen of 20 (65%) patients reported improvement in sleep disturbance. Three of 20 (15%) patients had insomnia, which they attributed to hospital environment on day 1 and day 2.

Comments

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