A Systematic Review of the Literature Related to Elevating the Head of the Bed for Patients With Gastroesophageal Reflux Disease: Applications in Patients After Esophageal Cancer Surgery

Abstract

Acid regurgitation typically worsens during nighttime sleep, which influences the quality of life of patients and potentially causes pathological changes. As much as 80% of esophageal cancer patients experience acid regurgitation following esophagectomy and reconstruction surgery. Thus, improving this symptom is important to improving the quality of life of these patients. The purpose of the present study was to evaluate the effect of elevating the head of the bed for patients with gastroesophageal reflux disease (GERD). A systematic review was used. Electronic databases including CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, ProQuest, and PubMed/MEDLINE were retrieved for relevant articles that were published prior to June 2015. Keywords included "elevating the head of the bed/bed position/body position", "flat", "reflux", and the MeSh term "gastroesophageal reflux". A total of 37 articles that matched the search criteria were extracted. After screening the topics and deleting repetitions, three randomized controlled studies and one quasi-experimental designed study were selected. Results of this systemic review revealed that elevating the head of the bed for patients with GERD reduced the duration of exposure of the the esophagus to an acid environment. Furthermore, patients perceived that this intervention not only improved symptoms such as regurgitation and burn sensation without medication but also relieved symptoms better than taking medications alone. The reviewed studies support that elevating the head of the bed is an easy and effective way to alleviate the symptoms of acid regurgitation. A height of elevation of 20 to 28 cm is recommended in the literature. The slope of the elevated bed must also be considered. Elevating the head of the bed may be useful for improving acid regurgitation among esophageal cancer patients after surgery. A randomized controlled study may be used to validate this effect in the future.