Abstract

BackgroundOveruse 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.MethodsWe 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.ResultsWe 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.ConclusionsMethodological 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 registrationOpen Science Framework: http://osf.io/2hz3j

Highlights

  • 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

  • The aim of this study was to do a systematic review of controlled trials that evaluated the effect of head-of-bed elevation or positioning on relieving GORD symptoms among adults

  • Gastroesophageal reflux symptoms All the four studies that we identified evaluating the impact of head of bed elevation on patient-reported gastroesophageal reflux symptoms found an improvement among participants in the headof-bed elevation intervention arm [25, 26, 28, 29]

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Summary

Introduction

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. Albarqouni et al BMC Family Practice (2021) 22:24 initiatives are underway to reduce the use of PPIs [1, 11]. Against this backdrop of concern about widespread overuse, patient harm and waste, it is timely to investigate the evidence supporting non-drug interventions for the symptoms of GORD [12, 13]

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