title: Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
authors.forename: Bashir Ahmad
authors.initials: BA
authors.lastname: Khan
authors.forename: Jaswinder Singh
authors.initials: JS
authors.lastname: Sodhi
authors.forename: Showkat Ali
authors.initials: SA
authors.lastname: Zargar
authors.forename: Gul
authors.initials: G
authors.lastname: Javid
authors.forename: Ghulam Nabi
authors.initials: GN
authors.lastname: Yattoo
authors.forename: Altaf
authors.initials: A
authors.lastname: Shah
authors.forename: Ghulam Mohamad
authors.initials: GM
authors.lastname: Gulzar
authors.forename: Mushtaq Ahmad
authors.initials: MA
authors.lastname: Khan
mesh_terms: D000328:Adult; D001513:Beds; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000517:prevention & control*; D006356:Heartburn / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D010507:Periodicity; D011187:Posture / Q000502:physiology; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000209:etiology / Q000517:prevention & control; D016683:Supine Position / Q000502:physiology