title: Supraesophageal Reflux: Correlation of Position and Occurrence of Acid Reflux-Effect of Head-of-Bed Elevation on Supine Reflux.
abstract: BACKGROUND
  Supraesophageal reflux of gastric contents can contribute to perennial nasopharyngitis, cough, and asthma. However, effective treatment strategies for supraesophageal reflux disease (SERD) remain inadequately defined.
  
  
  OBJECTIVE
  The purpose of this study is to assess the prevalence and timing of SERD and to investigate the efficacy of head-of-bed elevation in its treatment.
  
  
  METHODS
  A retrospective chart review of patients seen at Scripps Clinic Division of Allergy, Asthma and Immunology was performed who had undergone overnight nasopharyngeal pH monitoring with a commercially available nasopharyngeal pH-monitoring device, Dx-pH Measurement System from Restech, San Diego, Calif. Subjects with reflux were classified based on the position of reflux as either supine only, upright only, or both supine and upright. In a subset of subjects with supine-only reflux, pH monitoring was compared before and after elevating the head of bed 6 inches.
  
  
  RESULTS
  Adequate nasopharyngeal pH-monitoring data were obtained for 235 patients. Reflux was detected in 113 (48%) patients. The pattern of reflux observed was 62 (55%) supine only, 4 (4%) upright only, and 47 (42%) upright and supine. Sequential overnight nasopharyngeal pH monitoring before and after head-of-bed elevation was obtained in 13 individuals with supine-only reflux. Ten subjects demonstrated significant improvement, 8 of whom demonstrated complete resolution of supine reflux with 6 inches of head-of-bed elevation.
  
  
  CONCLUSIONS
  This study provides new evidence that SERD frequently occurs in the supine position and that 6 inches of head-of-bed elevation is effective in reducing supine SERD.
authors.affiliation: Allergy and Asthma Center of Western Colorado, Grand Junction, Colo. Electronic address: deardrscott@gmail.com.
authors.forename: David R
authors.initials: DR
authors.lastname: Scott
authors.affiliation: Scripps Clinic Division of Allergy, Asthma and Immunology, San Diego, Calif.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Simon
mesh_terms: D001513:Beds; D002140:California; D006801:Humans; D006863:Hydrogen-Ion Concentration; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008499:Medical Records; D008991:Monitoring, Physiologic; D009305:Nasopharynx / Q000503:physiopathology*; D056888:Patient Positioning; D011237:Predictive Value of Tests; D015995:Prevalence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016683:Supine Position; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cough; Head-of-bed elevation; Laryngitis; Laryngopharyngeal reflux; Postnasal drip; Rhinitis; Throat clearing