Introduction
Gastro-oesophageal reflux disease (GERD) is a common condition, for which proton pump inhibitors (PPI) are usually prescribed. PPIs are not without some safety concerns so a non-pharmacological approach that can reduce their use would be beneficial.
Intervention
Elevating the head of the bed using blocks under the legs or wedge pillows. In the research, the elevation was 20 cm.
Indication
To relieve symptoms of GERD
Precautions
Elevating the bed is relatively safe. Adverse events, which were largely minor, included varicose vein pain and slipping down the bed.
Availability
Cheap and relatively easy to implement
Description
A systematic review reported weak evidence that elevating the head of the bed by 20 cm using bed blocks or wedge pillows can improve GERD symptoms. The intervention has been shown to have an effect on reducing acid exposure (defined as percent of total time intra-oesophageal pH remained ≤4). The trials were short (up to 6 weeks at the most) and were unblinded. The review did not report effect of the intervention on GERD medication use.
Elevating the bed appears to reduce GERD symptoms in some people and is safe, so it should be tried.
Tips and Challenges
It is reasonable to elevate the head of the bed to 10 cm initially, and if that fails after a trial of a few weeks, to increase the elevation to 20 cm for a trial of another few weeks.
Grading
Low (We have low confidence in the research evidence, ie, further research is likely to have an important impact, which may change the estimates.) A strong recommendation based on the assumption that implementation is relatively easy.