Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid

Hamilton, John; Boisen, Ronald J.; Yamamoto, Dennis T.; Wagner, Jennifer; Reichelderfer, Mark

doi:10.1007/bf01798350

Cited by 125 publications

(62 citation statements)

References 9 publications

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“…Randomized trials have shown that this practice can decrease esophageal acid exposure and lead to shorter reflux periods and a rapid esophageal clearance [Hamilton et al 1988]. Elevating the head of the bed is important for people with nocturnal or laryngeal symptoms.…”

Section: Sleep Positionmentioning

confidence: 99%

Optimal treatment of laryngopharyngeal reflux disease

Martinucci

Bortoli

Savarino

et al. 2013

Therapeutic Advances in Chronic Disease

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Laryngopharyngeal reflux is defined as the reflux of gastric content into larynx and pharynx. A large number of data suggest the growing prevalence of laryngopharyngeal symptoms in patients with gastroesophageal reflux disease. However, laryngopharyngeal reflux is a multifactorial syndrome and gastroesophageal reflux disease is not the only cause involved in its pathogenesis. Current critical issues in diagnosing laryngopharyngeal reflux are many nonspecific laryngeal symptoms and signs, and poor sensitivity and specificity of all currently available diagnostic tests. Although it is a pragmatic clinical strategy to start with empiric trials of proton pump inhibitors, many patients with suspected laryngopharyngeal reflux have persistent symptoms despite maximal acid suppression therapy. Overall, there are scant conflicting results to assess the effect of reflux treatments (including dietary and lifestyle modification, medical treatment, antireflux surgery) on laryngopharyngeal reflux. The present review is aimed at critically discussing the current treatment options in patients with laryngopharyngeal reflux, and provides a perspective on the development of new therapies.

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Section: Sleep Positionmentioning

confidence: 99%

Optimal treatment of laryngopharyngeal reflux disease

Martinucci

Bortoli

Savarino

et al. 2013

Therapeutic Advances in Chronic Disease

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“…Stanciu and Bennett 80 compared the effect of different body positions (sitting, lying, and elevated HOB) in 63 patients with GERD symptoms using pH monitoring and showed that compared with patients who slept flat, patients who slept with an elevated HOB (using 28-cm blocks) had significantly fewer reflux episodes, shorter reflux episodes, faster acid clearing, and fewer reflux symptoms. Hamilton et al 94 conducted a randomized clinical trial comparing sleeping on a wedge, sleep with HOB elevation, and sleeping in the horizontal position and found that sleeping on a wedge was associated with significantly less esophageal acid exposure compared with sleeping in the horizontal position. Sleeping with HOB elevation also showed improved acid exposure, but this difference was not statistically significant.…”

Section: Recumbent Position and Hob Elevationmentioning

confidence: 99%

Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease?

2006

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ifestyle modifications are first-line therapy for patients with gastroesophageal reflux disease (GERD). We applied an evidence-based approach to determine the efficacy of lifestyle measures for GERD management. We used PubMed and Ovid to perform a search of the literature published between 1975 and 2004 using the key words heartburn, GERD, smoking, alcohol, obesity, weight loss, caffeine or coffee, citrus, chocolate, spicy food, head of bed elevation, and late-evening meal. Each study was reviewed by 2 reviewers who assigned one of the following ratings: evidence A, randomized clinical trials; evidence B, cohort or case-control studies; evidence C, case reports or flawed clinical trials; evidence D, investigator experience; or evidence E, insufficient information. We screened 2039 studies and identified 100 that were relevant. Only 16 clinical trials examined the impact on GERD (by change in symptoms, esophageal pH variables, or lower esophageal sphincter pressure) of the lifestyle measure. Although there was physiologic evidence that exposure to tobacco, alcohol, chocolate, and high-fat meals decreases lower esophageal sphincter pressure, there was no published evidence of the efficacy of dietary measures. Neither tobacco nor alcohol cessation was associated with improvement in esophageal pH profiles or symptoms (evidence B). Head of bed elevation and left lateral decubitus position improved the overall time that the esophageal pH was less than 4.0 (evidence B). Weight loss improved pH profiles and symptoms (evidence B). Weight loss and head of bed elevation are effective lifestyle interventions for GERD. There is no evidence supporting an improvement in GERD measures after cessation of tobacco, alcohol, or other dietary interventions.

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“…The wedge caused a statistically significant decrease in the time that the distal oesophageal pH was <4 as compared to the flat position. Elevation on blocks caused an improvement in parameters, but this was not statistically significant [5] .…”

Section: Introductionmentioning

confidence: 70%

The Medical Management of Gastro-Oesophageal Reflux Disease

Sharma

2016

Inflamm Intest Dis

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tion, Barrett's oesophagus, dysplasia and, ultimately, adenocarcinoma. Survival of oesophageal adenocarcinoma is bleak with an estimated 5-year survival rate of 15%. Hence, appropriate management of GORD is needed in order to hinder progression.This review highlights the current evidence in reference to the medical management of GORD. Lifestyle MeasuresInitial management relies on lifestyle-based improvements including a focus on smoking and alcohol cessation, weight reduction, raising the head of the bed, reduction of eating meals late and reduction of foods that can primarily lead to enhanced reflux occurrence. These include coffee, chocolate, spiced, acidic and heavily fatty foods.Kaltenbach et al.[1] screened 2,039 studies and identified trials that examined GORD in relation to lifestyle measures. Exposure to tobacco, alcohol, chocolate and high-fat meals decreased lower oesophageal sphincter pressure. However, neither tobacco nor alcohol cessation was associated with improvement in oesophageal pH or symptoms. Head of bed elevation and left lateral decubitus position improved the overall time that the oesophageal pH was <4.0. Weight loss improved oesophageal pH and symptoms. Focusing on body mass index (BMI), Jacobson et al. [2] observed a relationship between increasing BMI and Key WordsBarrett's oesophagus · Gastro-oesophageal reflux disease · Lifestyle interventions · Medical therapy · Oesophageal adenocarcinoma Abstract Background: Gastro-oesophageal reflux disease (GORD) is a common global phenomenon. It is associated with the backflow of gastric contents proximally, typically due to transient relaxations of the lower oesophageal sphincter. Various factors contribute to GORD, including obesity, smoking, alcohol and pregnancy. The primary concern of GORD is its association with the development over time of Barrett's oesophagus and, ultimately, oesophageal adenocarcinoma. Summary: This review focuses on the various medical interventions that are useful in the treatment of GORD. Key Messages: Various lifestyle interventions such as weight loss and smoking cessation are useful in the treatment of GORD. Medical therapy relies on the use of acid suppressants such as proton pump inhibitors and histamine H 2 receptor antagonists.

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Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid

Cited by 125 publications

References 9 publications

Optimal treatment of laryngopharyngeal reflux disease

Optimal treatment of laryngopharyngeal reflux disease

Are Lifestyle Measures Effective in Patients With Gastroesophageal Reflux Disease?

The Medical Management of Gastro-Oesophageal Reflux Disease

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