{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T18:04:33Z","timestamp":1793642673232,"version":"4.5.1"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Fam Pract"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Overuse of proton pump inhibitors (PPIs) \u2013 frequently used for relieving symptoms of gastroesophageal reflux disease (GORD) \u2013 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We 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 \u2018bed blocks\u2019 under the bed legs; one used \u2018sleeping on a wedge\u2019 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Methodological 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Protocol registration<\/jats:title><jats:p>Open Science Framework:<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/osf.io\/2hz3j\">http:\/\/osf.io\/2hz3j<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1186\/s12875-021-01369-0","type":"journal-article","created":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T19:03:01Z","timestamp":1611082981000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4114-9106","authenticated-orcid":false,"given":"Loai","family":"Albarqouni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray","family":"Moynihan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Mae","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Duggan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Del Mar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,19]]},"reference":[{"issue":"1","key":"1369_CR1","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s12875-020-01158-1","volume":"21","author":"J Wu","year":"2020","unstructured":"Wu J, Dickinson S, Elgebaly Z, Blogg S, Heaney A, Soo Y, et al. Impact of NPS MedicineWise general practitioner education programs and choosing wisely Australia recommendations on prescribing of proton pump inhibitors in Australia. BMC Fam Pract. 2020;21(1):85.","journal-title":"BMC Fam Pract"},{"issue":"3","key":"1369_CR2","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1038\/ajg.2012.444","volume":"108","author":"PO Katz","year":"2013","unstructured":"Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308\u201328 quiz 29.","journal-title":"Am J Gastroenterol"},{"key":"1369_CR3","doi-asserted-by":"crossref","unstructured":"The Third Atlas of Healthcare Variation 2018 - 2.3 Proton pump inhibitor medicines dispensing 18-years and over. Australian Commission on Safety and Quality in Health Care and Australian Institute of Health and Welfare (ACSQHC). Sydney; 2018.","DOI":"10.21820\/23987073.2018.2.80"},{"issue":"7634","key":"1369_CR4","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1136\/bmj.39406.449456.BE","volume":"336","author":"I Forgacs","year":"2008","unstructured":"Forgacs I, Loganayagam A. Overprescribing proton pump inhibitors. BMJ. 2008;336(7634):2\u20133.","journal-title":"BMJ."},{"issue":"975","key":"1369_CR5","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1136\/pgmj.2006.051151","volume":"83","author":"BT Batuwitage","year":"2007","unstructured":"Batuwitage BT, Kingham JG, Morgan NE, Bartlett RL. Inappropriate prescribing of proton pump inhibitors in primary care. Postgrad Med J. 2007;83(975):66\u20138.","journal-title":"Postgrad Med J"},{"issue":"9","key":"1369_CR6","first-page":"e228","volume":"16","author":"JJ Heidelbaugh","year":"2010","unstructured":"Heidelbaugh JJ, Goldberg KL, Inadomi JM. Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Am J Manag Care. 2010;16(9):e228\u201334.","journal-title":"Am J Manag Care"},{"issue":"1","key":"1369_CR7","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s00198-018-4788-y","volume":"30","author":"TN Poly","year":"2019","unstructured":"Poly TN, Islam MM, Yang HC, Wu CC, Li YJ. Proton pump inhibitors and risk of hip fracture: a meta-analysis of observational studies. Osteoporos Int. 2019;30(1):103\u201314.","journal-title":"Osteoporos Int"},{"issue":"7","key":"1369_CR8","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1038\/ajg.2011.113","volume":"106","author":"S Ngamruengphong","year":"2011","unstructured":"Ngamruengphong S, Leontiadis GI, Radhi S, Dentino A, Nugent K. Proton pump inhibitors and risk of fracture: a systematic review and meta-analysis of observational studies. Am J Gastroenterol. 2011;106(7):1209\u201318 quiz 19.","journal-title":"Am J Gastroenterol"},{"issue":"3","key":"1369_CR9","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1503\/cmaj.092129","volume":"183","author":"CS Eom","year":"2011","unstructured":"Eom CS, Jeon CY, Lim JW, Cho EG, Park SM, Lee KS. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ. 2011;183(3):310\u20139.","journal-title":"CMAJ."},{"issue":"35","key":"1369_CR10","doi-asserted-by":"publisher","first-page":"6500","DOI":"10.3748\/wjg.v23.i35.6500","volume":"23","author":"A Trifan","year":"2017","unstructured":"Trifan A, Stanciu C, Girleanu I, Stoica OC, Singeap AM, Maxim R, et al. Proton pump inhibitors therapy and risk of Clostridium difficile infection: systematic review and meta-analysis. World J Gastroenterol. 2017;23(35):6500\u201315.","journal-title":"World J Gastroenterol"},{"issue":"5","key":"1369_CR11","first-page":"354","volume":"63","author":"B Farrell","year":"2017","unstructured":"Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, et al. Deprescribing proton pump inhibitors: evidence-based clinical practice guideline. Can Fam Physician. 2017;63(5):354\u201364.","journal-title":"Can Fam Physician"},{"issue":"9","key":"1369_CR12","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1001\/archinte.166.9.965","volume":"166","author":"T Kaltenbach","year":"2006","unstructured":"Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166(9):965\u201371.","journal-title":"Arch Intern Med"},{"issue":"1","key":"1369_CR13","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1186\/s12916-016-0718-z","volume":"14","author":"C Scarpignato","year":"2016","unstructured":"Scarpignato C, Gatta L, Zullo A, Blandizzi C, Group S-A-F, Italian Society of Pharmacology tIAoHG, et al. Effective and safe proton pump inhibitor therapy in acid-related diseases - A position paper addressing benefits and potential harms of acid suppression. BMC Med. 2016;14(1):179.","journal-title":"BMC Med"},{"key":"1369_CR14","doi-asserted-by":"publisher","first-page":"l6483","DOI":"10.1136\/bmj.l6483","volume":"367","author":"LH Eusebi","year":"2019","unstructured":"Eusebi LH, Black CJ, Howden CW, Ford AC. Effectiveness of management strategies for uninvestigated dyspepsia: systematic review and network meta-analysis. BMJ. 2019;367:l6483.","journal-title":"BMJ."},{"issue":"1\u20132","key":"1369_CR15","first-page":"65","volume":"42","author":"G Cooke","year":"2013","unstructured":"Cooke G, Valenti L, Glasziou P, Britt H. Common general practice presentations and publication frequency. Aust Fam Physician. 2013;42(1\u20132):65\u20138.","journal-title":"Aust Fam Physician"},{"key":"1369_CR16","volume-title":"Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management","author":"National Institute for Health and Care Excellence (NICE)","year":"2019","unstructured":"National Institute for Health and Care Excellence (NICE). Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. 2019."},{"issue":"581","key":"1369_CR17","doi-asserted-by":"publisher","first-page":"e459","DOI":"10.3399\/bjgp10X544050","volume":"60","author":"LB Dibley","year":"2010","unstructured":"Dibley LB, Norton C, Jones R. Non-pharmacological intervention for gastro-oesophageal reflux disease in primary care. Br J Gen Pract. 2010;60(581):e459\u201365.","journal-title":"Br J Gen Pract"},{"issue":"8","key":"1369_CR18","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1097\/MCG.0000000000000359","volume":"49","author":"E Person","year":"2015","unstructured":"Person E, Rife C, Freeman J, Clark A, Castell DO. A novel sleep positioning device reduces Gastroesophageal reflux: a randomized controlled trial. J Clin Gastroenterol. 2015;49(8):655\u20139.","journal-title":"J Clin Gastroenterol"},{"issue":"2","key":"1369_CR19","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1002\/oby.20279","volume":"21","author":"M Singh","year":"2013","unstructured":"Singh M, Lee J, Gupta N, Gaddam S, Smith BK, Wani SB, et al. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial. Obesity (Silver Spring). 2013;21(2):284\u201390.","journal-title":"Obesity (Silver Spring)"},{"issue":"10","key":"1369_CR20","doi-asserted-by":"publisher","first-page":"2128","DOI":"10.1111\/j.1572-0241.2007.01348.x","volume":"102","author":"M Piesman","year":"2007","unstructured":"Piesman M, Hwang I, Maydonovitch C, Wong RK. Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? Am J Gastroenterol. 2007;102(10):2128\u201334.","journal-title":"Am J Gastroenterol"},{"key":"1369_CR21","doi-asserted-by":"publisher","first-page":"b2700","DOI":"10.1136\/bmj.b2700","volume":"339","author":"A Liberati","year":"2009","unstructured":"Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.","journal-title":"BMJ."},{"issue":"2","key":"1369_CR22","doi-asserted-by":"publisher","first-page":"195","DOI":"10.5195\/jmla.2020.834","volume":"108","author":"JM Clark","year":"2020","unstructured":"Clark JM, Sanders S, Carter M, Honeyman D, Cleo G, Auld Y, et al. Improving the translation of search strategies using the polyglot search translator: a randomized controlled trial. J Med Libr Assoc. 2020;108(2):195\u2013207.","journal-title":"J Med Libr Assoc"},{"key":"1369_CR23","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","volume":"343","author":"JP Higgins","year":"2011","unstructured":"Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.","journal-title":"BMJ."},{"key":"1369_CR24","doi-asserted-by":"publisher","first-page":"l6890","DOI":"10.1136\/bmj.l6890","volume":"368","author":"M Campbell","year":"2020","unstructured":"Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890.","journal-title":"BMJ."},{"issue":"2","key":"1369_CR25","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1159\/000197991","volume":"15","author":"C Stanciu","year":"1977","unstructured":"Stanciu C, Bennett JR. Effects of posture on gastro-oesophageal reflux. Digestion. 1977;15(2):104\u20139.","journal-title":"Digestion."},{"issue":"8569","key":"1369_CR26","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1016\/S0140-6736(87)91332-8","volume":"2","author":"RF Harvey","year":"1987","unstructured":"Harvey RF, Gordon PC, Hadley N, Long DE, Gill TR, Macpherson RI, et al. Effects of sleeping with the bed-head raised and of ranitidine in patients with severe peptic oesophagitis. Lancet. 1987;2(8569):1200\u20133.","journal-title":"Lancet."},{"issue":"5","key":"1369_CR27","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1007\/BF01798350","volume":"33","author":"JW Hamilton","year":"1988","unstructured":"Hamilton JW, Boisen RJ, Yamamoto DT, Wagner JL, Reichelderfer M. Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid. Dig Dis Sci. 1988;33(5):518\u201322.","journal-title":"Dig Dis Sci"},{"key":"1369_CR28","doi-asserted-by":"crossref","unstructured":"Huang HC, Chang YJ, Tseng YL, Fang SY. Effect of Head-of-Bed Elevation on Nocturnal Reflux Symptoms of Esophageal Cancer Patients With Esophagectomy and Reconstruction. Cancer Nurs. 2019. Online ahead of print.","DOI":"10.1097\/NCC.0000000000000769"},{"issue":"6","key":"1369_CR29","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.gastrohep.2020.01.007","volume":"43","author":"IM Villamil Morales","year":"2020","unstructured":"Villamil Morales IM, Gallego Ospina DM, Otero Regino WA. Impact of head of bed elevation in symptoms of patients with gastroesophageal reflux disease: a randomized single-blind study (IBELGA). Gastroenterol Hepatol. 2020;43(6):310\u201321.","journal-title":"Gastroenterol Hepatol"},{"issue":"6","key":"1369_CR30","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1016\/j.jclinepi.2003.12.010","volume":"57","author":"I Boutron","year":"2004","unstructured":"Boutron I, Tubach F, Giraudeau B, Ravaud P. Blinding was judged more difficult to achieve and maintain in nonpharmacologic than pharmacologic trials. J Clin Epidemiol. 2004;57(6):543\u201350.","journal-title":"J Clin Epidemiol"},{"key":"1369_CR31","doi-asserted-by":"publisher","first-page":"f3755","DOI":"10.1136\/bmj.f3755","volume":"347","author":"TC Hoffmann","year":"2013","unstructured":"Hoffmann TC, Erueti C, Glasziou PP. Poor description of non-pharmacological interventions: analysis of consecutive sample of randomised trials. BMJ. 2013;347:f3755.","journal-title":"BMJ."},{"key":"1369_CR32","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"JPTT Higgins","year":"2019","unstructured":"Higgins JPTT, J., Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions; 2019."},{"key":"1369_CR33","doi-asserted-by":"publisher","first-page":"b2535","DOI":"10.1136\/bmj.b2535","volume":"339","author":"D Moher","year":"2009","unstructured":"Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.","journal-title":"BMJ."},{"issue":"3","key":"1369_CR34","first-page":"83","volume":"63","author":"HC Huang","year":"2016","unstructured":"Huang HC, Fang SY. A systematic review of the literature related to elevating the head of the bed for patients with Gastroesophageal reflux disease: applications in patients after esophageal Cancer surgery. Hu Li Za Zhi. 2016;63(3):83\u201393.","journal-title":"Hu Li Za Zhi"},{"key":"1369_CR35","doi-asserted-by":"publisher","unstructured":"Safety of Long-Term PPI Use. JAMA. 2017;318(12):1177\u20138. https:\/\/doi.org\/10.1001\/jama.2017.13272.","DOI":"10.1001\/jama.2017.13272"}],"container-title":["BMC Family Practice"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01369-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12875-021-01369-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01369-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T06:51:48Z","timestamp":1670827908000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-021-01369-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,19]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1369"],"URL":"https:\/\/doi.org\/10.1186\/s12875-021-01369-0","relation":{},"ISSN":["1471-2296"],"issn-type":[{"value":"1471-2296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,19]]},"assertion":[{"value":"4 September 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"No support from any organisation for the submitted work; no other relationships or activities that could appear to have influenced the submitted work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"24"}}