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Table 1 Characteristics of included studies (n = 5)

From: Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review

Study author, year, country, study design

Participants, condition or symptom, setting, age

Intervention

Comparison

Co-interventions

Outcomes assessed in this review

Morales et al., 2020, Columbia

cross-over RCT [29]

65 participants with GORD-associated sleep disturbance recruited from a hospital outpatient unit with mean age of 56 years

Bed blocks + PPIs and/or sodium alginate

Head-of-bed elevation for 6 weeks at home using 20 cm wooden blocks under bed

Lying flat

No Head-of-bed elevation as clinically indicated.

PPIs and/or sodium alginate

Gastroesophageal reflux symptoms

Patient preferences

Adverse Events

Huang et al., 2019, Taiwan,

cross-over RCT [28]

14 participants with oesophageal cancer and nocturnal reflux symptoms or reflux esophagitis, recruited from hospital database, with mean age of 62 years

Sleeping on a Wedge + PPIs

Using a 20 cm high wedge-shaped pillow at home (with an elevation angle of 20 degree) for 2 weeks + PPIs

PPIs only

Not using the pillow for 2 weeks

One pillow of ≤8 cm high

Gastroesophageal reflux symptoms

Hamilton et al., 1988, United States, cross-over RCT [27]

15 participants with chronic reflux symptoms and endoscopic evidence of erosive esophagitis, recruited from hospital outpatients, aged between 51 and 74 years

Sleeping on a Wedge

Using a 25 cm high foam wedge (with an elevation angle of 22 degree) for one night.

Bed blocks

Head-of-bed elevated using 20 cm high metal cones under the bed legs for one night.

Lying flat

One pillow on a standard hospital bed for one night. b

All anti-reflux medications stopped. Other chronic medications allowed.

Intra-oesophageal pH measurement (Acid exposure/reflux episodes/acid clearance time)

Patient preferences

Harvey et al., 1987, United Kingdom, factorial RCTa [26]

71 participants with severe gastro-oesophageal reflux, recruited from a hospital, with a median age of 59 years

Bed blocks

Head-of-bed raised on 20 cm blocks (with 10% elevation slope) for 6 weeks at home.

Lying flat

No bed elevation

Antacid tablets as needed

Gastroesophageal reflux symptoms

Adverse Events

Stanciu et al., 1977, United Kingdom, cross-over trial [25]

63 participants with typical symptoms of Gastroesophageal reflux, recruited within a hospital, with mean age of 49 years

Bed blocks

Head-of-bed elevated with 28 cm blocks during part of the night

Sleeping on a Wedge

Sitting propped up during part of the night

Lying flat

One or two pillows during part of the night

None

Gastroesophageal reflux symptoms

Intra-oesophageal pH measurement (Acid exposure/reflux episodes/acid clearance time)

  1. aFactorial RCT – 2 factors ranitidine and head-of-bed elevation. bAll groups in hospital and for each group a pillow was allowed