“Silent reflux” symptoms reduced by raising the head-of-bed

Published Online: January 16, 2015

Although most people think acid reflux only causes heartburn, there is a growing interest in another form of reflux, which causes mostly respiratory symptoms. This form of reflux, known as supraesophageal reflux disease (SERD) or laryngopharyngeal reflux (LPR), is caused by acid from the stomach regurgitating into the throat, mouth, nasal passages, and even the lungs, resulting in symptoms such as chronic cough, hoarseness, sinusitis, and tooth decay. Supraesophageal reflux can be challenging to diagnose and treat, in part because it often goes unrecognized. Therefore, it is often referred to as “silent reflux” (“silent” for the lack of heartburn). Also, unlike heartburn-causing reflux, SERD often does not respond to antacid medications, making treatment a challenge.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Drs. David Scott and Ronald Simon explored the prevalence and timing of SERD and investigated the efficacy of head-of-bed elevation in its treatment.

The authors reviewed charts from over 200 subjects evaluated at Scripps Clinic Health, Division of Allergy, Asthma and Immunology, who had undergone a special overnight pH monitoring study to look for acid within the throat. Subjects found to have acid reflux in the throat were classified based on which position they were in when reflux was observed; they were classified as either upright, lying down, or both. Among patients who only experienced acid reflux while lying flat, the authors repeated the pH monitoring after elevating the head-of-bed by 6 inches. The repeat pH readings were then analyzed to determine if this simple lifestyle intervention could prevent acid from reaching the throat.

A total of 235 patients were included and reflux was detected in 113 (48%) of patients. Most patients (55%) exhibited reflux only when lying flat, while 42% had reflux regardless of position, and a minority (4%) had reflux only when upright. Among 13 of those with reflux only when lying flat, repeat pH monitoring after head-of-bed elevation showed resolution of reflux in 8 (62%) of the individuals.

This study provides new evidence that SERD is a frequent cause of respiratory symptoms and, contrary to what was previously thought, most frequently occurs when lying down. It also shows that six inches of head-of-bed elevation is effective in reducing supine SERD. If future studies confirm that this intervention also improves symptoms, it will be very good news for patients with a disease that is difficult to treat with medication.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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