Gastro-oesophageal reflux disease: Posture is important

doi:10.1136/bmj.332.7535.236-c

BMJ 2006;332:236 (28 January), doi:10.1136/bmj.332.7535.236-c

Letter

Gastro-oesophageal reflux disease

Posture is important

Editor—Fox and Forgacs do not mention the effects of postureon gastro-oesophageal reflux disease in their review.¹ Controlledtrials are not possible in this respect, but some weight mustbe given to the experience of many patients and doctors.

I can report on over 70 years of coming to terms with pepticulceration and over 30 years of trying to cope with severe reflux.Gross adverse reactions to the modern acid suppressants as wellas clarithromycin have forced me to rely on a postural approach,which is effective when combined with a simple antacid mixturetaken after meals and at bedtime. Patients should be advisedto avoid bending down, especially after meals. They should beencouraged to sleep in a semi-upright position.

This is achieved ideally by the use of an adjustable mattress,but such beds are expensive and not transportable. A backrestis easily improvised, but a "donkey" is required behind theknees to prevent sliding down the bed. Traditionally, a bolsterhas been used for this purpose. To prevent it rolling down thebed, it has to be wrapped in a drawsheet with its ends tuckedunder the mattress on each side. This works well but may betoo awkward to take on holiday.

A portable, inflatable plastic bolster is needed. Were it tobe coated with, or wrapped in, a material with a suede finishthe friction generated would stop it from sliding. I have improvisedcushions of this type with success, but some manufacturing problemshave to be overcome.

Norman K Gibbon, retired consultant urologist

Liverpool L37 2EY nok-gibbon{at}mersinet.co.uk

Competing interests: None declared.