Evaluation of elevation of the head of the bed, bethanechol, and antacid foam tablets on gastroesophageal reflux


To ascertain how elevation of the head of the bed, bethanechol, and antacid foam tablets affect gastroesophageal reflux, we used prolonged intraesophageal pH monitoring in 55 symptomatic patients. Acid exposure was separated into reflux frequency and esophageal acid clearance time and recorded during the day in the upright posture and recumbent at night. Values before and during each therapy were compared to physiologic reflux in 15 asymptomatic controls. Ten patients slept with the head of the bed elevated and had a 67% improvement in the acid clearance time (P<0.025); however, the frequency of reflux episodes remained unchanged. Twelve patients given 25 mg of bethanechol 4 times a day had a 50% decrease in recumbent acid exposure only (P<0.05), due to a trend towards decreased reflux episodes and acid clearance time. Bethanechol combined with head of bed elevation in 19 other patients decreased both reflux frequency (30%) and acid clearance time (53%, allP<0.05). Antacid foam tablets failed to significantly diminish acid exposure. Nocturnal reflux responded the best to those therapies tested.

This is a preview of subscription content, log in to check access.


  1. 1.

    Johnson LF, DeMeester TR: Twenty-four pH monitoring of the distal esophagus, a quantitative measure of gastroesophageal reflux. Am J Gastroenterol 62:325–332, 1974

    Google Scholar 

  2. 2.

    DeMeester TR, Johnson LF, Guy JJ, et al: Patterns of gastroesophageal reflux in health and disease. Ann Surg 184:459–470, 1976

    Google Scholar 

  3. 3.

    Farrell RL, Roling GR, Castell DO: Cholinergic therapy of chronic heartburn, a controlled trial. Ann Intern Med 80:573–576, 1974

    Google Scholar 

  4. 4.

    Castell DO, Johnson LF: The lower esophageal sphincter: Its function in health and disease.In Developments in Digestive Disease, JE Berk (ed). Philadelphia, Lea and Febriger, 1978, p 37

    Google Scholar 

  5. 5.

    Johnson LF, DeMeester TR, Haggitt RC: Esophageal epithelial response to gastroesophageal reflux, a quantitative study. Am J Dig Dis 23:498–509, 1978

    Google Scholar 

  6. 6.

    Hendrix TR: Medical treatment of reflux symptoms.In Gastroesophageal Reflux and Hiatus Hernia, DB Skinner, HR Belsey, TR Hendrix, GD Guidema (eds). Boston, Little Brown, 1972, p 130

    Google Scholar 

  7. 7.

    Skinner DB: Reflux esophagitis and hiatal hernia.In Tices Practice of Medicine, FL Iber (ed). Hagerstown, Harper Row, 1970, p 10.

    Google Scholar 

  8. 8.

    Stanciu C, Bennett JR: Oesophageal acid clearing: One factor in the production of reflux esophagitis. Gut 15:852–857, 1975

    Google Scholar 

  9. 9.

    Babka JC, Hager GW, Castell DO: The effect of body position on lower esophageal sphincter pressure. Am J Dig Dis 18:441–442, 1973

    Google Scholar 

  10. 10.

    Turlbeck WM, Marshall RM: Topography of esophageal pressure in the dog. J Appl Physiol 34:590–596, 1973

    Google Scholar 

  11. 11.

    Banchero N, Schwartz PE, Wood EH: Intraesophageal pressure gradient in man. J Appl Physiol. 22:1066–1074, 1967

    Google Scholar 

  12. 12.

    Thurer RL, DeMeester TR, Johnson LF: The distal esophageal sphincter and its relationship to gastroesophageal reflux. J Surg Res 16:418–423, 1974

    Google Scholar 

  13. 13.

    Dubois A, Gross HA, Richter J, Ebert MH: Bethanechol stimulates gastric emptying and acid output in anorexia nervosa patients. Clin Res 28:274A, 1980

    Google Scholar 

  14. 14.

    Miller WN, Ganeshappa KP, Dodds WJ, et al: Effect of bethanechol on gastroesophageal reflux. Am J Dig Dis 22:230–234, 1977

    Google Scholar 

  15. 15.

    Hollis JB, Castell DO: Effects of cholinergic stimulation on human esophageal peristalsis. J Appl Physiol 40:40–43, 1976

    Google Scholar 

  16. 16.

    Phaosawasdi K, Malmud LS, Stelzer FA, et al: Cholinergic effects on esophageal transit. Chin Res 26:665A, 1978

    Google Scholar 

  17. 17.

    Atkinson M, VanGelder A: Esophageal intraluminal pH recording in the assessment of gastroesophageal reflux and its consequences. Am J Dig Dis 22:365–370, 1977

    Google Scholar 

  18. 18.

    Thanik KD, Chey WY, Shah AN, et al: Effect of oral bethanechol on symptoms and endoscopic findings of reflux esophagitis. Ann Intern Med 93:805–811, 1980

    Google Scholar 

  19. 19.

    Davenport HW: Physiology of the Digestive Tract. Chicago, Year Book Medical Publishers, 1968, p 48.

    Google Scholar 

  20. 20.

    Lichter I: Measurement of gastroesophageal acid reflux: Its significance in hiatus hernia. Br J Surg 61:253–258, 1974

    Google Scholar 

  21. 21.

    Leon CSC, Flannagan JR Jr, Moorrees CFA: The frequency of deglutition in man. Arch Oral Biol 10:83–96, 1965

    Google Scholar 

  22. 22.

    Johnson LF, Lin YC, Hong SK: Gastroesophageal dynamics during immersion in water to the neck. J Appl Physiol 38:449–454, 1975

    Google Scholar 

  23. 23.

    Siegel CL, Hendrix TR: Esophageal motor abnormalities induced by acid perfusion in patients with heartburn. J Clin Invest 42:686–695, 1963

    Google Scholar 

  24. 24.

    Stanciu C, Bennett JR: Alginate/antacid in the reduction of gastroesophageal reflux. Lancet 1:109–111, 1974

    Google Scholar 

  25. 25.

    Graham DY, Lanza F, Dorsch ER: Symptomatic reflux esophagitis: A double-blind controlled comparison of antacids and alginate. Curr Ther Res 22:653–658, 1977

    Google Scholar 

  26. 26.

    DeMeester TR, Johnson LF, Kent AH: Evaluation of current operation for the prevention of gastroesophageal reflux. Ann Surg 180:511–525, 1974

    Google Scholar 

  27. 27.

    DeMeester TR, Johnson LF: Evaluation of the Nissen antireflux procedure by esophageal manometry and 24-hour pH monitoring. Am J Surg 129:94–100, 1975

    Google Scholar 

  28. 28.

    Chernow B, Johnson LF, Janowitz W, et al: Pulmonary aspiration as a consequence of gastroesophageal reflux—a diagnostic approach. Dig Dis Sci 24:839–844, 1979

    Google Scholar 

  29. 29.

    Pellegrini CA, DeMeester TR, Johnson LF, et al: Gastroesophageal reflux and pulmonary aspiration: Incidence, functional abnormality and results of surgical therapy. Surgery 86:110–119, 1979

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Col Lawrence F. Johnson MD.

Additional information

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Johnson, L.F., DeMeester, T.R. Evaluation of elevation of the head of the bed, bethanechol, and antacid foam tablets on gastroesophageal reflux. Digest Dis Sci 26, 673–680 (1981). https://doi.org/10.1007/BF01316854

Download citation


  • Public Health
  • Foam
  • Symptomatic Patient
  • Gastroesophageal Reflux
  • Upright Posture