Doença do refluxo gastroesofágico: tratamento não farmacológico

Impact of head of bed elevation in symptoms of patients with gastroesophageal reflux disease: a randomized single-blind study (IBELGA)

BACKGROUND

The clinical impact of head-of-bed elevation in patients with gastro-oesophageal reflux disease is unclear, because of inconsistency and methodological limitations of previous studies.

PATIENTS AND METHODS

A randomised single-blind single-centre controlled clinical trial with a 2x2 cross-over design, in 39 pharmacologically treated patients with gastro-oesophageal reflux disease. Active intervention was to use a head-of-bed-elevation of 20cm for 6 weeks and then to sleep without inclination for 6 additional weeks, with a wash-out of 2 weeks between periods. The primary outcome was a change ≥10% in RDQ score and secondary outcomes were a change ≥10% in SF-36 score, patient preference and frequency of adverse events.

RESULTS

27 (69.2%) patients who used the intervention reached the primary outcome vs 13 (33.3%) patients in the control group (RR: 2.08; 95 CI%: 1.19 - 3.61). No effect was found in SF-36 score (RR: 1.11; 95% CI: 0.47 - 2.60). Preference favouring the intervention was 77.1% and adverse event proportion was 54.0%.

CONCLUSION

Head-of-bed elevation improved reflux symptoms but there was no effect on quality of life. The finding of a non-optimal risk-benefit ratio warrants additional studies before this intervention can be recommended (IBELGA, ClinicalTrials.gov identifier NCT02706938).

Dificuldades enfrentadas pelos pais de crianças com doença do refluxo gastroesofágico

Objetivo Identificar as dificuldades enfrentadas pelos pais de crianças com doença do refluxo gastroesofágico.Métodos Pesquisa qualitativa realizada com 16 familiares de crianças com doença do refluxo gastroesofágico. Foi utilizada uma questão norteadora, as entrevistas foram gravadas e transcritas. Utilizou-se a técnica de análise de conteúdo.Resultados Emergiram oito categorias relacionadas às dificuldades enfrentadas pelos pais: vômitos frequentes, pneumonia, custo com tratamento, convívio social prejudicado, perda de peso, padrão de sono prejudicado, gerando dificuldade na adesão ao tratamento com orientações insuficientes.Conclusão As dificuldades enfrentadas pelos pais de crianças com refluxo gastroesofágico foram representadas por categorias que podem servir de indicadores para a qualidade do cuidado prestado.