People may be confined to bed for any number of reasons, including spinal cord injury, severe cerebral palsy, and stroke. Many bed-bound patients suffer from severe acid reflux disease because they are in bed all or most of the time. One large study recently confirmed that high levels of acid reflux disease in institutionalized individuals who require full-time care. Many of these patients had evidence of prolonged or persistent acid reflux, including esophagitis, and they had a much higher than normal rate of Barrett's esophagus ans esophageal strictures.
Acid reflux occurs for a variety of reasons in people who are mostly bed-bound. First, sometimes such people cannot communicate well and this cannot inform their friends, family, or caregivers that they are suffering from GERD symptoms. Second, a person who is flat in bed all or most of the day is at a mechanical disadvantage. In this position, the esophagus is often on the same level as the stomach, which makes it easy for acid to wash up into the esophagus. Finally, many such people are taking medications that decrease pressure in the LES can make heartburn more likely.
Diagnostic testing and treatment are the same for this group of individuals as for people who are not bed-bound. The first diagnostic test in this case, however, requires a high index of suspicion on the part of the health care provider and family members. That is, if there is a reasonable concern that acid reflux is occurring, even if the patient cannot communicate that he or she is having symptoms of acid reflux, then we recommend empiric therapy with a poton-pump inhibitor. Clues that the patient is having acid reflux are water brash, excessive salivation, a loss of appetite, a loss of weight, chronic nausea, or coughing or wheezing. We prefer to use the strongest medicine available right from the start for such people, because these medicines usually need to be taken only once a day, they quickly eliminate symptoms, and they rapidly promote healing of the injured esophagus. In addition, it the symptoms clear up after a trial of medication, then the diagnosis of acid reflux disease is confirmed, and no special tests need to be performed. This is important, because many of these tests can be difficult or stressful for patient who are bed-bound.