As a low-cost non pharmacological anti-reflux treatment for GERD, head of bed elevation (HBE) is nowadays a moderate-strength recommendation with low level of evidence. Clinical impact of this measure in patients with night-time symptoms remains unknown, due to inconsistent results and methodological limitations among different clinical trials; most of which were performed before the widespread use of proton pump inhibitors in clinical practice. Evidence from several non-randomized studies suggest that HBE could reduce esophageal acid exposure time and could decrease GERD symptoms; however, another study found no significant differences in those same outcomes. On the other hand, all randomized controlled clinical trials published this far show inconsistent results. A study published before widely accepted clinical use of PPI, revealed significant clinical and endoscopic improvement with HBE in patients with GERD and grade C-D esophagitis, when compared to controls. In contrast, a multi-centre clinical trial found no difference in symptom score or antacid use among groups allocated to HBE and control group. All cited studies have methodological limitations and heterogeneity in outcome assessments, which makes difficult conducting a meta-analysis with these data. No published studies evaluating impact of HBE in quality of life or work productivity were found.