Effects of inspiratory muscle training in patients with gastroesophageal reflux disease

Abstract

The gastroesophageal reflux disease (GERD) is caused by acid reflux of gastric contents into the esophagus-peptic or supraesophageal estruture. The antireflux barrier is dependent on the integrity of both Lower Esophageal Sphincter-LES and the crural diaphragm. OBJECTIVE:The aim of this randomized study was to evaluate the effect of inspiratory muscle training in patients with erosive esophagitis.METHOD:20 subjects with past history of GERD were allocated to a control (C group) and an experimental group (T group) and underwent clinical evaluation by endoscopy (EGD),manovacuometry,high-resolution manometry and pH monitoring before and after IMT with 50% of their Maximum Inspiratory Pressure (MIP) three times a week, once a day during eight weeks. Diseases that could affect the study were excluded. Personal information and medical history were obtained by a questionnaire.Student t and Wilcoxon Test were used to analyze the data.RESULTS: 3 males and 7 females-T group,aged from 43,20 ± 3,23 years and 5 males and 5 females- C group,aged 41,70±3,59 years.A significant increase of MIP (76,90±6,6% to 105,60±8,6% ρ=0.002 ;T group) versus (87,00±7,6% to 94,20±9,5% p=0,11;C group),frequency reduction of throat cleaning (2-4/week to < 1/week;ρ=0.016) and intensity of heartburn (2-4/week to <1 week;ρ=0.007).The IMT increased the basal LES pressure at T group (18,84±2,6 mmHg to 22,82±2,9 mmHg;ρ=0,03) versus 25,26±3,9 mmHg to 25,04±3,3 mmHg p=0,95 C group.CONCLUSION:This data strongly support that IMT reduces the intensity of heartburn and frequency of throat clearing, increasing MIP and basal LES pressure,possibly due to a significant improvement in mechanical efficiency of the crural diaphragm.