Diaphragm in the role of esophageal sphincter and possibilities of treatment of esophageal reflux disease using physiotherapeutic procedures

Abstract

Background: Diaphragm (crural part), is considered to be a part of the antireflux barrier. This work is dedicated to the diaphragm in the role of the lower esophageal sphincter (LES). We want to point out the potential impact of the diaphragm on the competence of this LES by patients with esophageal reflux disease and to reveal the possibilities how physiotherapy can help in the training of this part of the skeletal muscle.

Method: The group: 60 patients. average 46,5 (20 - 77) years, 29 women and 31 men. BMI 26.2. Examination using MMS's High Resolution Esophageal Manometry using a 36-channel and a special spirometry focused on the strength of the respiratory muscles, so-called occlusal pressures (MasterScope version 5.5 from Jaeger).

Results: The mean resting pressure in the region of the lower esophageal sphincter was 14mm/Hg.

Cervical Traction: Increased statistically significantn LES pressure (p= 0.000276574).

Manual Chest Stabilisation: LES pressure increased on 23 mm/Hg (p = 2,37727E-10).

Abdominal Breathing: LES pressure increased on 22 mm/Hg (p = 0.00000852412).

Leg Raise: LES pressure increased on 30mm/Hg (p = 1,96313E-8).

Patients with GERD have a significantly lower PEmax than the norm (p= 0.0000055177) and PImax (p = 7.61528E-11).

Summary: Patients with GERD have decreased inspiration and expiratory function. The results indicate the sphincter function of the diaphragm, the influence of postural and respiratory mechanics on the crural part of diaphragm and lower esophagus area and also the possibility of functional training in the LES area (during respiratory and postural maneuvers).