Inspiratory muscle training improves antireflux barrier in GERD patients

The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7...

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Bibliographic Details
Published in:	American journal of physiology: Gastrointestinal and liver physiology Vol. 305; no. 11; p. G862
Main Authors:	Nobre e Souza, Miguel Ângelo, Lima, Maria Josire Vitorino, Martins, Giovanni Bezerra, Nobre, Rivianny Arrais, Souza, Marcellus Henrique Loiola Ponte, de Oliveira, Ricardo Brandt, dos Santos, Armênio Aguiar
Format:	Journal Article
Language:	English
Published:	United States 01-12-2013
Subjects:	Adult Esophagus - physiopathology Female Gastroesophageal Reflux - physiopathology Gastroesophageal Reflux - therapy Humans Male Middle Aged Resistance Training Respiratory Muscles - physiopathology GERD lower esophageal sphincter muscle training crural diaphragm
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Summary:	The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20-47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20-41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 ± 2.4 vs. 29.5 ± 2.1 mmHg; P < 0.001) and inspiratory EGJ pressure during SAM (89.6 ± 7.6 vs. 125.6 ± 13.3 mmHg; P = 0.001) and during TH maneuvers. The EGJ-pressure gain across 35- and 70-cmH2O loads was lower for GERD volunteers. The number and cumulative duration of the transient lower esophageal sphincter relaxations decreased after IMT. Proximal progression of GER decreased after IMT but not the distal acid exposure. Low-frequency power increased after IMT and the higher its increment the lower the increment of supine acid exposure. IMT decreased heartburn and regurgitation scores. In conclusion, IMT improved EGJ pressure, reduced GER proximal progression, and reduced GERD symptoms. Some GERD patients have a CD failure, and IMT may prove beneficial as a GERD add-on treatment.
ISSN:	1522-1547
DOI:	10.1152/ajpgi.00054.2013