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Modified inspiratory muscle training (m-IMT) as promising treatment for gastro-oesophageal reflux disease (GERD)

Moffa A (1), Oliveto G (2), Matteo FD (3), Baptista P (4), Cárdenas A 5, Cassano M (5), Casale M (2)

(1) Unit of Otolaryngology, University of Foggia, Foggia, Italy.
(2) Unit of Otolaryngology, University Campus Bio-Medico, Rome, Italy.
(3) Unit of Gastroenterology, University Campus Bio-Medico, Rome, Italy.
(4) Unit of Otolaryngology, University of Navarra, Campus Universitario, Pamplona, Spain.
(5) Unit of Otolaryngology, University of Foggia, Foggia, Italy.

Revisão:Acta Otorrinolaringologica Española

Data: 15/Mai/2019

Departamento de Otorrinolaringología [ES]

BACKGROUND:

Gastro-oesophageal reflux disease (GERD) is one of the most common diseases, but is still a challenge to cure. Different medical treatments are used, first of all Proton pump inhibitors (PPIs), however these are sometimes ineffective and long-term intake can lead to underestimated complications. Recently, some studies investigated the role of inspiratory muscle training (IMT) in the medical treatment of GERD. It seems that IMT is able to increase the pressure generated by the lower oesophageal sphincter (LES), reduce spontaneous releases of LES, acid exposure, use of PPIs, and improve symptoms and quality of life for GERD patients.

OBJECTIVE:

The aim of this study was to evaluate the effectiveness of IMT in association with myofunctional therapy exercises of swallowing set by Daniel Garliner (m-IMT) on the symptoms of patients with non-erosive gastro-oesophageal reflux disease (NERD).

METHODS:

Twenty-one adult patients with NERD were enrolled from May to December 2017 and performed m-IMT over a period of 4 weeks. Before and after treatment, all the patients completed the following questionnaires: GERD oesophageal symptomatology (GERDQ), extra-oesophageal GERD symptomatology (RSI), quality of life (GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), and underwent laryngeal endoscopy.

RESULTS:

Nineteen patients completed m-IMT. GERDQ (from 8.36±3.94 to 1.7±3.41; p<.05), RSI (from to 21.68±10.26 to 6.93±8.37; p<.05) and GERDHRQL (from 25.68±16.03 to 8.4±11.06; p<.05) the questionnaire scores significantly reduced after treatment. In addition, the laryngeal endoscopy score greatly improved (from 14.24±4.15 to 7.4±1.77; p<.05).

CONCLUSIONS:

m-IMT is a low cost therapy without side effects. It could be useful in association with PPI or alone for selected GERD cases and for mild NERD forms, in association with diet. Further studies are required to prove the effects of m-IMT on GERD symptoms and decide the best treatment schedule.

CITAÇÃO DO ARTIGO  Acta Otorrinolaringol Esp. 2019 May 15. pii: S0001-6519(19)30043-3. doi: 10.1016/j.otorri.2019.01.003

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