Increase of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux

Participants

• Number: 38 people (25 female and 13 male)
• Criteria of inclusion: adult patients (age ≥18 years) sent to the Laboratory of Digestive Motility Investigation of the Gastroenterology Service of the Hospital das Clinicas of the University of São Paulo School of Medicine and who received a diagnosis of gastroesophageal reflux disease
• Group of study: 2 groups obtained through randomization
  • Group 1: OMT, 22 people (16 female and 6 male, average age 49.4 years)
  • Group 2: sham treatment, 16 people (9 female and 7 male, average age 50.5 years)

Interventions and evaluations

• Evaluation by esophageal manometry of the lower esophageal sphincter before and 20 seconds after the intervention. In particular, average respiratory pressure and maximum expiratory pressure were evaluated
• 1 single session of OMT or sham treatment
• OMT: diaphragmatic stretching technique, with the operator encouraging and coordinating deep breathing of the patients
• Sham treatment: the operator would encourage and coordinate deep breathing of the patients; however he would simply maintain a physical contact with his hands on the patients’ thorax and abdomen without applying any technique
• OMT and sham treatment administered by the same operator

Results

Primary outcomes: OMT showed a tendency to produce an increase in both parameters, while the sham treatment showed to induce their decrease. in particular, the difference between the increase induced by OMT on the average respiratory pressure compared to the decrease of the same variable induced by the sham treatment was statistically significant.

In this regard, the effect size (the relevance of the effect produced by OMT compared to sham treatment) according to the Cohen’s d was 0.80, indicating a particularly relevant result from a clinical point of view.

The difference between the increase in the maximum expiratory pressure induced by OMT and the reduction of the same variable induced by the sham treatment also allowed an effect size of 0.52, thus indicating a potentially relevant result from a clinical point of view.

Discussion

Compared to sham treatment, OMT entailed an improvement in the lower esophageal sphincter pressure measured by manometry. In particolare, mentre il trattamento sham ha favorito una discreta diminuzione e, quindi, un peggioramento della pressione, l’OMT ne ha favorito un leggero aumento.

The results obtained through the use of only one technique makes the authors hope that a complete OMT may have better results on gastroesophageal reflux disease. In addition, this single technique could become an adjuvant treatment in specific clinical or surgical situations.