Francesca Galiano
|
18/01/2023 - Last update 25/05/2023

Mikhail Volokitin, Anthony Song, Meredith T. Peck, Susan Milani | Year 2022

Reduction and Resolution of a Hiatal Hernia Using Osteopathic Manipulative Treatment: A Case Report

Pathology:

Hiatal hernia

Type of study:

Case Report

Date of publication of the study’:

2022/Jul/04

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Purpose of the study

  • Objective: to show the benefits of OMT in case of hiatal hernia
  • Measured outcomes: evaluation of the symptomes

Participants

  • Number: 1
  • Description: a 71-year-old woman with symptoms of heartburn, nausea, pain, heaviness on the stomach and night reflux for the last 3 years with ups and downs. Over the last 6 months, the symptoms had become more severe and frequent. A diagnosis of a 3-cm hiatal hernia was made through esophageoduodenoscopy.

Previously, the patient had taken omeprazole (40 mg per day) for 8 weeks and then ranitidine (300 mg per day) for another 8 weeks as prescribed by her primary care physician. She had not take proton-pump inhibitors, calcium carbonate, herbs or other remedies, but has removed from her diet acidic foods, caffeine and foods with high fat content. However, none of these treatments worked.

The osteopathic evaluation revealed uneven pressure in the abdominal cavity, with the rib cage rotated to the right and an uneven diaphragm tension, showing a greater restriction of the left hemidiaphragm. The cervico-thoracic junction appeared flattened, while various somatic dysfunctions were found at the thoraco-lumbar level and at the left sternocostal articulation 3-7, with bilaterally diffuse sternal restrictions at level 5-7. A reduced esophageal peristalsis was also detected.

No contraindications to OMT were detected investigating the patient’s medical history.

Interventions and evaluations

  • Symptoms evaluation
  • Evaluation by oesophagescopy after the last treatment
  • 4 30-minute sessions of OMT
  • OMT: balanced ligamentous tension techniques, myofascial release, muscle energy techniques and OMT in the cranial field.

Results

Visit after visit, the patient reported a continuous decrease in symptoms until their disappearance. Also the motility of the esophagus was eventually recovered. An esophagexoscopy carried out after the last treatment did not detect any hernia.

Although after the symptoms disappeared there were no follow-up visits, the patient showed up years later after an accident and reported to have not experienced any gastrointestinal problems ever since, except for a slight occasional nausea that would pass without the use of any medication.

Discussion

OMT can help with hiatal hernia by considering the gastroesophageal junction and promoting the ability of these tissues to relax and contract synchronously.

The applied techniques have been chosen in order to inhibit an overstimulated vagus nerve and to correct the somatic dysfunctions concerning the diaphragm. The vagus nerve is in fact involved in case of reflux, both because it affects gastroesophageal contractions and because the increased intrathoracic pressure due to hiatal hernia can stimulate the vagus nerve through its multiple afferent pathways, consequently altering its functionality.

Therefore, appropriate anatomical and neurological considerations are central in order to understand which osteopathic techniques may be useful for a patient with similar gastroesophageal problems.

The review of Osteopedia

By Marco Chiera

Strengths: first case to report the resolution of a hiatal hernia only through OMT; very useful the reportof the “accidental” follow-up occurred years later; interesting discussion on the relationship between anatomy, neurology and osteopathic techniques.

Limits: like every case report, it is difficult to generalize; it would have been interesting to have some more description about what happened during each visit and between visits, also reporting the symptoms reported by the patient each time; it lacks an assessment of the limitations of the study.

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