GERD: treating the reflux, not the acid
It takes 15 years to get 15 percent of research into usage. I chose blogging as a way of improving those percentages.
Facts about GERD
GERD/NERD/LPR
What is reflux
The spilling of contents from the stomach and duodenum into the esophagus. The refluxate may contain any contents in the stomach
Reflux is caused by ineffective barrier where the stomach and the esophagus meet. That barrier is created by certain fibers in the stomach, the lower esophageal sphincter and the diaphragm.
No-one exactly knows why this barrier gets weak but studies are showing that the diaphragmatic portion, can be strengthened.
Physical therapist work with unstable joints by dynamically training the muscles around that joint to regain function. That is the purpose of diaphragmatic breathing.
Laryngeal pharyngeal reflux
Reflux does not stop at the esophagus, and the refluxate can ascend to the level of the trachea, and potentially sinuses, and respiratory tract. These areas lack the protective mucosa that the stomach and esophagus have. This is why GERD is associated with asthma, sinusitis, chronic cough and other complaints.
GERD treatment
Front line treatment of GERD according to the 2022 recommendations of the American College of Gastroenterology
According to the ACG: “PPIs are the most effective medical treatment for GERD. Some medical studies have identified an association between the long-term use of PPIs and the development of numerous adverse conditions”. See the link for the list of numerous adverse conditions.
https://www.cghjournal.org/article/S1542-3565%2823%2900143-X/fulltext are Present treatment algorithm according to the Clinical Gastroenterology and Hepatology.
Manometry. manometry is the placement of a catheter lined with pressure sensors through the nose into the stomach. With this technology you can view how the lower end of the esophagus is affected by diaphragmatic contractions by changes in pressure readings.
Flouroscopy: is a moving x-ray and seeing this first had; during breath holding the lower end of the esophagus can be closed completely by the diaphragm. That shows the ability of the diaphragm to control reflux.
There are several potential effect factors from diaphragmatic breathing on reflux symtpoms.
- Strengthening the diaphragm does reduce the caliber of the lower esophagus
- Diaphragmatic breathing reduces tlesrs, the reflexive opening after eating. https://www.gastroenterologyadvisor.com/gastroesophageal-reflux-disease-gerd/diaphragmatic-breathing-may-be-effective-treatment-for-certain-patients-with-gerd/
- It may desensitize the para esophageal structures including the diaphragm.
- It may activate the parasympathetic nervous system, reducing gastric secretions and promoting relaxation.