Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University Graz, Graz, Austria.
Am J Gastroenterol. 2012 Mar;107(3):372-8. doi: 10.1038/ajg.2011.420. Epub 2011 Dec 6.
OBJECTIVES: The lower esophageal sphincter (LES), surrounded by diaphragmatic muscle, prevents gastroesophageal reflux. When these structures become incompetent, gastric contents may cause gastroesophageal reflux disease (GERD). For treatment, lifestyle interventions are always recommended. We hypothesized that by actively training the crura of the diaphragm as part of the LES using breathing training exercises, GERD can be positively influenced. METHODS: A prospective randomized controlled study was performed. Patients with non-erosive GERD or healed esophagitis without large hernia and/or previous surgery were included. Patients were randomized and allocated either to active breathing training program or to a control group. Quality of life (QoL), pH-metry, and on-demand proton pump inhibitor (PPI) usage were assessed at baseline and after 4 weeks of training. For long-term follow-up, all patients were invited to continue active breathing training and were further assessed regarding QoL and PPI usage after 9 months. Paired and unpaired t-test was used for statistical analysis. RESULTS: Nineteen patients with non-erosive GERD or healed esophagitis were randomized into two groups (10 training group and 9 control group). There was no difference in baseline patient characteristics between the groups and all patients finished the study. There was a significant decrease in time with a pH<4.0 in the training group (9.1±1.3 vs. 4.7±0.9%; P<0.05), but there was no change in the control group. QoL scores improved significantly in the training group (13.4±1.98 before and 10.8±1.86 after training; P<0.01), but no changes in QoL were seen in the control group. At long-term follow-up at 9 months, patients who continued breathing exercise (11/19) showed a significant decrease in QoL scores and PPI usage (15.1±2.2 vs. 9.7±1.6; 98±34 vs. 25±12 mg/week, respectively; P<0.05), whereas patients who did not train had no long-term effect. CONCLUSIONS: We show that actively training the diaphragm by breathing exercise can improve GERD as assessed by pH-metry, QoL scores and PPI usage. This non-pharmacological lifestyle intervention could help to reduce the disease burden of GERD.
目的：食管下括约肌（LES）被膈状肌环绕，防止胃食管反流。当这些结构变得功能不全时，胃内容物可能会导致胃食管反流病（GERD）。治疗时，始终建议进行生活方式干预。我们假设通过积极训练膈的脚作为 LES 的一部分，使用呼吸训练运动，可以对 GERD 产生积极影响。
方法：进行了一项前瞻性随机对照研究。纳入非糜烂性 GERD 或愈合食管炎无大疝和/或既往手术的患者。患者随机分配至主动呼吸训练方案或对照组。在基线和 4 周训练后评估生活质量（QoL）、pH 监测和按需质子泵抑制剂（PPI）使用情况。为了长期随访，所有患者均被邀请继续进行主动呼吸训练，并在 9 个月后进一步评估 QoL 和 PPI 使用情况。使用配对和非配对 t 检验进行统计分析。
结果：19 例非糜烂性 GERD 或愈合食管炎患者被随机分为两组（10 例训练组和 9 例对照组）。两组患者的基线特征无差异，所有患者均完成了研究。训练组 pH<4.0 的时间明显减少（9.1±1.3 对 4.7±0.9%；P<0.05），但对照组无变化。训练组的 QoL 评分显著改善（训练前 13.4±1.98，训练后 10.8±1.86；P<0.01），但对照组的 QoL 无变化。9 个月的长期随访时，继续呼吸运动的患者（11/19）的 QoL 评分和 PPI 使用量显著下降（15.1±2.2 对 9.7±1.6；98±34 对 25±12mg/周，分别；P<0.05），而未训练的患者无长期影响。
结论：我们表明，通过呼吸运动积极训练膈可以改善 pH 监测、QoL 评分和 PPI 使用情况评估的 GERD。这种非药物生活方式干预可能有助于减轻 GERD 的疾病负担。
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