Study of the possibility of using osteopathic correction for the treatment of patients with non-erosive gastroesophageal refl ux disease

Abstract

Introduction. Gastroesophageal refl ux disease (GERD) is a chronic relapsing disease characterized by regularly repeated refl ux of gastric and, in some cases, duodenal contents into the esophagus. The urgency of the GERD problem is due to the widespread prevalence of this disease, a signifi cant decrease in the life quality and working capacity of patients, and it leads to signifi cant material losses and increases the risk of complications with long-term use of proton pump inhibitors. There is evidence of the effectiveness of osteopathic correction as a non-drug method as part of the complex treatment of non-erosive GERD. However, taking into considertion the potential risk of complications (osteoporosis and fractures, vitamin B12 and iron defi ciency, dementia, hypomagnesemia, impaired renal function, infectious complications, neoplasms, cardiovascular complications) caused by the use of the drugs′ treatment of GERD, it is in demand to search for evidence of the effectiveness of osteopathic correction as monotherapy for non-erosive GERD. The aim of the study was to investigate the possibility of using osteopathic correction as a monotherapy for the treatment of patients with non-erosive GERD. Materials and methods. The study involved 26 patients with non-erosive form of GERD. The age of patients was from 22 to 50 years old. Using the method of randomization envelopes, the two groups were formed (control and main). There were 13 patients (4 females and 9 males) in each group. All the study participants were prescribed a correction of the diet and regime of work and rest. Participants in the control group received basic drug therapy according to the Guidelines of the Russian Gastroenterological Association for the diagnosis and treatment of GERD. The dosage and duration were selected individually depending on the clinical manifestations and their duration. Participants of the main group received a course of osteopathic correction (2 sessions with an interval of 12–14 days). All participants underwent an esophagogastroduodenoscopy (EGD) examination at the start of the study. Before and after the treatment in both groups, the severity of GERD symptoms was assessed using the GerdQ questionnaire, as well as osteopathic status was estimated. In addition, we studied the relationship between the structure of dominant somatic dysfunctions (SD) and some indicators of the state of the esophagus and stomach, measured as part of an EGD examination: the cardia of the esophagus and stomach (closes, closes incompletely), transcardial migration of the stomach folds during calm breathing (yes, no), Hiss angle (acute, smoothed), the arch of the stomach during calm breathing (shifts, shifts to a limited extent), the shape of the arch of the stomach (normal, fl attened), the contents of the stomach (usual, with an admixture of bile). Results. The use of an osteopathic correction course for patients with a non-erosive form of GERD is accompanied by a statistically signifi cant (p<0,05) decrease in the severity of symptoms of the disease, assessed by the GerdQ questionnaire. The achieved indicators (the severity of symptoms of the disease, assessed using the GerdQ questionnaire) do not statistically signifi cantly differ from those achieved using standard drug therapy. The course of osteopathic correction is accompanied by a statistically signifi cant (p<0,05) decrease in the severity of biomechanical disorders of the thoracic region. A signifi cant correlation was established between the presence of dominant SD in the thoracic region and the presence of some features of the esophagus and stomach state (incomplete closure of the cardia of the esophagus and stomach, transcardial migration of the stomach folds during quiet breathing, a fl attened Hiss angle, a limited displacement of the gastric fornix during quiet breathing, a fl attened shape of the gastric fornix). Conclusion. The obtained results allow to consider the possibility of using osteopathic correction as a monotherapy for patients with non-erosive GERD. However, it is recommended to continue research in this direction on a larger sample size and using instrumental methods of examination in dynamics.