Effects of diaphragm biofeedback training on the function of esophagogastric junction in patients with gastroesophageal reflux disease

Objective To evaluate the effects of diaphragm biofeedback training on gastroesophageal reflux disease (GERD). Methods Nineteen GERD patients underwent diaphragm biofeedback training combined with acid suppression by proton pump inhibitor (PPI). The patients exercised abdominal deep breathing under the guidance of biofeedback device about 15 min once a week in hospital and 20 min twice daily at home in fasting state. The symptoms, endoscopic findings, and esophageal motility were re-evaluated at the end of the 8th week. Results ( 1 ) Fourteen patients completed 8-week training course. Eleven of the 14 patients discontinued the acid inhibitor and 2 of the 14 patients continued the acid suppression on-demand at the end of the course, and one patient made no response. (2) Esophageal remanometry in 10 of the 14 patients showed that the crural tension at resting state was (12±4) mm Hg,significantly higher than the baseline value [ (8±3) mm Hg, P＜0.05 ], however, there were not significant differences in the lower esophageal sphincter (LES) pressure, esophagogastric junction (EGJ) pressure,and peristaltic amphtude of the distal esophagus ( all P＞0.05 ). (3) Six of the 7 patients with reflux esophagitis (RE) who underwent follow-up endoscopy presented normal findings and the grading of 1 patient was changed from RE LA-C to RE LA-A. (4) Two of the 14 patients who were followed up for 4 weeks intermittently used antacids and relapse occurred in 1 of the 9 patients who were followed up for 8 weeks.Conclusion Diaphragm biofeedback improves reflux symptoms significantly and discontinues or reduces the dosage of acid inhibiter in a part of patients. Biofeedback training may provide a new way to enhance antireflux barrier at the EGJ in GERD patients. Key words: Gastroesophageal reflux;  Biofeedback (psychology) ;  Crural diaphragm