Therapeutic mechanism of diaphragm training at different periods in patients with gastroesophageal reflux disease

Objective To explore the effects of postprandial diaphragm training (DT) on esophageal acid exposure, esophageal motility and proximal gastric volume at different postprandial periods in patients with gastroesophageal reflux disease (GERD). Methods Thirty GERD patients and 9 healthy subjects (HS) with matched demographic characteristics were enrolled from June 2005 to June 2006 at Peking Union Medical College Hospital.Esophageal manometry with a Dentsleeve catheter and simultaneous esophageal pH monitoring were recorded in a 30-min fasting period and a 120-min postprandial period.The GERD patients were divided into 3 groups: 9 patients received diaphragm training at 1st hour after meal (group DT1 h) and another 10 at 2nd hour after meal (group DT2 h) whereas no diaphragm training after meal in 11 (group NDT).Ultrasonic imaging of proximal gastric volume was undertaken at 0, 30,60, 90 and 120 min after meal. Results (1) The percentage time with pH 0.05). (2) Esophagogastric junction (EGJ) and crural diaphragm pressures at the 1st hour after meal in group DT 1 hwere both significantly higher than those in group NDT during diaphragm training ((44.4±8.1) vs (16.2±4.5) mm Hg, (38.2±4.2) vs (9.8±4.5) mm Hg, 1 mm Hg=0.133 kPa, both P 0.05). (3) After test meal, the groups DT1 h, DT2 hand N-DT had similar proximal stomach volume (all P>0.05). Conclusions Diaphragm training at the 1st hour after meal might reduce the 120-min postprandial esophageal acid exposure in GERD patients.The reduction in esophageal acid exposure may result from enhanced antireflux barrier of EGJ function.Therefore postprandial diaphragm training provides a new approach to conservative treatment of GERD. Key words: Gastroesophageal reflux; Diaphragm; Esophagus; Esophageal motility