10. Esophageal dysphagia and reflux symptoms before and after oral IQoro® training.

Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.

Hägg M, Tibbling L, Franzén T. World J Gastroenterol 2015; 21(24): 7558-7562

Abstract as published

Aim To examine whether muscle training with an oral IQoro screen (IQS) improves esophageal dysphagia and reflux symptoms. Methods A total of 43 adult patients (21 women and 22 men) were consecutively referred to a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study (group A; median age 52 years, range: 19–85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients (group B; median age 57 years, range: 22–85 years). Before and after training with an oral IQS for 6–8 mo, the patients were evaluated using a symptom questionnaire (esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale (ability to swallow food: score 0–100), lip force test (≥ 15 N), velopharyngeal closure test (≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients (median age 53 years, range: 22–68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry.
Results Esophageal dysphagia was present in all 43 patients at entry, and 98 percent of patients showed improvement after IQS training [mean score (range): 2.5 (1–3) vs 0.9 (0–2), P < 0.001]. Symptoms of reflux were reported before training in 86 percent of the patients who showed improvement at follow-up [1.7 (0–3) vs 0.5 (0–2), P < 0.001). The visual analogue scale scores were classified as pathologic in all 43 patients, and 100 percent showed improvement after IQS training [71 (30–100) vs 22 (0–50), P < 0.001]. No significant difference in symptom frequency was found between groups A and B before or after IQS training. The lip force test [31 N (12–80 N) vs 54 N (27–116), P < 0.001] and velopharyngeal closure test values [28 s (5–74 s) vs 34 s (13–80 s), P < 0.001] were significantly higher after IQS training. The oral IQS traction results showed an increase in mean pressure in the diaphragmatic hiatus region from 0 mmHg at rest (range: 0-0 mm HG) to 65 mmHg (range: 20–100 mmHg).
Conclusion Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.

Relevance to conditions

Dysphagia: Proof of effect of IQoro on mis-directed swallowing.
Hiatus hernia: Proof of effect of IQoro training on hiatal incompetence and several HH symptoms.
Snoring and sleep apnoea: Velum Closure competence is linked to snoring and OSA.

Study type

Peer reviewed, Prospective, Cohort pre- and post- study

Aim

To examine whether training with an IQoro Neuromuscular Training (IQNT) improves esophageal dysphagia and reflux symptoms.

Patients

43 patients (F=22, M=21) median age 57 years (range 22 – 85) with esophageal dysphagia of a non-stenotic nature, of which:

  • 21 patients with median age 52 years (range 19 – 85) with a confirmed Hiatal hernia,
  • 22 patients with median age 57 years (range 22 – 85) exhibited Hiatal hernia symptoms but had no confirmed diagnosis.

All patients had been using PPI medication for more than one year.

Methods

IQoro training 3 x 10 seconds three times per day for a duration of 6 months. Outcome measurements were made at two time points: before training and at end of training.

Outcome measurements

12 patients, median age 53 years (range 22 – 68 years) with hiatal hernia were measured using:

  • High Resolution Manometry during IQoro traction to record pressure in the upper esophageal sphincter and hiatus canal.

All patients were measured using:

  • Symptom questionnaire (esophageal dysphagia and acid chest symptoms)
  • Swallowing questionnaire (ability to swallow food), measured using Visual Analogue Scale (VAS)
  • Swallowing ability (measured using Timed Water Swallow Test – TWST) – lower normal value for swallowing rate ≥ 10 ml / sec
  • Pharyngeal sling force (measured using Lip Force meter) – lower normal value ≥ 15 N
  • Velopharyngeal Closure Test (VCT) – lower normal value ≥ 10 sec
  • Orofacial motor tests
  • Orofacial sensory test

Results

All Orofacial motor tests and Orofacial sensory test scores were normal before treatment, indicating that there was no neurological cause to the patient’s symptoms.

No significant difference in symptom frequency was found between the group with confirmed hiatus hernia, and those without a confirmed diagnosis, this was true both before and after training.

  • Esophageal dysphagia was present in all 43 patients at start of treatment, and 98 percent of patients showed improvement after IQoro neuromuscular training (p < 0.001).
  • Reflux symptoms were reported before training in 86 percent of the patients, 100 percent of these showed improvement at end of training, (p < 0.001) and 58 percent were entirely symptom free and ceased PPI medication.
  • VAS scores were classified as pathologic in all 43 patients, and 100 percent showed improvement after IQoro neuromuscular training (p < 0.001).
  • Pharyngeal sling force (p < 0.001) and velum closure test values (p < 0.001). were significantly higher after IQoro neuromuscular training.
  • High Resolution Manometry during IQoro traction showed an increase in mean pressure in the diaphragmatic hiatus region from 0 mm Hg at rest (range: 0-0 mm Hg) to 65 mm Hg (range: 20-100 mm Hg).

Statistical significance of result

(p < 0.001) esophageal dysphagia
(p < 0.001) reflux symptoms
(p < 0.001) VAS values
(p < 0.001) pharyngeal sling force scores significantly higher
(p < 0.001) VCT scores significantly higher
(p = NS) No statistical difference between symptoms or outcomes between those with or without confirmed Hiatal hernia diagnosis – both before and after treatment.

Conclusion

IQoro neuromuscular training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence. The similarity of the results in the two groups suggest that many people suffer from Hiatus hernia despite this not having been confirmed by diagnosis.