15. Oral neuromuscular training relieves hernia-related dysphagia and GERD symptoms as effectively in obese as in non-obese patients.

Franzén T., Tibbling L., Hägg M. January 2019 Acta Oto-Laryngologica 138(11):1-5. DOI: 10.1080/00016489.2018.1503715

Abstract as published

Background Many physicians insist patients lose weight before their hiatal hernia (HH) condition and related symptoms including intermittent esophageal dysphagia (IED) and gastroesophageal reflux disease (GERD) can be treated, but it is not proven that body mass index (BMI) has an impact on exercise-based treatment of HH-related symptoms. Aims/Objectives To investigate whether BMI has significance on IQoro neuromuscular training (IQNT) effectiveness in treating HH-related symptoms. Material and Methods Eighty-six patients with sliding HH and enduring IED and GERD symptoms, despite proton pump inhibitor medication, were consecutively referred for 6 months’ IQNT comprising 1 1/2 minutes daily. They were grouped by BMI which was recorded before and after IQNT, as were their symptoms of IED, reflux, heartburn, chest pain, globus sensation, non-productive cough, hoarseness, and misdirected swallowing. They were also assessed on food swallowing ability, water swallowing capacity and lip force both before and after treatment. Results After IQNT, all BMI groups showed significant improvement (p < .001) of all assessments’ and symptoms; and heartburn, cough and misdirected swallowing were significantly more reduced in the severely obese. Conclusions and significance IQNT can treat HH-related IED and GERD symptoms as successfully in moderately or severely obese patients as in those with normal bodyweight.

Relevance to conditions

Hiatus hernia: Proof of the effectiveness of IQoro in treating Hiatal hernia, and independent of patient’s BMI.

Study type

Peer reviewed, Prospective, Clinical Study, Cohort pre- and post- study.

Aim

To investigate whether Body Mass Index (BMI) has significance on IQoro neuromuscular training’s effectiveness in treating Hiatal hernia (HH) related symptoms.

Patients

86 adult patients (F = 46, M = 40) with verified hiatal hernias and long- standing Intermittent Esophageal Disease (IED) and other Gastro Esophageal Reflux Disease (GERD) symptoms.

Before entry into the study the patients were partitioned into three groups according to BMI:

Group A:

  • normal weight, BMI < 25
  • (n = 37: 19 women of median age 68 yrs., 18 men of median age 72 yrs.)
  • GERD symptoms – median duration 5 yrs (1–75).
  • PPI medication history median 5 yrs.

Group B:

  • moderately obese, BMI 25 – 29
  • (n = 28: 16 women of median age 59 yrs., 12 men of median age 56 yrs.)
  • GERD symptoms – median duration 6 yrs (1–15).
  • PPI medication history median 6 yrs

Group C:

  • severely obese, BMI 30 – 37
  • (n = 21: 11 women of median age 52 yrs., 10 men of median age 70 yrs.
  • GERD symptoms – median duration 3 yrs (1–29).
  • PPI medication history median 3 yrs

Methods

All patients received IQoro neuromuscular training 3 x 10 seconds, three times per day for a duration of 6 months. All patients were measured before and after treatment.

Outcome measurements

Radiology or gastroscopy was used to confirm HH and to rule out esophageal stenosis before inclusion.

An Orofacial Muscle Function Test (OFMT) and an Orofacial Sensory Test (OST) were performed in order to exclude symptoms of any central nervous lesion. Patients with neurological diseases were excluded.

All patients were measured before and after treatment using:

  • Symptom questionnaire (IED, GERD, reflux, heartburn, chest pain, globus sensation, non-productive cough, hoarseness, and misdirected swallowing.)
  • 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

Results

At entry into the study there were no significant differences between the three BMI groups in:

  • TWST, LFT or VAS values
  • IED and GERD symptom severity, except that:
    – heartburn and cough were significantly more common in Groups B and C, and that
    – misdirected swallowing was significantly more common in Group C.

After IQoro neuromuscular training, the following was observed in all three BMI groups:

  • all IED and GERD symptom scores were significantly improved or reduced (p < 0.001)
  • median BMI was not significantly changed
  • self-assessed GERD symptom improvement showed no significant difference across the groups, except for heartburn, cough and misdirected swallowing which were significantly (p < 0.01) more reduced in obese patients than in normal bodyweight patients.
  • VAS score, TWST, and pharyngeal sling force (LFT), showed significant improvement (p < 0.001) in median values, with no significant difference between the BMI groups except for:
    – TWST values, which were significantly (p < 0.01) more improved in Group C than in Group A
    – pharyngeal sling force (LFT), which was significantly (p < 0.05) more improved in Group B than in Group A.

Statistical significance of result

(p < 0.001) all IED and GERD symptom scores were significantly improved or reduced
(p < 0.01) heartburn, cough and misdirected swallowing were significantly more reduced in obese patients than in normal bodyweight patients
(p < 0.001) VAS score, TWST, and pharyngeal sling force (LFT) improved
(p < NS) no significant difference between other results across the three groups

Conclusion

IQoro neuromuscular training (IQNT), a non-surgical treatment for IED and other GERD symptoms in hiatal hernia patients, is equally successful in treating moderately- or severely obese patients as in treating sufferers of normal weight. Obesity in itself does not therefore seem to be a handicap in treating IED and other GERD symptoms by IQNT.