Does Osteopathic Visceral Treatment Help Improve GERD?
Gastroesophageal reflux disease (GERD) is prevalent worldwide, and the disease burden seems to be increasing. Osteopathic consultations are mainly related to musculoskeletal issues, followed by gastrointestinal disorders. World Health Organization (WHO) considers osteopathy to be a Complementary and Alternative Medicine and suggests the use of osteopathy for visceral symptoms, as well as a multidisciplinary approach to patients.
Osteopathic manual treatment has been recommended as a complimentary treatment for Gastroesophageal Reflux Disease (GERD). Key factors leading to GERD are lower esophageal sphincter relaxation, crural diaphragm inhibition, hiatal hernia, esophageal shortening, and pressure between the stomach and the esophageal sphincter. These mechanisms suggest that acid reflux events confined to the lower esophagus may produce GERD.
Research Review: Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux
A 2019 randomised controlled study shows osteopathic visceral technique for GERD produced a significant improvement in GERD symptoms one week after the intervention compared to the control group. This may mean that osteopathic treatment is useful for improving symptoms of GERD.
The study also found that the worse the reflux symptoms based on the GerdQ test score, the lower PPT in C4. Moreover, higher reflux symptoms are also related to lower GerdQ improvement, obtained after the application of this osteopathic technique for only a 5 min session.
This study of 60 patients diagnosed with GERD were randomised to the experimental group (31) and control group (29) in Pamplona, Spain for 5 months and received to treatment sessions. The experimental group recieved visceral osteopathic technique, which is commonly used for GERD. To perform the technique, the patient was seated, and the osteopath stayed behind, with the osteopath´s hands placed in the patient´s epigastric area. The patient was then asked to bend in flexion while breathing in, so the osteopath deepened her hands on the patient´s epigastrium. After that, the patient was asked to straighten his whole spine and to extend his neck while breathing out, and at that time the osteopath pushed caudally with her hands. The procedure was repeated for 5 mininutes. This technique has been proposed for patients suffering from GERD.
The control group recieved the sham technique, where the investigator’s hands only maintained physical contact with the patient, without exerting any pressure, or putting any incentive or restriction on the tissues or the movements of the thoracic cage. The GerdQ questionnaire was used to assess symptom changes the week after intervention.
The results show the application of the osteopathic manual treatment in patients with GERD produced a 37.8% significant improvement in symptoms one week after the intervention, compared to the control group based on the scores of the GerdQ questionnaire. In addition, higher reflux symptoms are also related to lower GerdQ improvement. The main limitation of this study was its short-term follow up and limited to one technique for two sessions. A more comprehensive osteopathic treatment for a longer duration might achieve even better results.
In view of these findings, manual therapy, and this technique, could be considered as an option for GERD treatment, especially for those with hiatal hernia.
References:
Eguaras, N., Rodríguez-López, E. S., Lopez-Dicastillo, O., Franco-Sierra, M. Á., Ricard, F., & Oliva-Pascual-Vaca, Á. (2019). Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial. Journal of clinical medicine, 8(10), 1738. https://doi.org/10.3390/jcm8101738