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

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.

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

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

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

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

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.

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