Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7558
Peer-review started: November 22, 2014
First decision: December 11, 2014
Revised: January 17, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: June 28, 2015
AIM: To examine whether muscle training with an oral IQoroR 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% 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% 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% 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 mmHG) 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.
Core tip: Oropharyngeal dysphagia can be improved by training with an IQoroR screen (IQS). The present study investigated whether IQS training may improve esophageal dysphagia (ED) in a similar manner as surgical repair of a hiatal hernia. Forty-three patients with longstanding ED and reflux symptoms, which were not relieved by treatment with proton pump inhibitors, received IQS training three times daily for six months; all showed increased diaphragm hiatus pressure. ED improved in 42 patients and reflux symptoms improved in 36. IQS training can be a valuable alternative to surgery with restoration of hiatal competence in patients with ED and reflux symptoms.