Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7558-7562
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7558
Esophageal dysphagia and reflux symptoms before and after oral IQoroR training
Mary Hägg, Lita Tibbling, Thomas Franzén
Mary Hägg, Speech and Swallowing Centre, Department of Otorhinolaryngology, Hudiksvall Hospital, Hudiksvall, SE 82481, Sweden
Mary Hägg, Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, SE 80188, Sweden
Lita Tibbling, Thomas Franzén, Department of Surgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, SE 58185, Sweden
Author contributions: Hägg M, Tibbling L and Franzén T contributed equally to this work; Hägg M and Franzén T designed the study and performed the research; Hägg M and Tibbling L participated in the conception, analysis and interpretation of data, and drafted the article; Franzén T participated in the analysis of the high-resolution manometry readings and drafted this section of the manuscript; all the authors revised the manuscript for final submission.
Supported by Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden, and the Council for Regional Research in Uppsala and Örebro, Sweden.
Ethics approval: The patients in this study who were referred to a swallowing center, as part of an otorhinologic department for the investigation and treatment of dysphagia, were examined on a regular basis and were therefore not subject to any ethical consideration.
Informed consent: The twelve patients referred to an esophageal laboratory provided informed consent to receive IQS traction in addition to standard esophageal examination.
Conflict-of-interest: IQoroR is patented and CE-marked by MYoroface AB. Mary Hägg is the inventor. Swedish patent SE 1350314-9, 2014 July 14. IQoroR is an orofacial medical device and a method for therapeutic use. The authors declare that they have no conflict of interest.
Data sharing: The presented data (anonymized and without risk of identification) were shared between the three authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mary Hägg, DDS, PhD, Speech and Swallowing Centre, Department of Otorhinolaryngology, Hudiksvall Hospital, Hudiksvall, SE 82481, Sweden.
Telephone: +46-650-92754 Fax: +46-65-92412
Received: November 21, 2014
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.

Keywords: Esophageal dysphagia, Manometry, Muscle training, Oral screen, Reflux

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.