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World J Respirol. Mar 28, 2015; 5(1): 28-33
Published online Mar 28, 2015. doi: 10.5320/wjr.v5.i1.28
Respiratory physiotherapy in gastroesophageal reflux disease: A review article
Renata Carvalho de Miranda Chaves, Tomás Navarro-Rodriguez
Renata Carvalho de Miranda Chaves, Tomás Navarro-Rodriguez, Department of Gastroenterology, FMUSP, São Paulo PE 51030-010, Brazil
Author contributions: Chaves RCM and Navarro-Rodriguez T contributed equally to the literature review and writing of this paper.
Conflict-of-interest: Nothing to declare.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Renata Carvalho de Miranda Chaves, MD, Department of Gastroenterology, FMUSP, Rua Setúbal, 812/101 Recife, São Paulo PE 51030-010, Brazil. remicasa@hotmail.com
Telephone: +55-81-94317722 Fax: +55-11-30697560
Received: September 29, 2014
Peer-review started: September 29, 2014
First decision: December 12, 2014
Revised: January 20, 2015
Accepted: February 4, 2015
Article in press: February 5, 2015
Published online: March 28, 2015
Abstract

Gastroesophageal reflux disease (GERD) is a frequent disorder which is expensive to diagnose and treat. Initiating therapy with empiric trial of proton-pump inhibitor is a well established strategy; however, symptoms of GERD do often persist regardless of effective medication. Nowadays, increasing interest concerning the efficacy and safety of chronic acid suppression with proton-pump inhibitors (PPIs), prompts a consideration for GERD treatment strategies related to the basic physiology of the lower esophageal sphincter, including modulation of its tone and ending of spontaneous transient lower esophageal sphincter relaxation, which contributes to reflux. Together, the lower esophageal sphincter and the crural diaphragm represent the major antireflux barrier, protecting the esophagus from reflux of gastric content. In order to prevent the need for enduring PPIs therapy or surgical procedures, substitute therapeutics approaches are being researched. Recently, studies have focused on the response of the respiratory muscles to inspiratory muscle training. As a result, inspiratory muscle training has emerged as a potential alternative for treatment of gastroesophageal reflux. The present report reviews the physiologic factors contributing to GERD, and presents the newly developed therapies that can be applied either alone or in association with available efficient GERD therapy.

Keywords: Gastroesophageal reflux disease, Lower esophageal sphincter, Inspiratory muscular training, Threshold

Core tip: Gastroesophageal reflux disease is a common gastrointestinal condition in the Western world, but remains challenging to treat. Acid suppression with proton-pump inhibitors substantially improves medical therapy, though it is not successful in all patients. Recently, some studies have shown that inspiratory muscle training increases lower esophageal sphincter pressure in patients with gastroesophageal reflux disease. However, other well-controlled studies are needed to establish if there is a substantial gain and maintenance in pressure, as well as clinical improvement, and to access the influence of inspiratory muscle training in particular group of individuals.