膈肌生物反馈训练治疗胃食管反流病

目的 探讨膈肌生物反馈训练对胃食管反流病(GERD)的治疗效果.方法 19例GERD患者同时接受生物反馈训练和质子泵抑制剂(PPI)抑酸药治疗,疗程为8周.患者每周在膈肌生物反馈训练仪的指导下进行腹式深吸气训练一次(15 min),空腹早、晚每日训练腹式深吸气2次,每次20 min.疗程结束后再次评价反流症状、食管动力和内镜下反流性食管炎改善情况.结果 (1)14例GERD患者完成8周疗程,1例NERD疗效不佳,11例停抑酸药,2例仍需抑酸药物.(2)疗程结束后10例患者复查食管动力,结果显示,膈脚张力由(8±3)mm rig(1 mm Hg=0.133 kPa)增加至(12±4)mm Hg(P＜0.05),而下食管括约肌(LES)压力、胃食管交界处(EGJ)压力及食管远端蠕动收缩波幅训练前后比较差异均无统计学意义.(3)7例反流性食管炎(RE)患者复查胃镜,6例阴性,1例由洛杉矶分级(LA)-C级转为LA-A级;(4)14例患者随访4周,其中2例患者按需用抑酸药物,1例无效.9例患者随访8周,复发1例.结论 膈肌生物反馈训练能显著改善反流症状,减少GERD患者对抑酸药依赖性;增加GERD患者膈脚的张力,从而增强胃食管交界处的抗反流屏障作用.

Effects of diaphragm biofeedback training on the function of esophagogastric junction in patients with gastroesophageal reflux disease

Objective To evaluate the effects of diaphragm biofeedback training on gastroesophageal reflux disease (GERD). Methods Nineteen GERD patients underwent diaphragm biofeedback training combined with acid suppression by proton pump inhibitor (PPI). The patients exercised abdominal deep breathing under the guidance of biofeedback device about 15 min once a week in hospital and 20 min twice daily at home in fasting state. The symptoms, endoscopic findings, and esophageal motility were re-evaluated at the end of the 8th week. Results ( 1 ) Fourteen patients completed 8-week training course. Eleven of the 14 patients discontinued the acid inhibitor and 2 of the 14 patients continued the acid suppression on-demand at the end of the course, and one patient made no response. (2) Esophageal remanometry in 10 of the 14 patients showed that the crural tension at resting state was (12±4) mm Hg,significantly higher than the baseline value (8±3) mm Hg, P＜0.05 ], however, there were not significant differences in the lower esophageal sphincter (LES) pressure, esophagogastric junction (EGJ) pressure,and peristaltic amphtude of the distal esophagus ( all P＞0.05 ). (3) Six of the 7 patients with reflux esophagitis (RE) who underwent follow-up endoscopy presented normal findings and the grading of 1 patient was changed from RE LA-C to RE LA-A. (4) Two of the 14 patients who were followed up for 4 weeks intermittently used antacids and relapse occurred in 1 of the 9 patients who were followed up for 8 weeks.Conclusion Diaphragm biofeedback improves reflux symptoms significantly and discontinues or reduces the dosage of acid inhibiter in a part of patients. Biofeedback training may provide a new way to enhance antireflux barrier at the EGJ in GERD patients.