GERD physiotherapy
Gastroesophageal reflux disease (GERD) is one of the most common diseases of the digestive tract and can fundamentally reduce the quality of life.
What is reflux?
Gastroesophageal reflux is the backflow of stomach contents into the esophagus. This is a natural phenomenon occurring in each of us, especially after eating, and serves primarily to remove gas from the stomach.
Repeated and prolonged exposure of the esophageal mucosa to stomach contents may cause unpleasant subjective symptoms or damage to the mucosa in the esophagus, pharynx, oral cavity, or respiratory tract. At that moment we are already talking about gastroesophageal reflux disease.
How does reflux developes?
Or what causes heartburn.
In the development of GERD, the ratio between pro-reflux factors (stomach or intestinal contents and its aggressiveness towards the esophageal mucosa) and protective mechanisms, which include the correct function of the diaphragm and the lower esophageal sphincter, the cleansing ability of the esophagus, proper gastric emptying, the resistance of the esophageal mucosa, etc., play a crucial role.
We talk about reflux disease when the capacities of defense mechanisms are exceeded and there is irritation or inflammation of the esophagus and unpleasant symptoms such as heartburn, regurgitation or chest pain.
Reflux is not just one
Esophageal reflux disease is characterized by a wide spectrum of various symptoms, from the mildest (occasional heartburn, acidity in the mouth, frequent belching or coughing, etc.) to major complications such as the presence of Barrett's esophagus.
There are also many definitions, terms and abbreviations describing different types of reflux, which we will explain at the beginning for a better understanding.
GERD
Gastroesophageal reflux disease is a general name that most often describes damage to the esophageal mucosa or subjective manifestations caused by the return of stomach contents into the esophagus.
Reflux esophagitis
It is an inflammation of the esophagus caused by reflux disease and at the same time a very typical symptom of it, which can be diagnosed by a doctor during a gastroscopy.
NERD
Non-erosive reflux disease describes a condition where people experience heartburn or other reflux symptoms but do not have damage to the lining of the esophagus. This type of reflux occurs in up to 50% of patients.
EER
Extraesophageal reflux - Sometimes also referred to as extraesophageal reflux, is a condition where stomach contents penetrate above the upper esophageal sphincter and cause problems in the pharynx, oral cavity, or airways. This type is often diagnosed by a pulmonary or ENT doctor.
LPRD
Laryngopharyngeal reflux disease is essentially the same term for EER used more abroad and describing manifestations in the area of the pharynx and larynx.
Silent
reflux
Laryngopharyngeal reflux disease is essentially the same term for EER used more abroad and describing manifestations in the area of the pharynx and larynx.
Duodenogastric reflux
This term describes a situation where the refluxate does not only come from the stomach, but even contains bile acids or the contents of the duodenum (the first part of the small intestine).
Stress
reflux
An expression that points to the connection between psychological stress and reflux disease. In some cases, this is the name given to reflux arising on the basis of increased intra-abdominal pressure (cough, deep breath, etc.).
Causes
Reflux disease is one of the most frequently treated diseases in Western countries, its incidence is constantly increasing and it can even be referred to as a disease of civilization. It is not so surprising that lifestyle is the main contributor to the disruption of defense mechanisms. The following factors can play a major role in the development of the disease.
Overweight, high BMI
Obesity is a strong risk factor for the development of symptoms of reflux disease and esophageal esophagitis.
Type of
diet
Unsuitable foods for reflux vary from person to person, it's always a good idea to try what specifically irritates your reflux.
Way
of eating
Especially going to bed shortly after eating, large portions, not chewing enough/rushing to eat.
Coffee and smoking
Smoking and frequent coffee drinking can reduce the activity of the lower esophageal sphincter and worsen GERD symptoms.
Movement habits
Above all, lack of movement or, on the contrary, some strength exercises with overloading of the abdominal wall.
Breathing
pattern
The predominance of chest breathing and the absence of use of the diaphragm leads to a weakening of the esophageal sphincter.
Ergonomics of work
An inappropriate working position can negatively affect body posture, breathing pattern and worsen reflux.
Mental
stress
Although this is a very general factor, stress can also play a very important role in the sensitivity of the autonomic nervous system.
Reflux disease is a multifactorial disease. In each person, the disease is caused by a combination of different influences, and according to the prevailing factors, it is possible to adapt an individual treatment plan to a certain extent.
Did you know that...
20%
of people in Western countries suffer from reflux. At the same time, studies mostly include only basic symptoms (heartburn and regurgitation), so these numbers are still significantly underestimated.
5x
Patients with untreated and long-standing reflux have a greater risk of developing Barrett's esophagus, which is a precancerous condition.
25%
in patients with heartburn, the esophageal mucosa is not damaged and their return of stomach contents is completely physiological. In addition, 50% of them do not respond to conventional drug treatment. This is the so-called "functional heartburn".
Symptoms
How do you know you have reflux? Below we list the most common manifestations of reflux, which can be divided into esophageal and extraesophageal.
Esophageal symptoms
-
Heartburn/heartburn – is the most common symptom of GERD. It is a subjective perception of the patient described as a burning, cutting or painful sensation behind the sternum.
-
Regurgitation (return of swallowed food back into the mouth) occurs in up to 60% of patients.
-
Frequent belching
-
Chest pains
-
Difficult or painful swallowing
-
Excessive or paroxysmal salivation
-
Dyspepsia - a collective term for a variety of digestive problems
Extraesophageal symptoms
Extraesophageal symptoms are manifested in extraesophageal reflux, in which the contents of the stomach or duodenum penetrate above the upper esophageal sphincter. Symptoms can be divided into the head, neck and oral cavity (ENT symptoms) and the larynx, airways and lungs (pulmonary symptoms).
ENT symptoms
-
Increased tooth decay - caused by the action of hydrochloric acid on the enamel
-
Bitterness or acidity in the mouth
-
Increased bad breath
-
Sensation of a lump in the throat (globus pharyngeus)
-
Otitis media
-
Dryness in the throat
-
Pain/pressure in the throat with no apparent cause
-
Ear pain (otalgia)
Pulmonary symptoms
-
Chronic cough
-
Frequent inflammation of the respiratory tract (bronchitis)
-
Inflammation of the larynx and pharynx (laryngitis/pharyngitis)
-
Hoarseness
-
Bronchial asthma - up to 70% of people with asthma have an altered pH in the esophagus, and a quarter of them respond positively to acid-suppressing treatment.
-
Heavy fogging
-
Stuffiness
More serious, but infrequent symptoms are heart rhythm disturbances in the sense of bradycardia or tachycardia. The last mentioned, but at the same time very important symptom is the effect on the patient's psyche. Reflux disease can be very limiting in normal everyday life, which can have a negative impact on a person's psychological side in the long term.
Reflux treatment
How to get rid of reflux and heartburn? Currently, the most used approaches in the treatment of reflux can be divided into two basic pillars - pharmacological and surgical treatment. Both types are widely used but have their own risks and side effects.
Medicines for reflux
Pharmacological treatment focuses on alleviating the symptoms and reducing the damage caused by the acid and enzymes, not on affecting the cause. The most common heartburn medications are proton pump inhibitors = PPIs (e.g. Omeprazole).
Advantages: high efficacy and low side effects
Disadvantages: they do not target the cause of the problem, after discontinuation they can lead to stomach acidification and PPI dependence, reduce the natural defenses of the digestive system, reduce the absorption of vitamin B12, calcium and iron (increased risk of osteoporosis and fractures especially in postmenopausal women).
Surgery
The aim of the operations is either to create greater pressure in the lower part of the esophagus or to adjust the anatomical conditions in the area where the esophagus and stomach meet.
In terms of effectiveness, surgeries are as effective as PPI treatment and there is no guarantee that the symptoms will not return after a few years. In addition, in some cases, digestive problems, feelings of fullness, inability to burp or vomit appear after surgery as side effects. Therefore, surgery should only be planned after failure of conservative treatment or in case of serious complications.
However, the essence of reflux disease does not lie in bad anatomy or excessive acid production, but in the improper function of the esophageal sphincter and its abnormal relaxations.
Physiotherapy
The esophageal sphincter is largely made up of the diaphragm, which is part of the antireflux barrier. The diaphragm is an inspiratory muscle, and it is possible to train it with appropriate breathing exercises and thus improve its function and condition. This will also improve the activity of the esophageal sphincter.
Principles of physiotherapy treatment in GERD
As part of the physiotherapeutic treatment of gastroesophageal reflux, the basis is a detailed initial interview and a careful anamnesis. Thanks to this, we can get a broad insight into your difficulties. You can read more about our approach to work here.
The therapy itself can be divided into four basic areas. The treatment plan is always individual and is created by combining these areas of care.
Myofascial
We mainly treat painful muscle spasms (trigger points) or functional disorders of the spine or ribs, which can directly limit the function of the esophageal sphincter or imitate digestive difficulties.
Postural
Working with posture, spinal stability or rib cage positioning improves the conditions for proper diaphragm function or increases the activity of the lower esophageal sphincter.
Respiratory
Properly applied respiratory rehabilitation can positively influence the activity of the esophageal sphincter by strengthening the diaphragm and thus improve the symptoms of GERD.
Visceral
Visceral therapy involves gentle manual techniques applied to internal organs, abdominal fascia or scars. Thanks to visceral techniques, tension can be released in the area of the abdominal organs and contribute to their better function.
Of course, the treatment also includes recommendations for appropriate regimen measures in terms of diet, exercise or work ergonomics.
What is your experience with GERD physiotherapy with us?
I came to Physiohub for my reflux problem and after 2 visits and some home exercises I am much better.
Jan Z.
And how satisfied are you with our care in general?
"I've been several times already and I have to say it's great. I can only recommend it to everyone."
Zdeněk N.
"A great approach and after two or three years of going through all the hell I finally feel like things are moving in the right direction."
Jana F.
"Empathetic approach, quick analysis of the problem and detailed explanation of what happened.
Jan T.
"Clean modern environment, great communication, everything explained and assessed comprehensively."
Hana Č.
For comprehensive care, it may be necessary to extend the treatment to other specialties such as gastroenterology or ENT. In this case, we will recommend or help you find the specialist.
When to see a doctor immediately?
At Physiohub, we welcome previous medical examinations as well as results from imaging methods or other examinations. However, they are not a necessity, and in case of suspicion of a more serious problem that does not fall under our competence, we send you to a doctor in the first place.
However, there are situations where your steps should be directed to the doctor immediately: unexplained weight loss, persistent chest pain, repeated vomiting, blood in the stool, significant difficulty or pain when swallowing.
What you will get from your visit
01
Detailed examination by a physiotherapist
02
Better insight into the origin of pain
03
Therapy in the context of painful areas
04
Tips and advice to prevent difficulties