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The Crura of the Diaphragm and GERD

The Crura of the Diaphragm and GERD
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Gastroesophageal reflux disease (GERD) is a condition that occurs when the contents from the stomach reflux back up into the esophagus—the tube that transfers food and drink from the mouth to the acidic environment of the stomach-leading to a foul burning taste in the throat and the chest pain known as heart burn. Standard treatment options include lifestyle modifications or the use of proton pump inhibitors (PPI). For the calcitrant (non-responders), a medical specialist may recommend surgery to tighten up the hiatus—or opening in the diaphragm through which the esophagus travels prior to connecting with the stomach. Due to the significant side-effects associated with long-term PPI use and a desire to avoid surgery, many patients may seek an alternative approach to manage GERD based on either their own research or at the recommendation of their treating doctor.

In recent years, several studies have focused on the use of manual therapies and other conservative approaches to strengthen the muscles associated with the esophagus to prevent reflux of acids from the stomach. One study demonstrated the benefit of specific respiratory exercises aimed at strengthening the crura of the diaphragm. The authors reported that this simple exercise increased the patients’ quality of life, decreased the GERD-related symptoms, and reduced their PPI use. The authors hypothesized that the crura of the diaphragm is a key component of the anti-reflux barrier because it functions as an extrinsic esophagogastric junction sphincter (valve). Another study that included 60 GERD patients found that visceral manipulation technique to improve function in this region also led to improvements in GERD-related symptoms, PPI use, and quality of life.

A more recent 30-patient randomized controlled trial evaluated the efficacy of myofascial release—a manual therapy performed by applying three-dimensional low-load pressures to the fascial tissue over extended periods with the goal of pain reduction and function improvement—in improving GERD symptoms using techniques designed to restore the myofascial properties of the crura of the diaphragm. Participants underwent either four 25-minute myofascial release sessions spread over two weeks or four sham treatments in the same time frame. Those in the myofascial release group reported significant improvements in GERD symptoms, PPI use, and quality of life after both the conclusion of the treatment period and one month later during a follow-up visit. A related study that used high-resolution esophageal manometry showed that myofascial release resulted in an immediate increase in lower esophageal sphincter pressure.

These studies support the fact that there are alternative treatment options for managing GERD without the indefinite use of PPIs or more invasive options. If you’re currently under treatment for GERD with your medical physician, ask them if they’d consider referring you to a doctor of chiropractic for manual therapy treatment to improve the function of the crura of the diaphragm and related tissues to see if it can improve your GERD-related symptoms.

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