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Physiotherapy for gastroesophageal reflux
ŠIRMAROVÁ, Jitka
This thesis deals with the issue of etiology and gastroesophageal reflux disease (GERD). It has been proved that the locomotor system affects occurrence of this disease in many aspects therefore, apart from the primary care of gastroenterologists and general practitioners, treatment using physiotherapeutic techniques becomes significant. Sphincter mechanism at the lower end of the oesophagus being the most important anti-reflux barrier in terms of function is described in the theoretical part in detail. Possible ways and factors involved in occurrence of gastroesophageal reflux and then current treatment of gastroesophageal reflux disease are mentioned. The other part of the theoretical part is aimed at: relations between the internal organs and locomotor system, the diaphragm function and its relation to occurrence of GERD, and possibilities of rehabilitation treatment of patients with this disease. The goal of the theoretical part was to provide a research on the current situation. The practical part was prepared by means of a qualitative research. The tested set consisted of three patients diagnosed with GERD being treated at the Gastroenterological Ward in České Budějovice Hospital. Patients? anamneses were taken and kinesiological testing was done. Similarly, all three patients were identified with a disorder of trunk stabilization. Upon this, individual therapies were proposed and carried out, which was the goal of the practical part, too. Physiotherapy was aimed at: affecting the position of the rib cage and improving its dynamics while breathing, training of breathing stereotype, activation of the abdominal wall, affecting the stabilizing function of legs, exercises in developmental series and modified positions, Jacobson's progressive muscle relaxation, and affecting reflexive changes using soft techniques. The research issue was whether the symptoms of GERD could be affected by treatment of functional disorders of the locomotor system in a positive way. There were certain changes in the kinesiological testing (e.g. change in the activity of lower and upper fixators of scapulae with relaxation of the trapezius, releasing the rigidity of the chest, affecting the dynamic stability of the body) during a three-month therapy. However, functional disorders were not affected that much so any described symptoms of GERD could be changed. The results of the therapy were limited by motivation, attitude and patients? metal state. Not only the internal organ but also the locomotor system probably plays a role in occurrence of the reflux; but also psyche, and all these parts of a human being affect each other. Therefore the treatment of a multifactorial disease such as GERD should be comprehensive. Apart from physiotherapy, metal area, too, and all factors should be treated at the same time, which requires interdisciplinary cooperation unfortunately lagging behind.
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