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Respiration and posture influence on the activity of upper and lower esophageal sphincters
Bitnar, Petr ; Kobesová, Alena (advisor) ; Dolina, Jiří (referee) ; Malá, Jitka (referee)
Respiration and posture influence on the activity of upper and lower esophageal sphincters Abstract This work explores the effect of postural respiratory function on pressures in the upper esophageal sphincter (UES) and the lower esophageal sphincter (LES). UES and LES pressures were measured using a high-resolution manometry (HRM). Leg raise in a supine position results in significant pressure increase in the UES and LES. Traction of the cervical spine and chest stabilization maneuver significantly reduces pressure in the UES and significantly increases pressure in the LES. Abdominal wall activity, i.e. intra-abdominal pressure (IAP) affecting UES and LES function, was measured using Ohm Belt sensors. IAP is related to body position, i.e. posture. Using verbal and manual guides, the subject can be instructed to increase abdominal wall activity and thus regulate (increase) IAP. Of the five monitored positions (sitting, lying on the back with leg raise, "bear", squat and hang), the greatest increase in IAP occurred in the bear position, i.e. in the position on all fours with a support on both hands and feet. IAP activation, which is significantly dependent on diaphragm activation, can potentially affect LES pressure and UES pressures. Based on the systematic review, it can be concluded that breathing...
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Activity of lower oesophageal sphincter in healthy patients in various postural positions
Beranová, Kateřina ; Bitnar, Petr (advisor) ; Hlava, Štěpán (referee)
The aim of this thesis is to describe information about GERD, its etiology, anatomy, pathology, treatment options and rehabilitation in patients with GERD. Lower oesophageal sphincter and antireflux barrier. The study was approved by the ethics committee. 30 probands were included in the study and their health status was verified using the Health Related Quality of Life questionnaire. A manometric catheter was inserted, proband was instructed to maintain various postural positions. Lying supine with lower limbs elevated above the surface, lying supine with lower limbs elevated above the surface with head fixated manualy, sitting and standing position, load in the center of gravity 3/6/9 kg, load outside the center of gravity 3/6/9 kg, lifting of the office chair. It has been shown that LES pressure increases in all postural positions compared to resting pressure. The positions activate the diaphragm to demonstrate the postural function of the diaphragm. The most significant change in LES pressures was in the postural position of lying supine with lower limbs elevated above the surface, the LES resting pressure of 20.34mmHg changed to the pressure of LES 40.92mmHg. Clinical experience and studies have shown that patients with GERD have disposition for respiratory and / or vertebrogenic difficulties....
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Effect of breathing training and DNS on lower esophageal sphincter and back pain in patients with gastroesophageal reflux disease
Jandáková, Vladana ; Mádle, Kateřina (advisor) ; Babková, Lenka (referee)
This thesis focuses on lower esophageal sphincter and low back pain in patients with gastroesophageal reflux disease (GERD). Common etiological factor of both GERD and low back pain frequently present in GERD patients is diaphragm dysfunction. Diaphragm fulfils respiratory, postural and sphincter functions, all these functions are interrelated which we benefit from in therapy. Theoretical section presents anatomy of the esophagus, upper and lower esophageal sphincters, diaphragm, follows etiology, diagnostic methods and treatment of GERD and LBP as well as common therapeutical approach by means of postural and respiratory physiotherapy. Basic principles of Dynamic Neuromuscular Stabilization and Respiratory muscle training are presented and their use in the treatment of GERD and LBP. Practical section contains a case study of a patient diagnosed with GERD, kinesiological analysis, high resolution manometry of esophagus and therapy focused on diaphragm activation achieved by improving trunk stabilization and by optimising patient's breathing stereotype.
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Monitoring of postural stability of crural diaphragm in patients suffering from functional disorders of upper digestive system with the help of manometry
Sedláčková, Iveta ; Bitnar, Petr (advisor) ; Kodríková, Kateřina (referee)
The diploma thesis aims to describe the functional disorders of the upper gastrointestinal tract with an emphasis on gastroesophageal reflux disease. The theoretical part describes the anatomy, pathophysiology, etiology of GERD and treatment options. In the practical part is measured postural reactivity of the diaphragm in the selected 15 probands with GERD. We measured the postural reactivity of the diaphragm using high resolution manometry in various postural situations: lying on the back with flexion of lower limbs above the surface, standing and standing on the AIREX mat, for standing patients, we used weights of 3,6 and 9 kilos inside and outside the center of gravity. Patients also completed the GERD Health-Related Quality of Life questionnaire. The measurements confirmed an increase in resting pressure in all positions except standing, which correlated with the highest occurrence of reflux episodes in standing. The results were compared with a healthy control group. The activation of the crural part of the diaphragm was the same in both groups. We found in patients with GERD decreased coordination, delayed and influent activation of the crural diaphragm. The most significant increase in pressure in GERD patients occurred in the postural position of the flexed lower limbs and in standing...
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The possibilities of physical therapy in patients with gastroesophageal reflux disease
Zeiselová, Jitka ; Kodríková, Kateřina (advisor) ; Pešková, Lucie (referee)
This bachelor thesis is focused on the problematics of the Gastroesophageal Reflux Disease and on the possibilities of its treatment by physical therapy. According to The Montreal Consensus the gastroesophageal reflux disease is defined as a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. It ranks among the most common gastrointestinal diseases, its prevalence in Europe moves between 8,8 - 25,9 %. As the gastroesophageal reflux disease can be influenced by the patient's lifestyle we can classify it as a lifestyle disease. Theoretical part of the thesis introduces the disease, its etiopathogenesis, symptomatology, diagnostic and therapeutic possibilities. The main aim of the theoretical part is to state an overview of possible physical therapy in patients with this disease. The practical section of the thesis consists of two case reports which include examination in the beginning and at the end of the therapy and the description of the therapy itself.
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Activity of lower oesophageal sphincter in healthy patients in various postural positions
Beranová, Kateřina ; Bitnar, Petr (advisor) ; Hlava, Štěpán (referee)
The aim of this thesis is to describe information about GERD, its etiology, anatomy, pathology, treatment options and rehabilitation in patients with GERD. Lower oesophageal sphincter and antireflux barrier. The study was approved by the ethics committee. 30 probands were included in the study and their health status was verified using the Health Related Quality of Life questionnaire. A manometric catheter was inserted, proband was instructed to maintain various postural positions. Lying supine with lower limbs elevated above the surface, lying supine with lower limbs elevated above the surface with head fixated manualy, sitting and standing position, load in the center of gravity 3/6/9 kg, load outside the center of gravity 3/6/9 kg, lifting of the office chair. It has been shown that LES pressure increases in all postural positions compared to resting pressure. The positions activate the diaphragm to demonstrate the postural function of the diaphragm. The most significant change in LES pressures was in the postural position of lying supine with lower limbs elevated above the surface, the LES resting pressure of 20.34mmHg changed to the pressure of LES 40.92mmHg. Clinical experience and studies have shown that patients with GERD have disposition for respiratory and / or vertebrogenic difficulties....
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Diaphragm in the role of external esophageal sphincter - spirometric - manometric study
Veličková, Barbora ; Bitnar, Petr (advisor) ; Šnajdauf, Martin (referee)
The aim of this thesis is to present a complex information about the etiology, diagnosis and treatment of gastroesophageal reflux disease (GERD) and to further elucidate the function of the diaphragm as the external esophageal sphincter and as a part of the antireflux barrier in patients with GERD. The study included 87 patients with verified GERD. Patients were subjected to a set of postural and respiratory maneuvers - caudal position of chest, abdominal breathing and measuring of the maximal respiratory pressures, all performed on the basis of tolerance to position and maneuver. The high-resolution manometry (HRM) was chosen to record the changes in pressure in the lower esophageal sphincter and for the measurement of respiratory pressures was used the spirometric system MasterScope. It was found that postural and respiratory maneuvers, that activate the diaphragm, increase the pressure in the EGJ. The most significant increase occurred during the maximal inspiratory maneuver, which increased LES pressure up to 261.2 %. The results also show that patients with GERD have reduced the strength of respiratory muscles, especially inspirational muscles. Reaching only 66.5 % of predicted PImax. We have demonstrated that patients with GERD have significantly lower diaphragm muscle strength, what...
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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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