In 2019, we opened a new centre for the diagnosis and treatment of gastroesophageal reflux disease as part of gastroenterology at the Centre of Physical Medicine. The principal idea behind the creation of the Reflux Centre was an effort to create a comprehensive approach and to combine the care of a gastroenterologist and physiotherapist, which is unique in our conditions. Using state-of-the-art methods such as 24-hour oesophageal pH/impedance monitoring and high-resolution oesophageal manometry, we can diagnose not only gastroesophageal reflux disease and its severity, but also other oesophageal motile disorders such as achalasia. Our technical facilities and top team allow us to approach each patient individually with a focus on the predominant cause of his/her symptoms. Our comprehensive therapeutic approach consists of not only assessing the risks leading to the development of gastroesophageal reflux disease and efforts to eliminate them, but in particular, the incorporation of specialised physiotherapy, which can often treat the cause of the disease.
Gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) is a common disease with a significant impact on the patient’s quality of life. It affects about 20-25% of the population worldwide and, apart from age, most risk factors are related to lifestyle. It mainly manifests as pyrosis (heartburn), regurgitation (gastric reflux into the mouth) or pain behind the sternum when swallowing. However, it can often also manifest in extraoesophageal symptoms such as hoarseness, mucous congestion or a chronic cough. Gastroesophageal reflux can cause inflammation of oesophageal mucosa (erosive reflux disease), which can be easily diagnosed by gastroscopic examination, however, a large percentage of patients (reported up to 70%) do not have inflammatory changes in the oesophagus and these patients can only be diagnosed by oesophageal pH monitoring. 24-hour oesophageal pH/impedance monitoring has become the gold standard for the examination of patients with suspected reflux disease. This method made it possible to detect the presence of pathological reflux and thus distinguish functional problems from reflux disease. Impedance significantly increased test sensitivity due to the ability to differentiate the type of reflux (based on pH, nature of the reflux and height of propagation up the oesophagus), which allows the examination of patients even on continued anti-reflux treatment. A major advantage is the ability to show the correlation between symptoms and reflux.
Standard treatment of GERD includes drugs to suppress the production of gastric acid, but this does not address the underlying cause, only the symptoms of the disease. The principal cause of gastroesophageal reflux disease is the failure of the anti-reflux barrier, whose main components are the lower oesophageal sphincter (LOS) and diaphragm. Our treatment consists of close cooperation between gastroenterology and physiotherapy, where, in addition to treatment with medication, we also use respiratory exercises and manual techniques focusing on the diaphragm under the guidance of a specialised physiotherapist. The effects of gastroenterological physiotherapy have been documented in a number of studies and are evident after six to eight weeks. In addition, continued exercise often results in a significant reduction in the need for antisecretory medication.
The cause and effects of reflux disease on oesophageal mobility can be diagnosed using high-resolution oesophageal manometry. Using this method, we can evaluate not only the motility of the oesophagus, but also the function of both oesophageal sphincters simultaneously. We also evaluate whether a patient with gastroesophageal reflux disease will benefit from physiotherapy by using manometry to display the LOS and diaphragm in detail and determining whether they are working together properly as the aforementioned anti-reflux barrier. A large percentage of patients with reflux have a separation (division) of the diaphragm and LOS, which is a major opportunity for physiotherapy.
Oesophageal manometry is also an irreplaceable method for the diagnosis of the majority of motility disorders of the oesophagus, which most often manifest as the feeling of food/liquid stuck in the oesophagus (dysphagia). Such a disorder may be oesophageal achalasia caused by a failure of the LOS to relax. In addition to dysphagia, achalasia also usually manifests as weight loss, but it is very successfully treated today, including endoscopically.
24-hour oesophageal pH/impendence monitoring and high-resolution oesophageal manometry are mini-invasive, state-of-the-art procedures. They play an irreplaceable role in the diagnosis of reflux disease and other functional disorders of the oesophagus.
Dr. Lucie Zdrhová M.D.
Do you suffer from symptoms such as heartburn, gastric reflux, acidity in the mouth or difficulty swallowing?