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Increase of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux


  • Conflict of Interest: Guarantor of the article: Tomas Navarro-Rodriguez, MD, PhD

  • Specific author contributions: Study conductance, database development, data analysis, and manuscript writing: Rafael Corrêa Vieira da Silva; Study conductance and database development: Cláudia Cristina de Sá; Protocol development, study conductance, database development, and data analysis: Luiz Henrique de Souza Fontes, Fernando Augusto Mardiros Herbella Fernandes, and Ricardo Anuar Dib; Data interpretation and manuscript writing: Ángel Oliva Pascual-Vaca, Cleofás Rodriguez Blanco, and Rogerio Augusto Queiroz; Protocol development, technology development, supervision of study conductance, data interpretation, and manuscript writing: Tomas Navarro-Rodriguez

  • Financial support: Nonfinancial

  • Potential competing interests: None

Dr Tomas Navarro-Rodriguez, MD, PhD, Department of Gastroenterology – Clinical Gastroenterology, University of São Paulo School of Medicine, Avenue Dr Eneas Carvalho de Aguiar, 255 – ICHC, 9th floor, office 9159, São Paulo 05403-000, Brazil. Email:


The treatment of gastroesophageal reflux disease may be clinical or surgical. The clinical consists basically of the use of drugs; however, there are new techniques to complement this treatment, osteopathic intervention in the diaphragmatic muscle is one these. The objective of the study is to compare pressure values in the examination of esophageal manometry of the lower esophageal sphincter (LES) before and immediately after osteopathic intervention in the diaphragm muscle. Thirty-eight patients with gastroesophageal reflux disease – 16 submitted to sham technique and 22 submitted osteopathic technique – were randomly selected. The average respiratory pressure (ARP) and the maximum expiratory pressure (MEP) of the LES were measured by manometry before and after osteopathic technique at the point of highest pressure. Statistical analysis was performed using the Student's t-test and Mann–Whitney, and magnitude of the technique proposed was measured using the Cohen's index. Statistically significant difference in the osteopathic technique was found in three out of four in relation to the group of patients who performed the sham technique for the following measures of LES pressure: ARP with P= 0.027. The MEP had no statistical difference (P= 0.146). The values of Cohen d for the same measures were: ARP with d= 0.80 and MEP d= 0.52. Osteopathic manipulative technique produces a positive increment in the LES region soon after its performance.

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