Bridge Swallowing Exercise for Gastroesophageal Reflux Disease Symptoms: A Pilot Study

Objectives: We previously reported that swallowing in the bridge position (bridge swallowing) increased distal esophageal contractions and lower esophageal sphincter pressure against gravity. Moreover, bridge swallowing had the potential to strengthen esophageal peristalsis. In this study, we sought...

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Published inProgress in Rehabilitation Medicine Vol. 7; p. 20220054
Main Authors Shigematsu, Takashi, Aoyama, Kei, Kunieda, Kenjiro, Wada, Emiko, Fujishima, Ichiro, Ohno, Tomohisa
Format Journal Article
LanguageEnglish
Published The Japanese Association of Rehabilitation Medicine 01.01.2022
JARM
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ISSN2432-1354
2432-1354
DOI10.2490/prm.20220054

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Abstract Objectives: We previously reported that swallowing in the bridge position (bridge swallowing) increased distal esophageal contractions and lower esophageal sphincter pressure against gravity. Moreover, bridge swallowing had the potential to strengthen esophageal peristalsis. In this study, we sought to evaluate whether the bridge swallowing exercise could improve gastroesophageal reflux disease (GERD) symptoms and gastroscopy findings.Methods: Seventeen subjects with scores of 8 points or higher on the Frequency Scale for Symptoms of GERD (FSSG) questionnaire participated in the study. The exercise of dry swallowing in the bridge posture lasted 4 weeks and was performed ten times per day. FSSG scores were compared before and after exercise. Three of the 17 participants underwent upper gastrointestinal endoscopy. The modified Los Angeles classification of reflux esophagitis was used for objective assessment before and after exercise.Results: No participants dropped out of this study. FSSG scores improved significantly after exercise (from median [range] 16 [13–21] points before exercise to 5 [4–10] points after exercise, P <0.001). Upper gastrointestinal endoscopy showed improvement in the modified Los Angeles classification grade in one participant.Conclusions: The bridge swallowing exercise significantly improves FSSG scores. This exercise can be performed easily and safely without adverse events. Further multicenter prospective studies are needed to validate that the bridge swallowing exercise is effective in improving GERD.
AbstractList Objectives: We previously reported that swallowing in the bridge position (bridge swallowing) increased distal esophageal contractions and lower esophageal sphincter pressure against gravity. Moreover, bridge swallowing had the potential to strengthen esophageal peristalsis. In this study, we sought to evaluate whether the bridge swallowing exercise could improve gastroesophageal reflux disease (GERD) symptoms and gastroscopy findings.Methods: Seventeen subjects with scores of 8 points or higher on the Frequency Scale for Symptoms of GERD (FSSG) questionnaire participated in the study. The exercise of dry swallowing in the bridge posture lasted 4 weeks and was performed ten times per day. FSSG scores were compared before and after exercise. Three of the 17 participants underwent upper gastrointestinal endoscopy. The modified Los Angeles classification of reflux esophagitis was used for objective assessment before and after exercise.Results: No participants dropped out of this study. FSSG scores improved significantly after exercise (from median [range] 16 [13–21] points before exercise to 5 [4–10] points after exercise, P <0.001). Upper gastrointestinal endoscopy showed improvement in the modified Los Angeles classification grade in one participant.Conclusions: The bridge swallowing exercise significantly improves FSSG scores. This exercise can be performed easily and safely without adverse events. Further multicenter prospective studies are needed to validate that the bridge swallowing exercise is effective in improving GERD.
We previously reported that swallowing in the bridge position (bridge swallowing) increased distal esophageal contractions and lower esophageal sphincter pressure against gravity. Moreover, bridge swallowing had the potential to strengthen esophageal peristalsis. In this study, we sought to evaluate whether the bridge swallowing exercise could improve gastroesophageal reflux disease (GERD) symptoms and gastroscopy findings.ObjectivesWe previously reported that swallowing in the bridge position (bridge swallowing) increased distal esophageal contractions and lower esophageal sphincter pressure against gravity. Moreover, bridge swallowing had the potential to strengthen esophageal peristalsis. In this study, we sought to evaluate whether the bridge swallowing exercise could improve gastroesophageal reflux disease (GERD) symptoms and gastroscopy findings.Seventeen subjects with scores of 8 points or higher on the Frequency Scale for Symptoms of GERD (FSSG) questionnaire participated in the study. The exercise of dry swallowing in the bridge posture lasted 4 weeks and was performed ten times per day. FSSG scores were compared before and after exercise. Three of the 17 participants underwent upper gastrointestinal endoscopy. The modified Los Angeles classification of reflux esophagitis was used for objective assessment before and after exercise.MethodsSeventeen subjects with scores of 8 points or higher on the Frequency Scale for Symptoms of GERD (FSSG) questionnaire participated in the study. The exercise of dry swallowing in the bridge posture lasted 4 weeks and was performed ten times per day. FSSG scores were compared before and after exercise. Three of the 17 participants underwent upper gastrointestinal endoscopy. The modified Los Angeles classification of reflux esophagitis was used for objective assessment before and after exercise.No participants dropped out of this study. FSSG scores improved significantly after exercise (from median [range] 16 [13-21] points before exercise to 5 [4-10] points after exercise, P <0.001). Upper gastrointestinal endoscopy showed improvement in the modified Los Angeles classification grade in one participant.ResultsNo participants dropped out of this study. FSSG scores improved significantly after exercise (from median [range] 16 [13-21] points before exercise to 5 [4-10] points after exercise, P <0.001). Upper gastrointestinal endoscopy showed improvement in the modified Los Angeles classification grade in one participant.The bridge swallowing exercise significantly improves FSSG scores. This exercise can be performed easily and safely without adverse events. Further multicenter prospective studies are needed to validate that the bridge swallowing exercise is effective in improving GERD.ConclusionsThe bridge swallowing exercise significantly improves FSSG scores. This exercise can be performed easily and safely without adverse events. Further multicenter prospective studies are needed to validate that the bridge swallowing exercise is effective in improving GERD.
ArticleNumber 20220054
Author Ohno, Tomohisa
Fujishima, Ichiro
Kunieda, Kenjiro
Wada, Emiko
Aoyama, Kei
Shigematsu, Takashi
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  organization: Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
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  fullname: Aoyama, Kei
  organization: Department of Rehabilitation Medicine, Chikamori Rehabilitation Hospital, Kochi, Japan
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  fullname: Kunieda, Kenjiro
  organization: Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
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  organization: Department of Rehabilitation Medicine, Chikamori Rehabilitation Hospital, Kochi, Japan
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  organization: Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
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  organization: Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
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10.1007/s00535-004-1417-7
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10.1111/bcpt.13023
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10.1111/j.1440-1746.2004.03591.x
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10.1097/01.mcg.0000225631.07039.6d
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10.5056/jnm.2014.20.1.6
10.1111/j.1572-0241.2005.41217.x
10.1016/S1047-9651(18)30699-5
10.1136/gut.2004.051821
10.1007/s00535-022-01861-z
10.2478/rjim-2020-0038
10.1007/s00228-020-02854-8
10.1038/ajg.2009.77
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References 16. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN, Wallin L: The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 1996;111:85–92. PMID:8698230, DOI:10.1053/gast.1996.v111.pm8698230
19. Kinoshita Y, Ashida K, Miwa H, Hongo M: The impact of lifestyle modification on the health-related quality of life of patients with reflux esophagitis receiving treatment with a proton pump inhibitor. Am J Gastroenterol 2009;104:1106–1111. PMID:19337239, DOI:10.1038/ajg.2009.77
11. Song HJ, Jiang X, Henry L, Nguyen MH, Park H: Proton pump inhibitors and risk of liver cancer and mortality in patients with chronic liver disease: a systematic review and meta-analysis. Eur J Clin Pharmacol 2020;76:851–866. PMID:32172363, DOI:10.1007/s00228-020-02854-8
21. Lin M, Gerson LB, Lascar R, Davila M, Triadafilopoulos G: Features of gastroesophageal reflux disease in women. Am J Gastroenterol 2004;99:1442–1447. PMID:15307857, DOI:10.1111/j.1572-0241.2004.04147.x
7. Iwakiri K, Fujiwara Y, Manabe N, Ihara E, Kuribayashi S, Akiyama J, Kondo T, Yamashita H, Ishimura N, Kitasako Y, Iijima K, Koike T, Omura N, Nomura T, Kawamura O, Ohara S, Ozawa S, Kinoshita Y, Mochida S, Enomoto N, Shimosegawa T, Koike K: Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021. J Gastroenterol 2022;57:267–285. PMID:35226174, DOI:10.1007/s00535-022-01861-z
5. Dent J, El-Serag HB, Wallander MA, Johansson S: Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005;54:710–717. PMID:15831922, DOI:10.1136/gut.2004.051821
13. Iwakiri K, Kinoshita Y, Habu Y, Oshima T, Manabe N, Fujiwara Y, Nagahara A, Kawamura O, Iwakiri R, Ozawa S, Ashida K, Ohara S, Kashiwagi H, Adachi K, Higuchi K, Miwa H, Fujimoto K, Kusano M, Hoshihara Y, Kawano T, Haruma K, Hongo M, Sugano K, Watanabe M, Shimosegawa T: Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol 2016;51:751–767. PMID:27325300, DOI:10.1007/s00535-016-1227-8
15. Kusano M, Shimoyama Y, Sugimoto S, Kawamura O, Maeda M, Minashi K, Kuribayashi S, Higuchi T, Zai H, Ino K, Horikoshi T, Sugiyama T, Toki M, Ohwada T, Mori M: Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J Gastroenterol 2004;39:888–891. PMID:15565409, DOI:10.1007/s00535-004-1417-7
9. DeVault KR, Castell DO: Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005;100:190–200. PMID:15654800, DOI:10.1111/j.1572-0241.2005.41217.x
12. Haastrup PF, Thompson W, Søndergaard J, Jarbøl DE: Side effects of long‐term proton pump inhibitor use: a review. Basic Clin Pharmacol Toxicol 2018;123:114–121. PMID:29658189, DOI:10.1111/bcpt.13023
14. Iwakiri K, Hayashi Y, Kotoyori M, Tanaka Y, Kawakami A, Sakamoto C, Holloway RH: Transient lower esophageal sphincter relaxations (TLESRs) are the major mechanism of gastroesophageal reflux but are not the cause of reflux disease. Dig Dis Sci 2005;50:1072–1077. PMID:15986857, DOI:10.1007/s10620-005-2707-5
17. Hoshihara Y, Hashimoto M: Endoscopic classification of reflux esophagitis [in Japanese]. Jpn J Clin Med 2000;58:1808–1812. PMID:11004807
1. Palmer JB, DuChane AS: Rehabilitation of swallowing disorders in the elderly. In: Felsenthal G, Garrison SJ, Steinberg FU (eds). Rehabilitation of the aging and elderly patient. Williams & Wilkins, Baltimore, 1994; 275–287.
2. Palmer JB, DuChane AS: Rehabilitation of swallowing disorders due to stroke. Phys Med Rehabil Clin N Am 1991;2:529–546. DOI:10.1016/S1047-9651(18)30699-5
4. Maradey-Romero C, Fass R: New and future drug development for gastroesophageal reflux disease. J Neurogastroenterol Motil 2014;20:6–16. PMID:24466441, DOI:10.5056/jnm.2014.20.1.6
6. Goh KL: Changing epidemiology of gastroesophageal reflux disease in the Asian-Pacific region: an overview. J Gastroenterol Hepatol 2004;19(Suppl 3):S22–S25. PMID:15324378, DOI:10.1111/j.1440-1746.2004.03591.x
18. Maruyama H, Hosomi S, Nebiki H, Fukuda T, Nakagawa K, Okazaki H, Yamagami H, Hara J, Tanigawa T, Machida H, Aomatsu K, Watanabe Y, Sato H, Uno H, Takaishi O, Nomura T, Ochi M, Oshitani N, Adachi K, Higashimori A, Ominami M, Nadatani Y, Fukunaga S, Otani K, Tanaka F, Kamata N, Nagami Y, Taira K, Watanabe T, Fujiwara Y: Gastrointestinal endoscopic practice during COVID-19 pandemic: a multi-institutional survey. Rom J Intern Med 2021;59:166–173. PMID:33826812, DOI:10.2478/rjim-2020-0038
3. Aoyama K, Kunieda K, Shigematsu T, Ohno T, Fujishima I: Effect of bridge position swallow on esophageal motility in healthy individuals using high-resolution manometry. Dysphagia 2021;36:551–557. PMID:32749546, DOI:10.1007/s00455-020-10169-0
8. Hershcovici T, Fass R: Gastro-oesophageal reflux disease: beyond proton pump inhibitor therapy. Drugs 2011;71:2381–2389. PMID:22117130, DOI:10.2165/11597300-000000000-00000
20. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J: Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2016;14:175–182. PMID:25956834, DOI:10.1016/j.cgh.2015.04.176
10. Fass R: Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol 2007;41:131–137. PMID:17245209, DOI:10.1097/01.mcg.0000225631.07039.6d
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References_xml – reference: 21. Lin M, Gerson LB, Lascar R, Davila M, Triadafilopoulos G: Features of gastroesophageal reflux disease in women. Am J Gastroenterol 2004;99:1442–1447. PMID:15307857, DOI:10.1111/j.1572-0241.2004.04147.x
– reference: 9. DeVault KR, Castell DO: Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005;100:190–200. PMID:15654800, DOI:10.1111/j.1572-0241.2005.41217.x
– reference: 16. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN, Wallin L: The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 1996;111:85–92. PMID:8698230, DOI:10.1053/gast.1996.v111.pm8698230
– reference: 10. Fass R: Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol 2007;41:131–137. PMID:17245209, DOI:10.1097/01.mcg.0000225631.07039.6d
– reference: 6. Goh KL: Changing epidemiology of gastroesophageal reflux disease in the Asian-Pacific region: an overview. J Gastroenterol Hepatol 2004;19(Suppl 3):S22–S25. PMID:15324378, DOI:10.1111/j.1440-1746.2004.03591.x
– reference: 11. Song HJ, Jiang X, Henry L, Nguyen MH, Park H: Proton pump inhibitors and risk of liver cancer and mortality in patients with chronic liver disease: a systematic review and meta-analysis. Eur J Clin Pharmacol 2020;76:851–866. PMID:32172363, DOI:10.1007/s00228-020-02854-8
– reference: 15. Kusano M, Shimoyama Y, Sugimoto S, Kawamura O, Maeda M, Minashi K, Kuribayashi S, Higuchi T, Zai H, Ino K, Horikoshi T, Sugiyama T, Toki M, Ohwada T, Mori M: Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J Gastroenterol 2004;39:888–891. PMID:15565409, DOI:10.1007/s00535-004-1417-7
– reference: 19. Kinoshita Y, Ashida K, Miwa H, Hongo M: The impact of lifestyle modification on the health-related quality of life of patients with reflux esophagitis receiving treatment with a proton pump inhibitor. Am J Gastroenterol 2009;104:1106–1111. PMID:19337239, DOI:10.1038/ajg.2009.77
– reference: 18. Maruyama H, Hosomi S, Nebiki H, Fukuda T, Nakagawa K, Okazaki H, Yamagami H, Hara J, Tanigawa T, Machida H, Aomatsu K, Watanabe Y, Sato H, Uno H, Takaishi O, Nomura T, Ochi M, Oshitani N, Adachi K, Higashimori A, Ominami M, Nadatani Y, Fukunaga S, Otani K, Tanaka F, Kamata N, Nagami Y, Taira K, Watanabe T, Fujiwara Y: Gastrointestinal endoscopic practice during COVID-19 pandemic: a multi-institutional survey. Rom J Intern Med 2021;59:166–173. PMID:33826812, DOI:10.2478/rjim-2020-0038
– reference: 13. Iwakiri K, Kinoshita Y, Habu Y, Oshima T, Manabe N, Fujiwara Y, Nagahara A, Kawamura O, Iwakiri R, Ozawa S, Ashida K, Ohara S, Kashiwagi H, Adachi K, Higuchi K, Miwa H, Fujimoto K, Kusano M, Hoshihara Y, Kawano T, Haruma K, Hongo M, Sugano K, Watanabe M, Shimosegawa T: Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol 2016;51:751–767. PMID:27325300, DOI:10.1007/s00535-016-1227-8
– reference: 14. Iwakiri K, Hayashi Y, Kotoyori M, Tanaka Y, Kawakami A, Sakamoto C, Holloway RH: Transient lower esophageal sphincter relaxations (TLESRs) are the major mechanism of gastroesophageal reflux but are not the cause of reflux disease. Dig Dis Sci 2005;50:1072–1077. PMID:15986857, DOI:10.1007/s10620-005-2707-5
– reference: 20. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J: Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2016;14:175–182. PMID:25956834, DOI:10.1016/j.cgh.2015.04.176
– reference: 2. Palmer JB, DuChane AS: Rehabilitation of swallowing disorders due to stroke. Phys Med Rehabil Clin N Am 1991;2:529–546. DOI:10.1016/S1047-9651(18)30699-5
– reference: 4. Maradey-Romero C, Fass R: New and future drug development for gastroesophageal reflux disease. J Neurogastroenterol Motil 2014;20:6–16. PMID:24466441, DOI:10.5056/jnm.2014.20.1.6
– reference: 3. Aoyama K, Kunieda K, Shigematsu T, Ohno T, Fujishima I: Effect of bridge position swallow on esophageal motility in healthy individuals using high-resolution manometry. Dysphagia 2021;36:551–557. PMID:32749546, DOI:10.1007/s00455-020-10169-0
– reference: 12. Haastrup PF, Thompson W, Søndergaard J, Jarbøl DE: Side effects of long‐term proton pump inhibitor use: a review. Basic Clin Pharmacol Toxicol 2018;123:114–121. PMID:29658189, DOI:10.1111/bcpt.13023
– reference: 5. Dent J, El-Serag HB, Wallander MA, Johansson S: Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2005;54:710–717. PMID:15831922, DOI:10.1136/gut.2004.051821
– reference: 8. Hershcovici T, Fass R: Gastro-oesophageal reflux disease: beyond proton pump inhibitor therapy. Drugs 2011;71:2381–2389. PMID:22117130, DOI:10.2165/11597300-000000000-00000
– reference: 1. Palmer JB, DuChane AS: Rehabilitation of swallowing disorders in the elderly. In: Felsenthal G, Garrison SJ, Steinberg FU (eds). Rehabilitation of the aging and elderly patient. Williams & Wilkins, Baltimore, 1994; 275–287.
– reference: 17. Hoshihara Y, Hashimoto M: Endoscopic classification of reflux esophagitis [in Japanese]. Jpn J Clin Med 2000;58:1808–1812. PMID:11004807
– reference: 7. Iwakiri K, Fujiwara Y, Manabe N, Ihara E, Kuribayashi S, Akiyama J, Kondo T, Yamashita H, Ishimura N, Kitasako Y, Iijima K, Koike T, Omura N, Nomura T, Kawamura O, Ohara S, Ozawa S, Kinoshita Y, Mochida S, Enomoto N, Shimosegawa T, Koike K: Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021. J Gastroenterol 2022;57:267–285. PMID:35226174, DOI:10.1007/s00535-022-01861-z
– ident: 17
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  doi: 10.2165/11597300-000000000-00000
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  doi: 10.1007/s00535-004-1417-7
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  doi: 10.1007/s00455-020-10169-0
– ident: 12
  doi: 10.1111/bcpt.13023
– ident: 14
  doi: 10.1007/s10620-005-2707-5
– ident: 21
  doi: 10.1111/j.1572-0241.2004.04147.x
– ident: 6
  doi: 10.1111/j.1440-1746.2004.03591.x
– ident: 16
  doi: 10.1053/gast.1996.v111.pm8698230
– ident: 1
– ident: 13
  doi: 10.1007/s00535-016-1227-8
– ident: 10
  doi: 10.1097/01.mcg.0000225631.07039.6d
– ident: 20
  doi: 10.1016/j.cgh.2015.04.176
– ident: 4
  doi: 10.5056/jnm.2014.20.1.6
– ident: 9
  doi: 10.1111/j.1572-0241.2005.41217.x
– ident: 2
  doi: 10.1016/S1047-9651(18)30699-5
– ident: 5
  doi: 10.1136/gut.2004.051821
– ident: 7
  doi: 10.1007/s00535-022-01861-z
– ident: 18
  doi: 10.2478/rjim-2020-0038
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  doi: 10.1007/s00228-020-02854-8
– ident: 19
  doi: 10.1038/ajg.2009.77
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Snippet Objectives: We previously reported that swallowing in the bridge position (bridge swallowing) increased distal esophageal contractions and lower esophageal...
We previously reported that swallowing in the bridge position (bridge swallowing) increased distal esophageal contractions and lower esophageal sphincter...
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SubjectTerms dry swallowing
dysphagia
esophageal motility
gastroscopy
GERD
Original
Title Bridge Swallowing Exercise for Gastroesophageal Reflux Disease Symptoms: A Pilot Study
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https://www.proquest.com/docview/2730647163
https://pubmed.ncbi.nlm.nih.gov/PMC9550520
Volume 7
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ispartofPNX Progress in Rehabilitation Medicine, 2022, Vol.7, pp.20220054
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