Esophageal dysphagia and reflux symptoms before and after oral IQoro^(R) training

AIM: To examine whether muscle training with an oral IQoroR screen(IQS) improves esophageal dysphagia and reflux symptoms.METHODS: A total of 43 adult patients(21 women a n d 2 2 m e n) w e re c o n s e c u t i ve l y re fe r re d t o a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study(group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients(group B; median age 57 years,range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire(esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale(ability to swallow food: score 0-100), lip force test(≥ 15 N), velopharyngeal closure test(≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients(median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry.RESULTS: Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score(range): 2.5(1-3) vs 0.9(0-2), P < 0.001]. Symptoms of reflux were reported before training in 86% of the patients who showed improvement at follow-up [1.7(0-3) vs 0.5(0-2), P < 0.001). The visual analogue scale scores were classified as pathologic in all 43 patients, and 100% showed improvement after IQS training [71(30-100) vs 22(0-50), P < 0.001]. No significant difference in symptom frequency was found between groups A and B before or after IQS training. The lip force test [31 N(12-80 N) vs 54 N(27-116), P < 0.001] and velopharyngeal closure test values [28 s(5-74 s) vs 34 s(13-80 s), P < 0.001] were significantly higher after IQS training. The oral IQS traction results showed an increase in mean pressure in the diaphragmatic hiatus region from 0 mm Hg at rest(range: 0-0 mm HG) to 65 mm Hg(range: 20-100 mm Hg). CONCLUSION: Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.