Abstracts: CLINICAL VIGNETTES/CASE REPORTS - ESOPHAGUS
Can Yoga Be Used to Treat Gastroesophageal Reflux Disease (GERD)?
Purpose: Case: A 62 year old male presented with several years history of heartburn which led to dysphagia with solid food. Endoscopy was performed. Based on the findings of severe esophagitis, he was started on high dose Proton Pump Inhibitor (PPI) therapy with dietary modification. A second Endoscopy with ambulatory pH monitoring test (BRAVO) was performed 7 months later, following this, in addition to the previous treatment, a regimen of specific Yoga exercises was initiated. The two Yoga exercises performed by the patient were Agnisar Kriya and Kapal Bhati (videos available on www.youtube.com). Agnisar Kriya can be done by sitting on chair with back straight or by sitting cross-legged on the floor. Following complete exhalation, the abdominal area is moved back and forth while holding the breath out. Kapal Bhati i.e., breathing exercise with forced exhalation. It is better to perform the Agnisar kriya after Kapal Bhati. Both Yoga exercises were performed by the patient for 10 minutes each every morning with an empty stomach. After 7 months of continuous treatment with PPI and yoga, the third endoscopy was performed. One month later, the patient was asked to discontinue the PPI for 10 days and fourth endoscopy was performed in addition to the BRAVO study. Results: The 1st endoscopy results showed a Grade D esophagitis, hiatal hernia with a non-obstructing stricture. The 2nd endoscopy revealed LA Grade C esophagitis, hiatal hernia with a non-obstructing stricture. A simultaneous BRAVO showed a Demeester score (normal < 14.7) of 81 on day 1 and 35 on day 2. The 3rd endoscopy showed a LA Grade A esophagitis, and a small hiatal hernia with non-obstructive stricture. The 4th endoscopy revealed LA Grade B esophagitis, and a large sliding hiatal hernia. A simultaneous BRAVO study was repeated and observed a Demeester score of 12 on day 1 and 17.2 on day 2. Conclusion: The patient used both yoga exercises and PPI that alleviated the symptoms of GERD but did not reduce the hiatal hernia. PPI treatment demonstrated a reduction in the LA grading of esophagitis. On the other hand, the Yoga exercises may have contributed towards a reduction of reflux as seen by an improvement of the Demeester score. One of the possible mechanisms resulting in reduction of the reflux may be that Yoga causes a decrease in the frequency of Transient Lower Esophageal Sphincter Relaxations (TLESR). In essence, the patient's regularity in performing yoga with the right technique has helped relieve his symptoms and can be used as an adjunct to PPI and lifestyle modification in the treatment of GERD.Since this is only a single patient experience, further investigation is warranted into the role of Yoga in the treatment of GERD.© The American College of Gastroenterology 2011. All Rights Reserved.