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Osteopathic manual therapy (OMT) in treatment of gastroesophageal reflux disease (GERD)

Kjell E Bjornaes, Geir Elvbakken, B�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?�?¥rd Dalhoi1, Tor Harald Garberg, Joachim Kaufmann, Espen Glomsrod, Ola Reiertsen and Stig Larsen*

Background: Osteopathic Manual Therapy (OMT) is a non-pharmaceutical and none-invasive treatment, designed to treat Gastroesophageal Reflux Disease (GERD). The aims were to determine a Minimum Efficacy Dose (MED) and the longterm effect of OMT in the treatment of GERD. Materials and method: The study was performed as a two-dimensional, between-patient Response Surface Pathway (RSP) designed multicenter study with “Number of OMTs” and “Treatment Interval” as interventional variables. The main response variable was the percent reduction in the sum of the five GERD-scores from baseline. Three patients on the first design level received six OMT with five days’ interval. The number of OMTs and treatment interval in the second (n=5) and third design levels (n=7) were based on the results of the previous design level. The mean age and duration of GERD were 50.2 and 10.9 years, ranging from 25.7 to 75.7 years and 0.2 to 36.3 years, respectively. Results: The percent reduction in GERD-score increased with increasing number of OMTs and time intervals, but flattered out after four OMTs and three to four days treatment interval. The estimated MED of OsMT was three treatments with two days interval resulting in a GERD-score reduction of 62.2% (95% CI: 50.3-80.1%). All the five GERD-symptoms and consequently the mean GERD-score were significantly reduced after the first two OMTs, one week, three and 12 months after the last treatment (p<<0.01). One week after last OMT, the GERD-score reduced with 75% and 33% symptoms free patients. At one-year follow-up, the reduction was 63.3% with 46.7% had no GERD-symptoms. Conclusion: Anti-reflux OMT significantly decreases the GERD-symptoms and the use of PPI. 46.7 percent of the patents had no GERD symptoms one year after treatment. The estimated MED of OMT was three treatments with two days (48 hours) interval.