title: Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training.
abstract: OBJECTIVE
  To examine whether muscle training with an oral IQoro(R) screen (IQS) improves esophageal dysphagia and reflux symptoms.
  
  
  METHODS
  A total of 43 adult patients (21 women and 22 men) were consecutively referred to 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 mmHg at rest (range: 0-0 mmHG) to 65 mmHg (range: 20-100 mmHg).
  
  
  CONCLUSIONS
  Oral IQS training can relieve/improve esophageal dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.
authors.affiliation: Mary Hägg, Speech and Swallowing Centre, Department of Otorhinolaryngology, Hudiksvall Hospital, Hudiksvall, SE 82481, Sweden.
authors.forename: Mary
authors.initials: M
authors.lastname: Hägg
authors.affiliation: Mary Hägg, Speech and Swallowing Centre, Department of Otorhinolaryngology, Hudiksvall Hospital, Hudiksvall, SE 82481, Sweden.
authors.forename: Lita
authors.initials: L
authors.lastname: Tibbling
authors.affiliation: Mary Hägg, Speech and Swallowing Centre, Department of Otorhinolaryngology, Hudiksvall Hospital, Hudiksvall, SE 82481, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Franzén
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004867:Equipment Design; D004947:Esophagus / Q000503:physiopathology*; D005081:Exercise Therapy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Esophageal dysphagia; Manometry; Muscle training; Oral screen; Reflux