W1074 obese subjects. Eligible participants were at least 18 years old with a BMI of 30-39 kg/m2.
The validated Gastrointestinal Symptom Severity Index was completed at baseline, 6 mos,
Curcumin, a Possible Alternative Treatment for Gastroesophageal Reflux
Jung H. Park, Chris N. Conteas
Curcumin, the active component of turmeric, a common spice used in Indian cooking, has
been used for medicinal purposes for centuries due to its anti-inflammatory properties.
AGA Abstracts
Curcumin regulates multiple molecular targets, including transcription factors, such as
nuclear factor κ-light-chain-enhancer of activated B cells and activator protein 1, which
promote the production of inflammatory cytokines. The traditional treatment for gastroeso-
phageal reflux (GERD) has involved mainly acid suppression. Recent literature (Souza et al,
Gastroenterology 2009; 137:1776-1784) suggests that cytokine mediated inflammation may
play a role in the pathophysiology of GERD. A small prospective pilot study was conducted
consisting of 14 typical GERD patients who are dependent on proton-pump inhibitors (PPIs)
or H2-receptor antagonists (H2 blockers) on a daily basis for complete symptomatic relief.
Our aim was to evaluate curcumin as a replacement therapeutic agent in place of PPIs and
H2 blockers. These patients were started on curcumin (2 g/day) and their PPI or H2 blockers
therapy was discontinued at 2 weeks after the initiation of curcumin therapy. They were
then followed for 2 months. 11 out of 14 patients (about 79% of patients with a 95%
confidence interval ranging from 45% - 95%) were asymptomatic on curcumin therapy
alone without their daily use of PPI or H2 blocker therapy. Of the 3 patients who were
non-responders, 1 patient was able to have complete symptomatic relief on a lower dose
of PPI therapy than the previous dose while on curcumin therapy. No patient had worsening
symptoms during the first 2 weeks while on both curcumin and their usual PPI or H2
blocker therapy. There were also no reports of side effects from curcumin. Based on our
small pilot study, curcumin appears to be a promising therapeutic agent for GERD patients.
Further larger scale studies are needed to fully elucidate the potential of curcumin as an
effective treatment alternative for GERD.
Patient Data
W1075
Symptomatic Improvement in Gastroesophageal Reflux Disease (GERD)
Following Weight Loss Through Caloric Restriction and Behavioral
Modification
Michael D. Crowell, Rona L. Levy, John K. DiBaise, Robert W. Jeffery
Background. Epidemiologic studies have established an association between increasing body
mass index (BMI) and symptoms of GERD. BMI is positively associated with symptoms of
GERD in both normal-weight and overweight individuals. Moderate weight gain has been
shown to exacerbate symptoms of reflux. Surgical interventions for morbid obesity have
also been shown to reduce GERD symptoms. However, few data are available on the effects
of weight loss through behavioral changes on GERD symptoms. We evaluated the hypothesis
that weight loss through participation in a behavior modification program that focused on
caloric restriction and increased exercise would result in a reduction in GERD symptoms
at 6, 12, and 18 mos compared to baseline levels. Methods. A prospective, longitudinal,
randomized controlled trial evaluated a behavioral modification weight loss program that
included parameters of successful weight loss and maintenance over 18 mos in healthy
AGA Abstracts
12 mos, and 18 mos. Data were obtained on the frequency, severity and bothersomeness
of GERD-related symptoms and the GERD symptom index was calculated. The primary
hypothesis was evaluated using Generalized Estimating Equations controlling for recruitment
wave, treatment, and gender. Data were evaluated at P < 0.05 and were presented as mean
+ SD. Results. The weight loss protocol enrolled 213 patients. At baseline, 15 patients were
taking PPIs and were excluded from evaluation of GERD symptoms. The final sample
included 198 (52F/48M) with a mean age of 49 + 11 yrs and BMI of 34.9 + 2.8 kg/m2. As
shown in Table 1, BMI significantly decreased from baseline to 6 mos (-2.2 + 1.7 kg/m2),
12 mos (-3.2 + 2.9 kg/m2), and 18 mos (-3.4 + 3.2 kg/m2). The prevalence of GERD
symptoms also decreased significantly from baseline 59% (116/198) to 6 mos 35% (63/
180), 12 mos 34% (57/167), and 18 mos 30% (43/103). After controlling for potential
confounders, greater changes in BMI from baseline were significantly associated with a
reduction in GERD symptoms (OR 1.10, 95% CI 1.01-1.19). Similar associations were found
for reductions in GERD symptoms and changes in WHR (OR 1.08, 95% CI 1.01-1.15).
Conclusion. Weight loss through behavior modification emphasizing caloric restriction and
increased exercise resulted in reduced in GERD symptoms that persisted at over 18 mos.
In overweight and obese patients, even moderate weight loss may reduce gastroesophageal
reflux symptoms.
W1076
Inspiratory Muscle Training Can Increase Lower Esophageal Sphincter
Pressure - A Prospective Study
Renata C. Sousa, Milena Suesada, Cláudia C. Sá, Fabiane Polisel, Tomas Navarro-
Rodriguez
INTRODUCTION: Inspiratory muscle training (IMT) has been shown to increase diaphragm
thickness. Considering that the diaphragmatic crural fibers, which surrounds the lower
esophageal sphincter (LES), acts as an external LES, it is unknown if patients with hypotensive
LES would benefit from IMT, in order to increase the midrespiratory pressure of the LES,
improving gastroesophageal reflux symptoms. AIM: To determine whether the inspiratory
muscle training would increase the midrespiratory and end-expiratory pressures of the LES
in patients with gastroesophageal reflux disease and hypotensive LES. PATIENTS AND
METHODS: Twelve patients with end-expiratory pressures between 5 and 10mmHg under-
went esophageal manometry and pulmonary function tests previously and after a 8-week
program of IMT using a threshold (Threshold IMT, Respironics, Cedar Grove, NJ) set at
30% of their maximal inspiratory pressure twice a day, seven days a week. The esophageal
manometry measured the midrespiratory and end-expiratory pressures prior and after the
IMT. In order to state the progression of IMT, the previous and final the maximal inspiratory
pressure were measured. RESULTS: The mean age of the patients (9 women) was 53 + 18
years old. Following 8 weeks of IMT there was an increase in midrespiratory pressure in 7
(58.3%) patients with an average gain of 5.8 mmHg (0.3 to 14 mmHg), representing an
increase of 29.8%. One patient had no changes after the training period, four (33.3%)
patients had their midrespiratory pressure lowered (mean reduction of 1.8 mmHg, from
-1.4 to -2.7 mmHg). There were no remarkable changes in end-expiratory pressure with
an average increase of 0.38 mmHg after IMT. The maximal inspiratory pressure had an
increase of 30% after progressive threshold loading. CONCLUSION: Inspiratory muscle
training increased midrespiratory pressure of the LES in 29.8% in 58.3% of the patients
after an 8-week program.
W1077
Prospective Study of Osteopathic Manipulative Technique Increasing the
Lower Esophageal Sphincter Pressure. Comparative Study With Control
Group
Rafael Correa, Cláudia C. Sá, Vanise D. Vecchia, Tomas Navarro-Rodriguez
INTRODUTION: In gastroesophageal reflux disease (GERD) the lower esophageal sphincter
(LES) pressure can be altered. Considering that the diaphragmatic crural fibers, that surround
the LES act as an external LES, it is unknown if patients would benefit from osteopathic
manipulative technique, increasing the midrespiratory and end-expiratory pressures of the
LES and therefore improving GERD. Other studies have been published verifying that the
osteopathic manipulative technique has good results in other gastrointestinal diseases, as
pancreatitis and irritable bowel syndrome. It can be of benefit to patients to give therapeutics
options before drug prescriptions or surgery, if the results are comparable. AIM: To determine
whether the osteopathic manipulative or sham techniques over the diaphragm, corresponding
area in the abdomen, increase the midrespiratory and end-expiratory pressures. METHODS:
Thirty-eight patients with GERD diagnostic were included in the study. Twenty-two patients
underwent osteopathic manipulative technique over the diaphragm, corresponding area in
the abdomen and 16 sham technique. Osteopathic manipulative technique was done in
supine position with bent legs, divided in two parts. In the first part, the patient was oriented
to do four deep ins- and expirations and the investigator touched the patient's thorax to
exacerbate the movements with manual contact. In the second part, four deep respirations
were done again, but during the expiratory period the investigator held the inferior part of
the lasts rips provoking resistance to the low portion of the thorax to exhale. During all the
procedure the investigator talks to the patient to the best coordination as possible. The sham
technique was done by the same investigator in the same position but the investigator
allocated his hand over the sternum without pressure. The oral orientations were the same
in the two groups. Esophageal manometry was done during the procedure in all patients.
RESULTS: When compared with previous measures the midrespiratory and end-expiratory
pressures after the practice in the osteopathic group had an increase of 9.18% and 21.03%,
respectively. In the sham group, the same pressures had a decrease of 14.02% and 8.06%,
respectively. CONCLUSION: The osteopathic technique originated the increase of the lower
esophageal sphincter pressure immediately after the procedure on the contrary of the sham
technique. More studies are necessary to corroborate the results and to verify how long the
results last.
S-646