Diseases of the gastrointestinal tract are often accompanied by a problem such as reflux esophagitis or reflux disease. To get rid of annoying, painful manifestations, complex therapy is needed. Along with drug treatment, exercises for reflux esophagitis will be required.

Gastroesophageal reflux disease (GERD) is the backflow of semi-digested food and gastric juice into the esophagus. This is due to improper functioning of the esophageal sphincters.

Such a common symptom as heartburn is experienced by about half of the total population of developed countries. The disease is characterized by discomfort, belching, a burning sensation behind the sternum, right up to the oropharynx. This is a symptom complex of GERD.

Why exercise is needed

Constant irritation from gastric contents causes inflammation of the esophagus. Usually during this period the patient already suffers from gastritis or ulcers, so serious drug treatment is required. To reduce the amount of medications taken, various exercises are additionally used for esophagitis.

Physical exercise alone, of course, is not enough, but special training speeds up the recovery process and reduces the number of relapses. This is an excellent prevention during remission. There is no need to constantly use medications - it is enough to maintain a healthy lifestyle and adhere to a diet.

Features of exercises for GERD

Physically active people are less bothered by disease symptoms than those who lead a passive lifestyle. This is especially true for overweight patients. They visit a gastroenterologist twice as often as people with a body mass index of no more than 25 units (normal).

When choosing the type of exercise, you should take into account the nature and degree of load and draw up an individual training plan.

Strong regular exercise eases the course of the disease, reduces symptoms, strengthens and heals a person. There are some rules that need to be considered before training:

• classes are carried out on an empty stomach;
• You can exercise 2 hours after eating;
• strictly adhere to the correspondence between food intake and training schedule;
• before classes, you should not eat foods that can cause heartburn and belching;
• Snacks are prohibited; you can eat an hour after training.

It is necessary to control the water balance, liquid is essential to stimulate digestion. Drinking a glass of water before meals reduces the concentration of gastric juice, which prevents heartburn from irritating the esophagus. And you shouldn’t drink immediately before class.

Contraindications

Reflux disease requires planning a training complex taking into account the patient’s preparation and the stage of his illness. The complex is performed standing, or at least sitting, so sports for esophagitis require a special approach. For exercise, it is better to choose yoga asanas or slow easy running. The patient may benefit from a bicycle (exercise bike), skates, or a stepper.

Significant loads performed lying down should be excluded, therefore Pilates, push-ups, bending forward are not recommended for patients with reflux esophagitis, and it is forbidden to pump the press. Weightlifting patients should limit the weight they typically lift. If training does not lead to noticeable improvement, it should be stopped, completed a full course of medication, and then resumed.

Basic exercises

Treatment of the disease requires a lot of effort, time and money. Medications eliminate heartburn, but insufficiency of the esophageal muscles and sphincter weakness persist. Gymnastics for reflux esophagitis strengthens the diaphragm and stimulates the work of the sphincters.

Healing Breath

The classes are aimed at returning to the kind of breathing that is typical for small children. Babies breathe through their stomachs, but this feature is lost with age. To master this type of breathing again, you should do 20–30 movements, and repeat the exercise after a two-minute break:

1. Breathing is performed on your back with your legs bent. One hand should be placed on the chest, the other on the abdominal area. Breathe slowly through your nose. It is important that the chest remains at rest, and the stomach should rise when inhaling and fall when exhaling. If the gastric cardia is insufficient, the exercise is repeated 3-4 times, two approaches throughout the day.
2. You can “breathe” while sitting with your hands on your knees; the principle of movement is the same. Inhale - the stomach protrudes and tenses, exhale - the stomach retracts. The repetition rate is 20–30 times.
3. In the next exercise, inhalation is done through the mouth, through a narrow slit, and exhaled through the “lips with a tube.” For one inhalation there are 10–15 abrupt, very short exhalations, gradually drawing in the stomach.

The next exercises are performed with breath holding and load. They do it like this:

1. The duration of inhalation is 4–5 seconds, the breath is held for 2–3 seconds, the duration of exhalation is 8–10 seconds. When inhaling, the stomach inflates, exhaling through one nostril. You should take 20 to 30 breaths, each time closing the right or left nostril.
2. The usual inhalation is through the nose, and exhalation is done through a cocktail straw, lowering it into a vessel with water.

When the patient has mastered delayed breathing (this usually takes 3–4 weeks), breathing exercises for reflux esophagitis based on the Strelnikova method are recommended. This method was developed to restore lost voice, but remains effective in treating pathologies of other organs. The essence of gymnastics is short breaths through the nose and one noisy, drawn-out exhalation through the mouth.

You need to inhale at least 20 times. The stomach works; the chest should not rise when breathing. As you inhale, you can cross your arms over your shoulders. The exercise is performed lying, sitting, standing or in a half-squat. At the same time, turn the body or head to the sides. The number of breathing movements gradually increases. After a week of classes, the norm should be about a thousand.

Benefits of physical therapy

The physical therapy complex is selected individually by the instructor. Excessive dynamism, bending, weighting, and abdominal swings are eliminated. During the period of stable remission, you can use aerobics, swimming is useful.

All exercises should be free and easy, performed at a slow pace. Loads can be increased gradually and very carefully. It is important to remember: you do not need to train the muscles of the back or limbs, you need to stimulate the function of the internal organs. You should not play sports if the disease is severe.

Aerobic training

The first classes should be carried out under the supervision of an experienced exercise therapy trainer. More active physical exercise is allowed. The main goal of training is to strengthen the diaphragm.

As aerobic exercise, patients are offered brisk walking for an hour. For jogging, it is enough to allocate 20 minutes. Nordic walking, cycling, exercises on parallel bars and horizontal bars are useful.

Loads should not lead to discomfort and fatigue. You need to exercise twice a week.

Yoga

This type of training also benefits the internal organs, especially static asanas. From the complex you can use asanas for breathing and stretching. Exercises are combined with light physical activity.

Yoga improves blood circulation, speeds up metabolism, and increases muscle tone, but exercises that require inversions are prohibited for GERD.

Perfectly executed movements will strengthen the diaphragm, esophageal ligaments and abdominal muscles. Since exercise requires proper breathing, the respiratory center in the brain is activated, and organ cells are saturated with oxygen.

Massage

Self-massage of the abdominal wall has a good effect. It is performed with extreme caution, only on an empty stomach, without pressure or excessive force.

In a lying position with your legs bent, you should find a point in the abdomen, approximately 5 cm above and to the right of the navel. The area is massaged with your fingers in a circular motion, clockwise. The massage is done while exhaling and holding your breath for 6–8 seconds. When inhaling, the stomach is inflated and the massage pressure is reduced.

Massage can be combined with proper breathing.

If possible, it is better to entrust the procedure to an experienced massage therapist. You should not create a set of exercises on your own; you need to visit a specialist who understands the specific effects on the body during illness. GERD can periodically worsen, in which case physical exercise should become a method of prevention.

HEALING POSITIONS-MOVEMENTS FOR THE STOMACH

The stomach is located in the upper part of the abdominal cavity under the thoraco-abdominal diaphragm, which separates the chest cavity from the abdominal cavity. Three quarters of the stomach are located in the region of the left hypochondrium, one quarter is located along the anterior midline of the body. In diseases of the stomach and duodenum, upon palpation, pain and reflected (radiating) pain in the perivertebral areas of the spine are noted. With a stomach and duodenal ulcer, areas of increased or decreased sensitivity appear in the XI-XII thoracic vertebrae.

THERAPEUTIC POSE-MOVEMENT FOR LIFTING A DOWN STOMACH #1

The therapeutic movement is carried out in a supine position with legs slightly bent at the knee and hip joints. Place the tips of the four fingers of both hands into the abdominal cavity under the left costal arch. With both hands, while exhaling, press on the stomach under the costal arch in the direction of the left shoulder and towards the head for 6-8 seconds. Repeat the therapeutic movement for 2-3 minutes during exhalations.

THERAPEUTIC POSTURE-MOVEMENT FOR LIFTING A DOWN STOMACH #2

The therapeutic movement is carried out in a sitting position on the couch with the thoracic spine slightly bent. In several stages, while exhaling, gradually increasing the flexion of the thoracic spine forward, immerse the clenched fist of the right hand, reinforced in the wrist joint with the hand of the left hand, deep into the abdomen under the left costal arch until it comes into contact with dense tissue (stomach). While exhaling, raise the stomach in the direction of the left shoulder for 6-8 seconds, while simultaneously extending the spine and turning to the left by 3-5°. While inhaling, hold the achieved position for 9-11 seconds. Repeat the therapeutic movement 3-6 times. Complete the therapeutic movement while inhaling.

Gastroptosis is a complex problem. Its “roots” are in violation of bile secretion, calcium metabolism, and poor nutrition. There are two exercises to be performed: - train the abs (lying on your back, one leg bent at the knee, doing lifts and swings with the other leg, start with 20 times with each leg and bring up to 50); - standing, legs wider than shoulders, arms clasped above your head, and while holding your inhalation, bend to the sides, 5 times in each direction. Diet: fats should be eaten from animals, separately from proteins and carbohydrates, 20 grams of butter per day, or lard. For bile secretion, I recommend taking hophytol from the pharmacy for a monthly course of treatment (dosages are from the instructions, to begin with, take minimal doses. Then you can increase them to medium ones).

SELF-MASSAGE FOR GASTROPTOSIS

Self-massage and physical therapy for prolapsed stomach

EXERCISES TO STRENGTHEN THE LOWER ESOPHAGAL SPHINTER

I found an exercise that seems to help. At least
the belching has passed. Especially if done immediately after eating.
The muscle (sphincter) needs to be pumped up, this is done with breathing exercises. The main task: to breathe with full breath “from the stomach, chest and shoulders” (that is, include lower, middle and upper breathing), men mainly breathe with lower breathing - the stomach. When breathing, protrude your stomach as much as possible, expand your ribs and raise your shoulders, filling all your lungs with air. Change the speed of your breathing: several deep long inhalations and exhalations, several quick intense inhalations and exhalations, exhale completely and hold your breath without breathing, and vice versa, fill your lungs with air and do not exhale, holding your breath, as when diving. Pump up the sphincter like you pump up your abs: a few intense movements, a few slow ones, just fixing the position, etc.

• #1

  When I started breathing so deeply, I immediately got heartburn :(

• #2

  This means your sphincter expands as you inhale. And the casting happens! It is important to do this on an empty stomach in the morning. Did you do it on empty?

• #3

  Not on an empty stomach. Apparently not enough time has passed since eating.

• #4

  Are there any exercises for the body muscles that we can do? Because we all became weak, our muscles seemed to dissolve.

• #5

  Bend over on an empty stomach, left and right, swing your arms, you can do squats, swing your legs... The main thing is not with dumbbells, and don’t lean forward..

• #6

  Chikurov. Healing the Internal Organs is a good exercise guide.

• #7

  [email protected] (Thursday, 06 September 2012 03:57)

  Good afternoon Please tell me in more detail how to strengthen the esophageal sphincter, or where I can read about it. I have a diaphragmatic hiatal hernia. Life is torture.

• #8

  My stomach is in a small pelvis. Nausea often. What to do?

• #9

  In essence, this is an exercise for playing sports in general. I have personally verified that it helps, but it has a special effect when exercising on a machine that replaces pull-ups. I usually do the head press (while exhaling, just like any other exercise). I think it just helps clear the airways and cleanse the esophagus. This is the first time I’ve heard about starting a sphincter. Maybe it’s true, although it doesn’t feel like it’s swinging. If someone had laid out specific methods, then perhaps after using them I would have felt the difference, but since I play sports, that’s a relief.
  By the way, riding a roller coaster and just a strong wind in the face have a similar effect, and breathing exercises also help

• #10

  Abdominal breathing
  Abdominal breathing leads to active work of the diaphragm, which means it becomes easier for the lungs to work. It is also beneficial for blood flow to the spleen and pancreas. Cells are actively enriched with oxygen, which has a positive effect on brain function.
  Method one. Take a breath - in a way that is comfortable for you. The tongue should be positioned in the mouth so that the middle part lightly touches the palate, and the tip touches the teeth. Mentally direct the life force below the navel. Focus your attention on this area and hold your breath. As you inhale, try to increase the size of your lower abdomen as much as possible. After this, the tongue can return to its normal position. Open your mouth slightly and exhale. At the same time, the lower abdomen contracts, and your attention is focused on the area below the navel.

  Method two. Inhale as in method one. Also direct the vital force to the lower abdomen. At the same time, the stomach does not protrude, but contracts. Focus on its lower part. Hold your breath for a few seconds, and then exhale according to the same rules as in the first case. Hold your breath again. Focus your attention on your navel.

  These exercises can be complicated with the help of meditative phrases such as: “I feel good and calm”; “I am in peace and harmony”; “I am balanced,” etc. Say the first part of the phrase mentally when your tongue touches the roof of your mouth. The lower abdomen increases in size. As you exhale, touch your teeth with the tip of your tongue and say the second part of the phrase. At the same time, the stomach contracts and remains in this position for a couple of seconds.

  There is a variant of the exercise when you inhale through the nose and exhale through the mouth. Repeat the exercise slowly and steadily.

• #11

  Thank you Luda!
  I wonder if sex also helps? - after all, if you think about similar techniques. From my own experience, it seems to be getting better) Now I’ll try to combine sex and this exercise

• #12

  Sexual activity is recommended even for very seriously ill people in a comfortable or accessible position. Take action and God bless you!

• #13

  Anton (Thursday, 28 November 2013 07:09)

  http://peredachnik.ru helps convicts here

• #14
• #15

  Thank you! Very detailed and accessible written.

• #16

  Good evening. I have this problem. The stomach has not gone down 5-6 times, but has risen (((as I was told.. while the last 2 times it became increasingly difficult to recover from this.. sometimes the temperature rose, aching pain, especially at night. I was forced to resort to the help of older people who straighten stomach massage, and then I have to walk around tied up. I play sports, it really interferes with me. Please tell me something, I will be very grateful.
  

• #17

  Breathing with protrusion of the abdomen as you exhale and then drawing it in to the limit, then vice versa, personally helped me a lot. Then it’s as if you’re making waves in your stomach with your breath (it doesn’t work right away). For a sliding diaphragmatic hernia, I somehow found it myself using the poke-and-feel method! But do everything with attention to your feelings - there should be a complete absence of discomfort, do it a little bit, try it carefully. I also drink a lot of water a day - both warm and room water and cooler water. It became much easier for me. It gets worse when I’m driving, and without power steering it’s categorically impossible, and you can immediately feel it after overeating! Health to everyone!

• #18

  I am addressing Evgeniy (message dated January 21). Eugene! My treating gastroenterologist (who pulled me out of a terrible state) warned me categorically NO STOMACH REDUCTIONS, otherwise it will only get worse. If you have a diaphragmatic hernia, what kind of compression can there be, you can’t do any abdominal tension. The pool is great!
  Read on other sites about your illness, what experts say, be sure - this is not a joke! This is not a case where you can just make do with grandparents. I wish you all the best, health is the main thing!
  

• #19

  Thank you very much for your answer. I will study and try.
  Thank you and I wish you good health!

• #20

  Good night! Is it possible to do pull-ups on the horizontal bar and on parallel bars if you have gastroptosis?
  

• #21

  What exercises can you do in the gym? (pull-ups, parallel bars?

• #22

Gymnastics for reflux esophagitis is an important therapeutic and prophylactic remedy. Aerobics, swimming, breathing exercises and other physical exercises help reduce the manifestations of the disease and restore not only normal well-being, but also a good mood.

When treating reflux esophagitis, special physical exercises are often prescribed, which should be combined with breathing exercises. This is the so-called aerobic training.

Typically this is not vigorous running or walking outdoors.

You should not eat before these exercises, as they relax the muscular system, so it is best to exercise in the morning, thereby preparing the body for food intake.

If you have been advised to engage in recreational walking, you should do it for one hour. Instead of regular walking, if the patient’s health allows, Scandinavian walking with ski poles is sometimes prescribed. At the same time, the load on the body increases significantly.

If your doctor has prescribed you to run, then you should do it for twenty minutes. It is not necessary to run fast; a light jog is enough.

In addition, you can additionally ride a bike and swim. It also improves abdominal tone.

While performing the exercises, try to avoid sudden bending of the body and strength exercises. If you experience heartburn during exercise, you should immediately stop exercising and reduce your load in the future.

Rules for playing sports with reflux esophagitis

Among the patients of the gastrointestinal ward there are many people who are passionate about sports. How is reflux esophagitis combined with sports?

We hasten to reassure and please everyone who is concerned about this issue. Sport is not only useful, but also vital, since it is an integral part of the healing process. Of course, it is unfortunately impossible to get rid of reflux esophagitis by physical exercise alone, however, coupled with therapeutic nutrition and drug therapy, feasible exercise contributes to a speedy recovery.

Many gastroenterologists note that among people who devote a certain amount of time to physical activity every day and lead an active lifestyle, there are significantly fewer people suffering from gastroesophageal reflux disease than among those whose route runs from the sofa to the refrigerator and back. Extra pounds are another reliable way to get acquainted with reflux esophagitis. People whose BMI exceeds 30 are much more likely to join the ranks of gastroenterologist patients than those whose body mass index barely reaches 25.

But don’t think that any exercise helps with GERD. To ensure that playing sports does not cause you harm, you must first take care of drawing up a training plan that would take into account not only how severe the disease is, but also the level of physical fitness of the patient.

You should always remember that significant physical activity is strictly contraindicated for this disease. In order not to harm your health, you must adhere to the recommendations of a gastroenterologist and strictly follow a number of important rules:

When creating a menu for the week, focus on your training schedule. The consumption of some foods (primarily fatty foods and dishes made from legumes) with reflux esophagitis is strictly prohibited, while others (meat or fish) require quite a long time to digest. Therefore, if you have to start sports exercises soon after breakfast or lunch (no earlier than two hours!), It is better to eat a carbohydrate dish that is easily digested and does not contain a large amount of proteins and fats). In addition, it is necessary to refrain from eating foods that can cause heartburn and severe belching.

If possible, choose a time for training before meals. Physical exercise on a full stomach already places too much stress on the esophageal sphincter, but if strength loads, jumping, squats and bends are added to it, deterioration in well-being cannot be avoided.

Avoid doing exercises that are supposed to be done while lying down (such as bench presses). They can become a provoking factor for an attack of reflux.

You should not get involved in aerobics, fast running or crossfit. These exercises are too intense for those who suffer from reflux esophagitis. In addition, their implementation is associated with shaking of the body and, accordingly, the contents of the stomach, which means the inevitable appearance of a feeling of discomfort. The best sport for those who suffer from gastroesophageal reflux disease is one in which the body maintains an even position. This could be yoga, cycling, or ice skating. In this case, a home exercise bike will be an excellent help.

Don't forget about water! It not only quenches the legitimate thirst that arises after physical exertion, but also promotes normal digestion, not to mention how important it is for stabilizing the functional state of the organs of the human body.

Healthy lifestyle with GERD

Gastroenterologists, when communicating with patients suffering from reflux esophagitis, pay special attention to lifestyle changes. Many patients are perplexed: can certain clothes, an evening walk, or a work schedule adjusted in accordance with the new condition really help?! Well, perhaps this seems funny or, at least, frivolous, however, only in this way, and in no other way, can such a problem be dealt with.

What changes should you prepare for?

1. First, stop aimlessly lying on the couch with a laptop on your beer belly and a hot dog in your hand. Ideally, it would be nice to get rid of all these items at once, but, at worst, you will have to limit yourself to only food. You should have only easily digestible healthy food on your plate that does not irritate the mucous membrane of the digestive tract. After eating, do not rush to lie down for long hours, switching TV channels - take a half-hour walk (at a calm, slow pace) along a park alley or just along a quiet street.
2. Secondly, after eating, do not rush to rearrange the cabinets and look for a new place for the piano. You can lift weights and engage in significant physical activity only after an hour and a half rest, even if you only ate half a banana before that.
3. Thirdly, learn to eat slowly and thoughtfully, chewing food until liquid and under no circumstances swallowing large pieces. Try to plan your day so that you have time for five or six meals a day.

The disease will recede if you find the strength to say goodbye to smoking and extra pounds.

You should pay great attention to your clothes: they must be spacious, made only from natural fabrics, and not restrict movement. And, of course, no belts!

And, of course, strengthen your nervous system. Learn to think positively and find positive aspects in any event, even the saddest one. Do you think this is unrealistic? Read the wonderful novel “Pollyanna” by American writer Elinor Porter. Perhaps it will help you reconsider your outlook on life.

Nutrition for reflux esophagitis

In addition to sports activities for reflux esophagitis, it is extremely important to organize proper nutrition. It should be fractional, portions should be small, and the food should undergo special heat treatment. Why is this necessary?

With reflux esophagitis (especially during the acute period), it is not easy for the human body to perform some basic functions, such as digesting food entering the stomach. If you continue to eat fatty borscht, goulash and fried potatoes, generously pouring ketchup and chili on it, complete digestion will not happen, and you will pay for such neglect of your health with heartburn, heaviness and stomach pain.

Small portion sizes allow food to be processed faster and easier.

Preference should be given to food that is steamed, stewed, baked or simply boiled in water. It is digested much faster, without irritating the inflamed mucous membrane of the esophagus.

Take your time! Food won’t run away from your plate, you’re not in the Stone Age! Eat calmly, admiring the scenery outside the window and thinking about something pleasant. Positive emotions contribute to the normalization of the gastrointestinal tract no less than medications.

Workouts for GERD

When training with reflux esophagitis, you need to be very careful and not overdo it. Never lift heavy weights or do excessive exercise.

Small physical activities are useful for GERD, however, if they are performed without measures, neglecting basic safety rules, a rupture of the wall at the site of the esophageal lesion may occur. This happens because the mucous membranes in this place are damaged. After this, you don’t even have to think about treatment at home: the patient is immediately hospitalized and undergoes surgical intervention.

If you feel reflux coming on during exercise, you should stop exercising immediately: hydrochloric acid can enter the trachea or bronchi and damage them, after which the patient will most likely be hospitalized.

Swimming for reflux esophagitis

There is one simple way to improve abdominal tone: swimming. Many doctors recommend this sport to quickly recover from reflux esophagitis.

Why is swimming so beneficial? Precisely because, due to the difference in environmental pressure (and water, as you know, is much denser than air and, accordingly, presses harder), all the muscles of the abdominal cavity tense, trying to balance the environmental pressure with the pressure inside the body. This is the tonic property of swimming. With good muscle tone, it will be easier for you to fight the symptoms of reflux and recovery will go much faster.

However, you should remember that you are still unwell and you could feel ill at any moment. It is best to practice swimming in a shallow pool, which is guarded by a lifeguard team. If you feel yourself starting to lose consciousness or choke on vomit, try to relax so you can stay afloat. Signal to the rescuers to help you out of the water.

Breathing exercises for GERD

Diaphragmatic breathing

This procedure is based on breathing not from the chest, but from the stomach. Thanks to this, muscles are strengthened and the functioning of all internal organs without exception is improved. This type of breathing exercises is most popular for reflux esophagitis.

There are three exercises that need to be performed in turn:

1. First exercise. Starting position: lying down with your knees bent. Place your left hand on your chest, your right hand on your stomach. Inhale air slowly, holding your chest from expanding, trying to direct all the air into your stomach. Do not prevent it from expanding, but, on the contrary, help it. Then also exhale slowly, while simultaneously returning to the starting position. Repeat the exercise thirty times, then rest for two to three minutes and repeat it thirty more times. Repeat the exercise three times a day.
2. Second exercise. Starting position: sitting on a chair, hands on your knees. Also, inhale slowly, but do not hold your chest with your hands. Tighten your muscles, as if preventing your lungs from expanding too much with your ribs. If you do everything correctly, you will soon notice that your stomach protrudes when you inhale, and when you exhale, it falls, while your chest remains motionless. Typically, it takes patients about a week to master this exercise. This exercise should be done in the middle of the day, repeating thirty times.
3. Third exercise. It is performed in exactly the same way as the second, but you need to inhale air not through your nose, but through loosely compressed lips. This exercise is one of the most difficult, so it is enough to repeat it only ten or twenty times.

Exercises for breathing problems resulting from GERD

If your trachea or bronchi are damaged as a result of gastroesophageal reflux disease, normal breathing techniques may harm you. Lightweight gymnastics have been specially developed for such patients.

1. First exercise. Inhale through your nose while inflating your stomach. Then hold your breath for three seconds. Close your right nostril with your finger and exhale. Repeat the exercise thirty times, alternating nostrils.
2. Second exercise. Before the exercise, pour some water into a dish with high sides. Inhale through your nose. Pull your lips out with a tube and dip them into the water. Release the air slowly. If this exercise seems too difficult for you, use a glass of water and a straw through which you slowly blow air.

Most often, these exercises are performed either during rehabilitation, after an acute form of the disease, or in cases where nothing else helps.

The essence of the exercise is that you need to take thirty small breaths through your nose, with each of which you need to hug your shoulders with your hands, followed by one large exhalation through your mouth.

You can do the proposed exercise while standing, lying down or sitting. The first days it is enough to take up to four hundred breaths at a time, however, in the future you should try to bring this figure to a thousand.

Contraindications

In case of gastroesophageal reflux disease, exercises that must be performed lying down are strictly contraindicated, since in this position the contents of the stomach are thrown into the esophagus, greatly increasing the discomfort: belching, heartburn and sharp chest pain.

In addition, the following exercises are contraindicated for GERD:

• Tilts of the body forward and similar;
• Training with sports equipment weighing more than ten kilograms;
• Abdominal exercises - the most dangerous are those in which you need to raise your legs while lying down.

You need to perform any exercises for reflux esophagitis either standing or sitting on a chair, and in no case overexert yourself. This - with a sufficient amount of high-quality water without gas - helps to strengthen the digestive function.

Before engaging in any sport if you have reflux esophagitis, be sure to consult your doctor.

AUTHORS: Dharmesh Kaswala, Shamik Shah, Avantika Mishra, Hardik Patel, Nishith Patel, Pravesh Sangwan, Ari Chodos, Zamir Brelvi
Department of Medicine, Division of Gastroenterology, University Hospital, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA

International Journal of Yoga, 2013, Volume 6

Translation from English: Elena Kazantseva (Chita)

The opinion of the site’s editors may not coincide with the opinion of the authors of the article

Various yoga methods, incl. pranayama are the best ways to prevent diseases and prevent their progression. Despite the widespread use of yoga practices, its effect on some diseases is still not fully understood. One of them is gastroesophageal reflux disease (GERD). GERD is an extremely common disease that requires frequent use of proton pump inhibitor (PPI) medications, either prescribed by a doctor or purchased by patients. For severe symptoms of GERD (which are aggravated by multiple etiologies of the disease), the use of PPIs is not sufficient to relieve the symptoms of gastric reflux. Regular practice of a well-designed yoga sequence along with a PPI can control severe symptoms of GERD and may prevent or delay the need for invasive procedures. The given practical case shows the effect of yoga practice on the course of GERD. This case report reflects the improvement of initially PPI-resistant patients with hiatal hernia and severe symptoms of GERD along with PPIs who regularly practiced kapalabhati and agnisara kriya.

Introduction

Gastroesophageal reflux disease (GERD) and its associated symptoms are the most common gastrointestinal diseases. Proton pump inhibitors (PPIs) have been shown to be most effective in relieving GERD symptoms, but severe cases of GERD may be refractory to PPIs and become drug resistant. There are many causes of GERD, such as disruption of the cardiac sphincter of the esophagus, abnormalities in the structure of the esophagus, gastric dysfunction (gastroparesis), hiatal hernia, asthma, diabetes, pregnancy, surgery, genetic factors and medications that increase the risk of GERD (non-steroidal anti-inflammatory drugs). (NSAIDs), bisphosphonate, etc.). Treatment varies depending on the etiology. When multiple causes are present, especially when a hiatal hernia is present, as demonstrated in this case, patients may be considered candidates for fundoplication (surgery on the stomach and esophagus). Taking a PPI in combination with yoga practice can relieve symptoms of severe GERD and delay or avoid the need for invasive interventions.

Disease history

A 62-year-old man with a history of heartburn accompanied by dysphagia. Endoscopy revealed a large hiatal hernia with peptic stricture, not interfering with the passage of food, located proximal to the gastroesophageal junction and resulting from erosive esophagitis. Esophagogastroduodenoscopy (EFGDS) revealed the presence of gastritis and duodenitis.

According to the Los Angeles classification of esophagitis (LA classification) [Table 1], this patient's disease was classified as class D. Initial treatment was started with high doses of PPI. After 6 months of continuous therapy, based on the results of repeated EGD, the patient’s esophagitis was assigned class C (according to the LA classification), the size of the large hiatal hernia did not change. We used the Bravo test method (Bravo is a pH recording capsule used to measure esophageal acidity) to measure acid reflux and correlate it with clinical symptoms while temporarily taking the patient off the PPI regimen. In the Bravo study, the patient's DeMeester score was 81.1 on day 1 and 35.1 on day 2, indicating severe acid reflux.

Table 1. Classification of reflux esophagitis

The patient was advised to continue treatment with high doses of PPI. For symptomatic relief of GERD, the patient began practicing Yoga daily. Regular practice included kapalabhati and agnisara kriya. After 6 months, repeated EGD confirmed the presence of a hiatal hernia with a peptic stricture not obstructing the passage of food, located proximal to the gastroesophageal junction, and the degree of esophagitis improved to level A compared to the original - class D according to the LA classification.

To confirm these results, we performed a Bravo study and a repeat EGD after 5 weeks. The Bravo study showed significant improvement in DeMeester scores; the first day score improved from 81.1 to 12, and the second day score improved from 35.1 to 17. These indicators characterize a significant improvement in the patient's symptoms over a period of 6 months of taking PPI combined with yoga practice, while the patient was previously unresponsive to taking high doses of PPIs. Symptoms of heartburn and dysphagia improved significantly: attack severity and frequency decreased. The patient did not experience any episodes of nausea, diarrhea, constipation, postprandial fullness, abdominal bloating, or any other additional complaints. Intestinal motility normalized. All blood tests are within normal limits. A repeat barium contrast study showed normal contrast transit time and reflex time and strength. The biopsy findings of the stomach and duodenum are normal, with the exception of signs of chronic gastritis.

This patient's case demonstrated the effect of regular practice of kapalabhati and agnisara kriya in severe GERD. Regular yoga practice combined with high-dose PPI treatment resulted in significant clinical improvement as assessed by Bravo and esophagitis classification.

Discussion

The pathogenesis and severity of GERD is primarily associated with anatomical and physiological dysfunction of the lower esophageal sphincter (LES), including transient dysfunction of the LES, chronic hypotensive dysfunction of the LES, and the effect of hiatal hernia on sphincter function. Mild to moderate non-erosive reflux disease most often occurs due to temporary dysfunction of the LES. More serious GERD, including erosive esophagitis, is usually associated with hypotensive dysfunction of the esophagus or hiatal hernia. In patients with GERD, there is an increase in the number of refluxes with temporary dysfunctions of the LES (60-70%) compared to the norm (40-50%), although the mechanism of these processes is not clear. They have a higher incidence of fluid reflux, a qualitative difference in the content of reflux, greater transverse opening of the esophagogastric junction, higher rates of fluid flow through the esophagogastric junction, and presumably a higher number of episodes of dysfunction compared with the control group. Even with PPI therapy, a large percentage of patients do not achieve complete symptomatic relief and may be worsened by esophagitis, esophageal ulcers, laryngeal strictures, chronic cough, Barrett's esophagus, and adenocarcinoma. Patients with symptoms that do not respond to PPI therapy may use complementary therapies, such as yoga practice, which can be used to control the patient's GERD symptoms.

The beneficial effects of yoga on functional dyspepsia, irritable bowel syndrome and inflammatory bowel disease have now been studied. . Yoga breathing techniques such as kapalbhati and agnisara kriya can be particularly helpful in addressing GERD by increasing the tone of the diaphragm, thereby reducing reflux from the stomach to the esophagus. Kapalbhati is one of the 10 types of pranayama (breath control techniques) in which inhalation is passive and active exhalation is performed by the abdominal muscles to clear the airways and strengthen the diaphragm. Agnisara Kriya is a method of squeezing or “flapping” the abdominal muscles that can improve digestion and gastrointestinal motility. Combined practices of kapalbhati and agnisara kriya demonstrate an increase in diaphragm tone and lead to a decrease in episodes of LES dysfunction and an increase in its tone. This synergistic effect reduces the episodes of reflux that occur with GERD.

Yoga may also be helpful in relieving GERD by influencing the autonomic nervous system, which limits the gastrointestinal tract's ability to continue peristaltic contractions and prevents the corresponding fluid shifts and secretions needed for digestion. During yoga practice, the relaxation response appears to be mediated by a decrease in adrenaline and target organ responses. Physiological changes in this relaxation response include a simultaneous decrease in heart rate, blood pressure, and respiratory rate, which are the opposite manifestations of physiological stress. Stress is associated with increased gastric secretion, which is a direct risk factor for developing peptic ulcers. On the other hand, yoga reduces the stress response of the digestive tract, which can be considered as a possible treatment option for GERD and peptic ulcers.

conclusions

The practice of yoga in combination with medication may be helpful in controlling and/or relieving symptoms associated with digestive disorders.

Bibliography

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They belong to antisecretory drugs (translator's note).

GERD - gastroesophageal reflux - is a disease characterized by heartburn, which occurs due to the reflux of part of the stomach contents along with hydrochloric acid into the esophagus. In this case, the patient feels a burning sensation behind the sternum or in the throat, a sour taste in the mouth, belching, and sometimes pain. The condition is aggravated in a lying position, while bending, during physical activity immediately after eating. GERD is most often caused by weakening of the sphincter muscle between the stomach and esophagus. If the disease is not treated or only periodically gets rid of symptoms, then there may be complications and serious problems with the gastrointestinal tract. Complex treatment works best: a combination of diet, medications and physical therapy prescribed by a doctor.

Exercise therapy for esophagitis

GERD requires therapeutic exercises, without weights, excessive dynamism, bending or abdominal exercises. It is recommended to conduct the first classes with an experienced exercise therapy trainer who has the appropriate certificate. There is no universal therapeutic exercise. Exercises are selected individually by the instructor, depending on the patient’s health, preparedness, and well-being.

All exercises should be aimed at strengthening the diaphragm for GERD. The quality of work depends on its condition. The exercise therapy complex is performed on an empty stomach or at least 2-3 hours after a meal. At the same time, food should be easily digestible and not cause heartburn. For example, fatty or protein foods take a long time to digest; it is better to eat something containing carbohydrates; drinking water before training is not recommended.

The role of physical therapy is to strengthen health, the immune system, muscles, improve blood circulation, enrich the blood with oxygen, and activate metabolic processes in the body. Exercises to strengthen the esophageal sphincter are aimed at preventing GERD, because frequent heartburn due to dysfunction of its function can lead to complications, including ulcers or esophageal cancer.

Aerobic exercise in the form of vigorous or Nordic walking, jogging, cycling or an exercise bike should be included in the set of exercises for reflux esophagitis. Exercises on the horizontal bar or parallel bars, without inversions, and swimming are encouraged.

The starting position for most exercises in the gym, at home, or in the fresh air should be sitting or standing. It is necessary to avoid lying on your back; you can lie, but at an angle, with your head above your feet or on your side, to avoid reflux.

Tilts are allowed only to the left or right, but not forward - down, smoothly, without jerking, the arm is lowered and moves along the body. You should not get carried away with Pilates, jumping, or intense aerobics. From yoga, you can only use breathing and stretching; inverted asanas are prohibited. Self-massage or massage of the abdominal wall is recommended. This can be done while performing breathing exercises, helping the abdomen in the hypochondrium area with your hands.

Breathing exercises for GERD

Breathing exercises are useful and effective. It is very important to reduce intra-abdominal pressure during exercise. Correct specific breathing copes with this task and gradually strengthens the diaphragm, as well as the lower esophageal sphincter. It is recommended to do breathing exercises in the following sequence:

• diaphragmatic or abdominal breathing - on a slow deep inhalation, the stomach protrudes strongly, on exhalation it relaxes, but does not retract. The exercise lasts 10 minutes, with a 20-second rest every minute;
• at the next stage, as you exhale, the stomach gradually retracts;
• the exercise must be repeated while sitting, then while walking, gradually combining with exercises, while the exhalation becomes twice as long as the inhalation, only the stomach works, the chest remains motionless.

Such breathing exercises for reflux esophagitis must be performed twice a day for 15-20 minutes. With the correct technique, diaphragmatic breathing strengthens the muscles of the diaphragm itself, saturates the blood with oxygen, cleanses the lungs of those who smoke a lot from tar and nicotine, promotes weight loss, reduces flatulence, and relieves constipation.

At the beginning of exercises, breathing exercises for GERD may cause dizziness due to a possible increase in blood pressure. In this case, you need to take less deep breaths. In a normal state, a person does not track breathing patterns. During breathing exercises, it is recommended to carefully monitor the behavior of the organs during them, the duration of inhalation and exhalation, and your condition. If you feel unpleasant, you need to relax and breathe calmly. In the future, the technique of such breathing will become clearer and easier, will benefit the body, including improving the functioning of the esophageal sphincter and the gastrointestinal tract as a whole.

Diaphragmatic breathing in combination with physical exercise is the basis of the “bodyflex” weight loss system. This is an effective method of combating excess weight. It can also be used by patients with GERD, excluding some exercises. In addition to inhaling and exhaling using the abdominal muscles, bodyflex involves holding your breath for 10 seconds after exhaling completely. Patients with high blood pressure or arrhythmia should perform the complex with caution after consulting a doctor. The value of the method is that it strengthens the diaphragm muscles and reduces weight, which has a beneficial effect on getting rid of GERD and its symptoms.

A course of gastroesophageal exercise therapy usually takes about 3 months. Breaks will have to be taken in case of exacerbation or complications that need to be eliminated by other means. For those who are not lazy to do gymnastics, and also combine it with diet and medications, the symptoms of GERD may completely disappear and not appear for a long time.

If the disease is advanced and proceeds with complications, then therapeutic exercises will have to be done later. First, it is necessary to relieve the exacerbation, severe symptoms in the form of bowel dysfunction, constant heartburn, and vomiting with the help of medications and nutrition. with esophagitis includes dishes that do not provoke increased secretion of gastric juice during digestion and the reflux of hydrochloric acid into the esophagus.

Proper nutrition, excluding heavy, poorly digestible or irritating gastrointestinal foods, helps the patient cope with GERD, eliminating heartburn and the severe discomfort associated with it. Proper drinking regime is also necessary. Water improves the digestion process, quenches thirst, improves well-being, and regulates metabolic processes.

Strength training, like deep bending, is prohibited for reflux symptoms due to increased intra-abdominal pressure and stress on the abdominal muscles. A set of exercise therapy exercises should be developed by an experienced instructor-doctor. You should not do this on your own, so as not to harm your health if you select it incorrectly.

Exercising alone will not cure GERD. The disease is treated in a complex that includes drug therapy, a special diet and physical therapy. Breathing exercises must be combined with light physical exercise. Intense sports for people with diagnosed GERD, especially complicated or during an exacerbation, are prohibited. Diaphragmatic breathing exercises are undesirable during respiratory diseases; they are not suitable for hypertensive patients or people with diseases of the cardiovascular system.

Self-massage of the abdomen or abdominal wall should be performed with extreme caution, without using excessive force, preferably under the supervision of a doctor. It is most convenient to entrust massage of this area to an experienced specialist, because this is an effective way to improve the functioning of the digestive organs. But in the absence of knowledge and experience, massage can cause harm to health, including exacerbation of chronic gastrointestinal diseases.

Strengthening the lower esophageal sphincter, as the main means of combating esophageal reflux, is impossible without therapeutic exercises, a special diet, and drug support. If a patient with GERD has a great desire and desire to get rid of extremely unpleasant symptoms in the form of heartburn and other manifestations listed above, then it is necessary to persistently and diligently carry out this entire complex of treatment. Then the quality of life will be much higher.

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Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and carries out treatment. Expert of the group for the study of inflammatory diseases. Author of more than 300 scientific papers.