EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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Key words: GERD, osteopathy, osteopathic manipulative therapy, OMT Purpose: to determine the role of OMT in treatment of GERD Materials and Methods: investigation was performed on children with GERD, inclusion criterion is GER 3 grade on x-ray investigation. Exclusion criterion is diaphragm hernia of 3 grade on x-ray.

Main group – 34 patients, received OMT without any pharmaceutical support during 6 month, collected during period 2006-2008. Control group – 32 patients, collected among patients of surgical department since 2003 to 2008, were put on typical gastroenterological treatment including antacid, antisecretory medication and prokinetics. Dietary recommendations and life style modifications were prescribed to both groups. Instrumental investigations included esophagogastroduodenoscopy (EGD), 1 hour ph-monitoring, and X-ray with barium swallow.

Results: Groups are statistically identical based on age and severity of illness. Mean age 13.41 ± 0.63 years in the main group and 12.36 0.92 years in the control group.

During the last year previous to investigation 23 (67.64%) in main group and 26 (81.25%) in control group were on drug therapy due to GERD. These patients underwent control investigation and conservative treatment, as preoperative evaluation. In control group 10 (31.25%) underwent surgery due to ineffective medical treatment, in main group there were none of that type of outcome (p<0.001).

Clinical symptoms: pain (retrosternal or epigastrial), heartburn, regurgitation – ceased in 75% of patients in main group and in 24% of patients in control group (p<0.01)

Esophagogastroduodenoscopy: incidence of mucous erosions decreased through treatment from 25.00% to 18.52% in main group, and was 8.33% in controls without any changes through treatment. Catarrhal process in main group decreased from 42.86% to 11.11%, and in controls from 62.5% to 43.48%. Normal mucous in main group was in 32.14% and changed to 70.37% after treatment, while in controls it was 29.17% and 43.48% correspondingly (p<0.05). In average there was a similar dynamic with the condition of mucous membrane in stomach. Statistical difference between groups on every measured index was on p<0.05 level.

X-ray: reduction of the GER level after treatment took place in 87.5% of patients in the main group and 36% in the control group (p<0.01).

pH-monitoring – in 83.33% of patients in the main group and in 25.00% in controls frequency of GER episodes came two times less after treatment (p<0.001), in 48.71% in the main group and in 7.89% in controls there was a cessation of duodenogastric reflux (p<0.05).

Conclusion:

1. OMT in children with intense levels of GER gives positive results in 75% based on clinical picture, in 76% based on EGD evaluation, in 87.5% based on x-ray and in 83.3% with pH-monitoring.
2. In case of failure with medications in treatment of GERD we should perform an OMT.
3. Treatment of GERD patients should be performed with OMT without medication support.
4. In case of failure of OMT that is performed during 6 month we should determine indications for surgical treatment.