Manual Therapy and Gastroesophageal Reflux Disease in Patients With Hiatal Hernia

NCT ID: NCT05283447

Last Updated: 2025-07-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

44 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-05-15

Study Completion Date

2023-06-30

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Introduction: Gastroesophageal reflux disease (GERD) is highly prevalent in our society. The association between GERD and hiatal hernia has been shown to be etiologically critical in the onset or worsening of these patients' clinic. Pharmacological treatment with proton pump inhibitors (IBPs) and H2 blockers is commonly prescribed and will be followed for many patients for life. The cost of health care and the effects of prolonged consumption of PPIs are questionable, and other therapeutic alternatives are being considered. Only in exceptional cases and in patients with GERD and certain types of hiatal hernia is surgery the treatment of choice. Physiotherapy at the time proposed respiratory and diaphragmatic training as a therapeutic alternative that would improve the function of anti-reflux barriers. Recently, other studies evaluating the effectiveness of manual techniques on the crural diaphragm or osteopathic maneuvers on the cervical and thoracic region have obtained good results in the improvement of the MRGE clinic. In this context, the clinical trial presented specifically treats those with reflux disease associated with a Type I hiatal hernia with manual therapy.

Material and methods: The aim of the clinical study is to evaluate the effects of a clinical intervention protocol on patients with GERD for type I hiatal hernia.

The variables are assessed: GERD impact using the GIS MRG Impact Scale, and the EVA format scale for the Reflux Clinic (IEPT) used by the Surgery Service of the Parc Taulí Hospital in Sabadell . The productivity and quality of life of these patients is also assessed using the QOLRAD reflux and dyspepsia patient quality of life questionnaire.

The randomized, double-blind clinical trial has a sample of 44 patients, divided into an intervention group treated with the protocol under study, and a control group undergoing treatment that does not affect the hernia. hiatus and reflux. A total of three treatment sessions are performed on each subject. The participants answer the different questionnaires, before the start of the treatment and for each session, one week after the treatment and one month later. In the protocol, maneuvers are performed on the epigastric region, thoracic diaphragm, mediastinum and anterior face of the neck.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Gastroesophageal Reflux

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Intervention

Specific manual therapy for GERD and hiatal hernia

Group Type EXPERIMENTAL

Osteopathic Medicine

Intervention Type OTHER

The clinical protocol subject to analysis for the intervention group consists of manual approach techniques for the myofascial and viscerofascial structures of the anterior face of the neck, maneuvers for the mediastinal region, techniques for normalizing the tone of the thoracic diaphragm and its pillars, on the peritoneal ligaments, and caudal traction of the stomach for manual correction of hiatal hernia.

Control

Manual therapy unrelated to GERD and hiatal hernia

Group Type PLACEBO_COMPARATOR

Control

Intervention Type OTHER

The physiotherapeutic treatment on the control group consists of an approach to the lumbopelvic joint restrictions and a massage on the inframesocolic abdominal region with minimal pressure, which does not affect the activity and position of the stomach.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Osteopathic Medicine

The clinical protocol subject to analysis for the intervention group consists of manual approach techniques for the myofascial and viscerofascial structures of the anterior face of the neck, maneuvers for the mediastinal region, techniques for normalizing the tone of the thoracic diaphragm and its pillars, on the peritoneal ligaments, and caudal traction of the stomach for manual correction of hiatal hernia.

Intervention Type OTHER

Control

The physiotherapeutic treatment on the control group consists of an approach to the lumbopelvic joint restrictions and a massage on the inframesocolic abdominal region with minimal pressure, which does not affect the activity and position of the stomach.

Intervention Type OTHER

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Patients diagnosed with Gastroesophageal Reflux disease (Vakil et al, 2006)
* Age between 18 and 90 years.
* Patients with GERD due to hiatal hernia type I, without surgical indication.
* Patients with GERD due to hiatal hernia type I, with surgical indication on the waiting list.
* Patients with GERD due to hiatal hernia type I, with surgical contraindication.

* Patients treated with Benzodiazepines (BZD)
* Patients with previous surgical interventions at the abdominal level, especially of supramesocolic structures
* Patients diagnosed with Barrett's esophagus
* Patients with paraesophageal and mixed hiatus hernias
* Diagnosed erosive esophagitis
* Active neoplasm
* Serious psychiatric disorders
* Neuromuscular or neurological injuries
* Aneurysms
* Pregnancy
* Hemophilia or treatment with anticoagulant therapy
* Hypersensitivity of the skin or dermatological diseases in the trunk that prevent the performance of the techniques
* Rejection of manual contact
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Corporacion Parc Tauli

OTHER

Sponsor Role collaborator

Escoles Universitaries Gimbernat

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Ricard Tutusaus

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Ricard Tutusaus Homs, MSc

Role: PRINCIPAL_INVESTIGATOR

EU Gimbernat

Salvador Navarro Soto, PhD

Role: STUDY_DIRECTOR

Corporación Parc Taulí

Alexis Luna Aufroy, PhD

Role: STUDY_DIRECTOR

Corporación Parc Taulí

Josep Maria Potau Ginés

Role: STUDY_DIRECTOR

Universidad de Barcelona

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Ricard Tutusaus Homs

Sant Cugat del Vallès, Barcelona, Spain

Site Status

Countries

Review the countries where the study has at least one active or historical site.

Spain

References

Explore related publications, articles, or registry entries linked to this study.

El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2014 Jun;63(6):871-80. doi: 10.1136/gutjnl-2012-304269. Epub 2013 Jul 13.

Reference Type BACKGROUND
PMID: 23853213 (View on PubMed)

Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006 Aug;101(8):1900-20; quiz 1943. doi: 10.1111/j.1572-0241.2006.00630.x.

Reference Type BACKGROUND
PMID: 16928254 (View on PubMed)

Dean C, Etienne D, Carpentier B, Gielecki J, Tubbs RS, Loukas M. Hiatal hernias. Surg Radiol Anat. 2012 May;34(4):291-9. doi: 10.1007/s00276-011-0904-9. Epub 2011 Nov 22.

Reference Type BACKGROUND
PMID: 22105688 (View on PubMed)

Bresadola V, Noce L, Ventroni MG, Vianello V, Intini S, Bresadola F. [Sliding hiatal hernia in patients with gastroesophageal reflux: physiopathology and surgical treatment]. Minerva Chir. 2000 Jun;55(6):415-20. Italian.

Reference Type BACKGROUND
PMID: 11059235 (View on PubMed)

Savas N, Dagli U, Sahin B. The effect of hiatal hernia on gastroesophageal reflux disease and influence on proximal and distal esophageal reflux. Dig Dis Sci. 2008 Sep;53(9):2380-6. doi: 10.1007/s10620-007-0158-x. Epub 2008 Jan 17.

Reference Type BACKGROUND
PMID: 18205046 (View on PubMed)

Smith RE, Sharma S, Shahjehan RD. Hiatal Hernia. 2024 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK562200/

Reference Type BACKGROUND
PMID: 32965871 (View on PubMed)

Patti MG, Goldberg HI, Arcerito M, Bortolasi L, Tong J, Way LW. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg. 1996 Jan;171(1):182-6. doi: 10.1016/S0002-9610(99)80096-8.

Reference Type BACKGROUND
PMID: 8554137 (View on PubMed)

Gryglewski A, Pena IZ, Tomaszewski KA, Walocha JA. Unsolved questions regarding the role of esophageal hiatus anatomy in the development of esophageal hiatal hernias. Adv Clin Exp Med. 2014 Jul-Aug;23(4):639-44. doi: 10.17219/acem/37247.

Reference Type BACKGROUND
PMID: 25166451 (View on PubMed)

von Diemen V, Trindade EN, Trindade MR. Hiatal hernia and gastroesophageal reflux: Study of collagen in the phrenoesophageal ligament. Surg Endosc. 2016 Nov;30(11):5091-5098. doi: 10.1007/s00464-016-4858-1. Epub 2016 Mar 22.

Reference Type BACKGROUND
PMID: 27005292 (View on PubMed)

Yu HX, Han CS, Xue JR, Han ZF, Xin H. Esophageal hiatal hernia: risk, diagnosis and management. Expert Rev Gastroenterol Hepatol. 2018 Apr;12(4):319-329. doi: 10.1080/17474124.2018.1441711. Epub 2018 Feb 22.

Reference Type BACKGROUND
PMID: 29451037 (View on PubMed)

Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308-28; quiz 329. doi: 10.1038/ajg.2012.444. Epub 2013 Feb 19. No abstract available.

Reference Type BACKGROUND
PMID: 23419381 (View on PubMed)

Wu AH, Tseng CC, Bernstein L. Hiatal hernia, reflux symptoms, body size, and risk of esophageal and gastric adenocarcinoma. Cancer. 2003 Sep 1;98(5):940-8. doi: 10.1002/cncr.11568.

Reference Type BACKGROUND
PMID: 12942560 (View on PubMed)

de Burgos Lunar C, Novo del Castillo S, Llorente Diaz E, Salinero Fort MA. [Study of prescription-indication of proton pump inhibitors]. Rev Clin Esp. 2006 Jun;206(6):266-70. doi: 10.1157/13088585. Spanish.

Reference Type BACKGROUND
PMID: 16762289 (View on PubMed)

Aguilera-Castro L, Martin-de-Argila-dePrados C, Albillos-Martinez A. Practical considerations in the management of proton-pump inhibitors. Rev Esp Enferm Dig. 2016 Mar;108(3):145-53. doi: 10.17235/reed.2015.3812/2015.

Reference Type BACKGROUND
PMID: 26666270 (View on PubMed)

Lopez-Doriga Bonnardeaux P, Neira Alvarez M, Mansilla Laguia S. [Proton bomb inhibitors: a study of the prescription in a functional recovery unit]. Rev Esp Geriatr Gerontol. 2013 Nov-Dec;48(6):269-71. doi: 10.1016/j.regg.2013.07.004. Epub 2013 Oct 5. Spanish.

Reference Type BACKGROUND
PMID: 24099902 (View on PubMed)

de la Coba Ortiz C, Arguelles Arias F, Martin de Argila de Prados C, Judez Gutierrez J, Linares Rodriguez A, Ortega Alonso A, Rodriguez de Santiago E, Rodriguez-Tellez M, Vera Mendoza MI, Aguilera Castro L, Alvarez Sanchez A, Andrade Bellido RJ, Bao Perez F, Castro Fernandez M, Giganto Tome F. Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Espanola de Patologia Digestiva. Rev Esp Enferm Dig. 2016 Apr;108(4):207-24. doi: 10.17235/reed.2016.4232/2016.

Reference Type BACKGROUND
PMID: 27034082 (View on PubMed)

Eherer AJ, Netolitzky F, Hogenauer C, Puschnig G, Hinterleitner TA, Scheidl S, Kraxner W, Krejs GJ, Hoffmann KM. Positive effect of abdominal breathing exercise on gastroesophageal reflux disease: a randomized, controlled study. Am J Gastroenterol. 2012 Mar;107(3):372-8. doi: 10.1038/ajg.2011.420. Epub 2011 Dec 6.

Reference Type BACKGROUND
PMID: 22146488 (View on PubMed)

Nobre e Souza MA, Lima MJ, Martins GB, Nobre RA, Souza MH, de Oliveira RB, dos Santos AA. Inspiratory muscle training improves antireflux barrier in GERD patients. Am J Physiol Gastrointest Liver Physiol. 2013 Dec;305(11):G862-7. doi: 10.1152/ajpgi.00054.2013. Epub 2013 Oct 10.

Reference Type BACKGROUND
PMID: 24113771 (View on PubMed)

Carvalho de Miranda Chaves R, Suesada M, Polisel F, de Sa CC, Navarro-Rodriguez T. Respiratory physiotherapy can increase lower esophageal sphincter pressure in GERD patients. Respir Med. 2012 Dec;106(12):1794-9. doi: 10.1016/j.rmed.2012.08.023. Epub 2012 Sep 29.

Reference Type BACKGROUND
PMID: 23026445 (View on PubMed)

Ding ZL, Wang ZF, Sun XH, Ke MY. [Therapeutic mechanism of diaphragm training at different periods in patients with gastroesophageal reflux disease]. Zhonghua Yi Xue Za Zhi. 2013 Oct 29;93(40):3215-9. Chinese.

Reference Type BACKGROUND
PMID: 24405544 (View on PubMed)

Sun X, Shang W, Wang Z, Liu X, Fang X, Ke M. Short-term and long-term effect of diaphragm biofeedback training in gastroesophageal reflux disease: an open-label, pilot, randomized trial. Dis Esophagus. 2016 Oct;29(7):829-836. doi: 10.1111/dote.12390. Epub 2015 Jul 30.

Reference Type BACKGROUND
PMID: 26227494 (View on PubMed)

Qiu K, Wang J, Chen B, Wang H, Ma C. The effect of breathing exercises on patients with GERD: a meta-analysis. Ann Palliat Med. 2020 Mar;9(2):405-413. doi: 10.21037/apm.2020.02.35. Epub 2020 Mar 17.

Reference Type BACKGROUND
PMID: 32233626 (View on PubMed)

Eguaras N, Rodriguez-Lopez ES, Lopez-Dicastillo O, Franco-Sierra MA, Ricard F, Oliva-Pascual-Vaca A. Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial. J Clin Med. 2019 Oct 19;8(10):1738. doi: 10.3390/jcm8101738.

Reference Type BACKGROUND
PMID: 31635110 (View on PubMed)

Bitnar P, Stovicek J, Hlava S, Kolar P, Arlt J, Arltova M, Madle K, Busch A, Kobesova A. Manual Cervical Traction and Trunk Stabilization Cause Significant Changes in Upper and Lower Esophageal Sphincter: A Randomized Trial. J Manipulative Physiol Ther. 2021 May;44(4):344-351. doi: 10.1016/j.jmpt.2021.01.004.

Reference Type BACKGROUND
PMID: 34090551 (View on PubMed)

Martinez-Hurtado I, Arguisuelas MD, Almela-Notari P, Cortes X, Barrasa-Shaw A, Campos-Gonzalez JC, Lison JF. Effects of diaphragmatic myofascial release on gastroesophageal reflux disease: a preliminary randomized controlled trial. Sci Rep. 2019 May 13;9(1):7273. doi: 10.1038/s41598-019-43799-y.

Reference Type BACKGROUND
PMID: 31086250 (View on PubMed)

Jones R, Coyne K, Wiklund I. The gastro-oesophageal reflux disease impact scale: a patient management tool for primary care. Aliment Pharmacol Ther. 2007 Jun 15;25(12):1451-9. doi: 10.1111/j.1365-2036.2007.03343.x.

Reference Type BACKGROUND
PMID: 17539985 (View on PubMed)

Nuevo J, Tafalla M, Zapardiel J. [Validation of the Reflux Disease Questionnaire (RDQ) and Gastrointestinal Impact Scale (GIS) in patients with gastroesophageal reflux disease in the Spanish population]. Gastroenterol Hepatol. 2009 Apr;32(4):264-73. doi: 10.1016/j.gastrohep.2008.12.004. Epub 2009 Apr 16. Spanish.

Reference Type BACKGROUND
PMID: 19371971 (View on PubMed)

Kulich KR, Pique JM, Vegazo O, Jimenez J, Zapardiel J, Carlsson J, Wiklund I. [Psychometric validation of translation to Spanish of the gastrointestinal symptoms rating scale (GSRS) and quality of life in reflux and dyspepsia (QOLRAD) in patients with gastroesophageal reflux disease]. Rev Clin Esp. 2005 Dec;205(12):588-94. doi: 10.1016/s0014-2565(05)72651-5. Spanish.

Reference Type BACKGROUND
PMID: 16527180 (View on PubMed)

Sobrino-Cossio S, Soto-Perez JC, Coss-Adame E, Mateos-Perez G, Teramoto Matsubara O, Tawil J, Vallejo-Soto M, Saez-Rios A, Vargas-Romero JA, Zarate-Guzman AM, Galvis-Garcia ES, Morales-Arambula M, Quiroz-Castro O, Carrasco-Rojas A, Remes-Troche JM. Post-fundoplication symptoms and complications: Diagnostic approach and treatment. Rev Gastroenterol Mex. 2017 Jul-Sep;82(3):234-247. doi: 10.1016/j.rgmx.2016.08.005. Epub 2017 Jan 5. English, Spanish.

Reference Type BACKGROUND
PMID: 28065591 (View on PubMed)

Pandolfino JE, Shi G, Curry J, Joehl RJ, Brasseur JG, Kahrilas PJ. Esophagogastric junction distensibility: a factor contributing to sphincter incompetence. Am J Physiol Gastrointest Liver Physiol. 2002 Jun;282(6):G1052-8. doi: 10.1152/ajpgi.00279.2001.

Reference Type BACKGROUND
PMID: 12016131 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

2018308

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Stretta Versus Conservative Treatment
NCT05781347 RECRUITING NA
Platelet Rich Plasma in Hiatal Hernia Repair
NCT05023174 ACTIVE_NOT_RECRUITING NA
Thorcolumbar Kyphosis Patients With GERD
NCT04521985 NOT_YET_RECRUITING