Can yoga be used to treat gastroesophageal reflux disease?
A 62-year-old male presented with history of heart burn followed by dysphagia. An endoscopy showed a large hiatal hernia with a nonobstructing peptic stricture proximal to the gastroesophageal junction due to erosive esophagitis. The esophagogastroduodenoscopy (EGD) revealed presence of gastritis and duodenitis. The patient had Grade D esophagitis according to Los Angeles (LA) classification of esophagitis []. Initially the patient was started on a high-dose PPI. After 6 months of continuous treatment, repeat EGD showed LA Grade C esophagitis and persistence of a large hiatal hernia. We used Bravo (Bravo is a pH recording capsule used to measure acidity levels in the esophagus) study to accurately measure acid reflux and correlate it with clinical symptoms by keeping the patient off the PPI regimen temporarily. On a Bravo study, the patients DeMeester score on the 1st day was 81.1 and on 2nd day was 35.1, indicating severity of acid reflux.\nThe patient was advised to continue treatment of high dose of PPI. In conjunction with PPI the patient began practicing Yoga daily for symptomatic alleviation of his GERD. Regular Yoga exercises included a Kapalbhati Pranayama and an Agnisar Kriya. After 6 months follow-up EGD revealed hiatal hernia and a nonobstructing peptic stricture just proximal to the gastroesophageal junction but his esophagitis grade improved to Grade A from initial Grade D esophagitis according to LA classification. To confirm these findings we did Bravo study and a repeat EGD after 5 weeks. The Bravo study showed a significant improvement in DeMeester scores; the day one score improved from 81.1 to 12 and the day two score improved from 35.1 to 17. These finding of EGD indicates that the patient had significant symptomatic improvement after 6 months of combined regimen of Yoga and PPI, which were refractory to high dose of PPI alone. His heart burn and dysphagia symptoms improved significantly in terms of both severity and frequency. He did not have nausea, diarrhea, constipation, postprandial fullness, bloating, and any other additional complaints. He had normal bowel movements. All of his blood tests were within normal limits. A follow-up Barium Swallow study was performed and showed normal oral transit time, pharyngeal transit time, reflex time and reflex strength. Biopsies of the stomach and duodenum demonstrated normal results except for chronic gastritis.\nThis patient has shown the effect of regular practice of a Kapalbhati Pranayama and Agnisar Kriya on severe GERD. After adding regular Yoga exercises to the ongoing treatment of high dose PPI, he had dramatic clinical improvement evidenced by both the reduction of Bravo scores and improvement in esophagitis grading.