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"Penyakit refluks gastroesofagus (GERD) merupakan kondisi kronik yang terjadi akibat asam lambung naik ke esofagus. COVID-19 dapat memperburuk gejala GERD dan berdampak pada fungsi pernapasan. Latihan diafragma mampu memperbaiki gejala GERD, namun efektivitasnya pada orang dewasa dengan GERD pasca COVID-19 belum pernah diteliti. Penelitian ini bertujuan untuk menguji efektivitas latihan diafragma modifikasi terhadap gejala GERD, tekanan inspirasi maksimal (TIM), ekskursi diafragma, dan fungsi paru. Penelitian ini merupakan uji klinis acak tersamar tunggal pada bulan September 2022 sampai April 2023 di Rumah Sakit Persahabatan. Dari data rekam medis terdapat 364 pasien yang mengalami gejala gastrointestinal persisten. Dari data pasien tersebut, 302 pasien mengalami gejala sebelum COVID-19 dan 62 pasien setelah COVID19. Sebanyak 55 pasien memenuhi kriteria inklusi dan lolos kriteria eksklusi. Selanjutnya dialokasikan secara random pada kelompok uji (n = 25) dan kontrol (n = 25), dan 5 pasien menjalani penelitian pendahuluan. Latihan diafragma selama empat minggu terdiri atas latihan diafragma modifikasi atau latihan diafragma standar. Evaluasi dilakukan 30 hari setelah latihan pertama. Dibandingkan dengan kelompok kontrol, kelompok uji menunjukkan peningkatan bermakna pada tekanan inspirasi maksimal (TIM; 42,68 cmH2O ± 16,46 vs. 55,40 cmH2O ± 20,33 dan 74,80 cmH2O ± 20,33 vs. 68,68 cmH2O ± 21,25), ekskursi diafragma kanan (4,75 cm ± 0,98 vs. 4,97 cm ± 0,93 dan 6,84 cm ± 0,92 vs. 5,57 cm ± 0,95), dan ekskursi diafragma kiri (4,42 cm ± 0,86 vs. 4,70 cm ± 0,85 dan 6,48 cm ± 0,78 vs. 5,33 cm ± 0,90). Selain itu, baik kelompok uji sebelum-dan-sesudah maupun kelompok kontrol mengalami penurunan bermakna pada skor GERDQ (10,44 ± 2,00 vs. 1,84 ± 2,17 dan 8,64 ± 0,57 vs. 3,32 ± 1,49), dengan nilai p < 0,001. Latihan diafragma meningkatkan nilai kapasitas vital paksa (KVP), tidak meningkatkan nilai volume ekspirasi paksa detik pertama (VEP1) maupun rasio antara volume ekspirasi paksa detik pertama dan kapasitas vital paksa (VEP1/KVP), tidak bermakna secara statistik (p > 0,05). Latihan diafragma modifikasi pada orang dewasa setelah COVID-19 dengan GERD meningkatkan TIM dan ekskursi diafragma, serta mengurangi gejala refluks gastroesofageal yang terlihat dari perbaikan skor GERDQ.

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Gastroesophageal reflux disease (GERD) is a common chronic condition characterized by stomach acid reflux into the esophagus. COVID-19 may worsen GERD symptoms and impact respiratory function. Diaphragmatic training has demonstrated potential effectiveness in managing GERD symptoms, but its effectiveness in adults with GERD after COVID-19 is unknown. This study aimed to examine the effectiveness of modified diaphragmatic training (MDT) on GERD symptoms, maximum inspiratory pressure (MIP), diaphragmatic excursion, and lung function in this population. This single-blinded randomized control trial was conducted from September 2022 to April 2023 at Persahabatan Hospital. The research team evaluated the medical records of 364 patients presenting persistent gastrointestinal symptoms; among these potential participants, 302 reported symptoms before COVID-19 infection, while 62 developed symptoms after being infected with COVID-19. After applying the study's inclusion and exclusion criteria, a total of 55 patients were selected and randomly assigned to either the intervention group (n = 25) or the control group (n = 25), and 5 patients were enrolled in the preliminary research. The intervention phase consisted of four weeks of diaphragmatic training, wherein participants received either modified diaphragmatic training (MDT) or standard diaphragmatic training. Following the training period, a follow-up assessment was conducted 30 days from the initiation of the intervention. In comparison to the control group, the intervention group demonstrated significant improvements in maximum inspiratory pressure (MIP; 42,68 cmH2O ± 16,46 vs. 55,40 cmH2O ± 20,33 and 74,80 cmH2O ± 20,33 vs. 68,68 cmH2O ± 21,25), right diaphragmatic excursion (RDE; 4,75 cm ± 0,98 vs. 4,97 cm ± 0,93 and 6,84 cm ± 0,92 vs. 5,57 cm ± 0,95), and left diaphragmatic excursion (LDE; 4,42 cm ± 0,86 vs. 4,70 cm ± 0,85 and 6,48 cm ± 0,78 vs. 5,33 cm ± 0,90). Additionally, both the pre–post-intervention group and the control group exhibited significant reductions in GERDQ scores (10.44 ± 2.00 vs. 1.84 ± 2.17 and 8.64 ± 0.57 vs. 3.32 ± 1.49, respectively), with a p-value < 0.001. Diaphragmatic training resulted in increased forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC), these differences were not statistically significant in both groups (p > 0,05). MDT in adults post-COVID-19 with GERD enhanced MIP and diaphragmatic excursion, along with a reduction in symptoms of GERD as evidenced by improvements in GERDQ scores."

"Gastro Esophageal Reflux Disease)  adalah suatu kondisi terjadinya refluks isi lambung ke dalam esophagus yang menyebabkan  berbagai gejala klinis. Penyebab dari GERD sudah banyak diketahui namun patofisiologi  densitas saraf pleksus Meissner dan pleksus Aurbach di daerah gastroesofagus junction (GEJ) akibat pemberian senyawa nitrat (NO₃) sehingga menyebabkan  GERD belum diketahui.

Metode : Membuat model hewan  GERD dan menilai variabel-variabel   pengaruh senyawa nitrat  di daerah GEJ menggunakan tikus wistar usia 10-12 minggu dengan berat badan 200-300 gram yang  dibagi dalam 4 kelompok :  kontrol (n=12) dan  kelompok perlakuan (n=36). Pada kelompok perlakuan dilakukan pemberian senyawa nitrat masing kelompok (n=12)  sebanyak 1 ml, 1.5 ml dan 2 ml  NaNO₃ . Pada hari ke 2,4,6 dan 8 setelah   puasa dan diberikan  senyawa nitrat, sebanyak 3 tikus dari setiap kelompok dianalisis menggunakan pemeriksaan biokimia, histologi, histokimia dan imunohistokimia (IHK).

Hasil: Tikus  model GERD berhasil dibuat. Dimana  pada hari ke 2 terdapat korelasi antara NO luminal dengan  fibroblast, NO jaringan dengan perpanjangan lamina propria, penebalan sel basal dengan limfosit, hiperplasi sel basal dengan  IHK IL6 dan perpanjangan lamina propria dengan  limfosit.  Pada hari ke 4 didapat korelasi antara NO luminal dengan penebalan sel basal, NO luminal dengan GSH, penebalan  sel basal dengan GSH, dan korelasi limfosit dengan IHK IL6.  Pada ke 6 terdapat korelasi antara NO luminal dengan FGF₂. Pada hari ke 8 didapati  korelasi antara NO luminal dengan densitas saraf pleksus Meissner dan pleksus Auerbach didapat korelasi kuat dan bermakna ( r = 0,758 dan p = 0,004) , penebalan sel basal dengan fibroblas , limfosit dengan fibroblast, IHK IL6 dengan fibroblast dan IHK FGF₂ dengan penebalan sel basal.

Kesimpulan: Pemberian senyawa NO₃ meningkatkan kadar NO luminal yang mengakibatkan  perubahan morfologi makrokopis dan mikroskopis, penurunan antioksidan endogen, inflamasi serta peningkatan densitas saraf pleksus Meissner dan pleksus Auerbach didaerah sfingter GEJ sehingga menyebabkan terjadinya GERD.

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Background: GERD (Gastro Esophageal Reflux Disease) is a condition with reflux of gastric contents into the esophagus which causes various clinical symptoms. The causes of GERD have been  known but the pathophysiology of the density of the Meissner plexus nerve and the Aurbach plexus in the gastroesofagus junction region (GEJ) due to administration of nitrate (NO₃) compounds is not known unknown.

Methods: GERD animal models were prepared to asses the variables affected by nitrate compounds in the GEJ area using wistar mice aged 10-12 weeks with a weight of 200-300 grams divided into 4 groups: control (n = 12) and treatment group (n = 36). In the treatment group, nitrate compounds were given as NaNO3 in each group (n = 12) with the doses of 1 ml, 1.5 ml and 2 ml. On days 2,4,6 and 8 after fasting and gavage of nitrates, 3 rats from each group were sacrificed, and esophageal tissue was taken for biochemical, histological, histochemical and immunohistochemical (IHC) examinations.

Results: GERD model rats were successfully made. On day 2, there was a significant correlation between luminal NO level with fibroblasts, tissue NO with extension of lamina propria, thickening of basal cells with lymphocytes, basal cell hyperplasia with IL6 IHC and extension of lamina propria with lymphocytes. On day 4, there was a correlation between luminal NO and basal cell thickening, luminal NO with GSH, basal cell thickening with GSH, and lymphocyte with IL6 IHK. On day 6, we found a significant correlation between luminal NO and FGF2. On day 8, there was a correlation between luminal NO and the density of Meissner plexus nerve and Auerbach plexus with a strong and significant correlation (r = 0.758 and p = 0.004), thickening of basal cells with fibroblasts, lymphocytes with fibroblasts, IL6 IHC with fibroblasts and FGF2 IHC with thickening of basal cells.

Conclusion: The administration of NO₃ compounds increases luminal NO levels which results in changes in macroscopic and microscopic morphology, decreased endogenous antioxidants, inflammation and increased density of Meissner plexus nerve and Auerbach plexus in the area of the GEJ sphincter leading to development of GERD."