A Simple Exercise to Strengthen the Lower Esophageal Sphincter and Eliminate Gastroesophageal Reflux: An Autobiographical Case Report

Gastroesophageal reflux results from weakness or relaxation of the lower esophageal sphincter (LES) [1]. Personal experience of this problem has made me think about it, many times. I came to harbor hope that strengthening LES might alleviate my reflux problem. Voluntary muscles can be strengthened with resistance training, but involuntary muscles like the LES usually cannot be strengthened this way. The esophagus, however, offers a special case. The swallowing process begins with a voluntary act that eventually triggers a peristaltic wave of involuntary contractions through smooth muscle in the lower two-thirds of the esophagus [2]. It occurred to me that the LES could be strengthened if they were made to do a little extra work. The new resistance training described here accomplishes this by having the LES push food upwards against gravity.

I suffered from gastroesophageal reflux disease for several years. Symptoms worsened dramatically immediately after a 2016 endoscopy during which an inexplicably large biopsy (estimated at 0.3 x 0.5 x 0.2 cm, but not actually measured in three dimensions) was taken from my esophagus to exclude Barrett’s esophagus. Nevertheless, all of my symptoms were eventually substantially controlled with ranitidine (150mg three times a day) and a bed wedge. The ranitidine was a minor nuisance, but even after several refinements, the bed nook was still intolerable.

Ultimately, I devised the following diet with the intention of providing LES with resistance training. Resistance was provided by positioning my head under my belly in a kneeling posture. This required swallowing food to be pushed down a slope. I started eating part of every breakfast (oatmeal) and sometimes lunch (a sandwich) in the exercise position. I would kneel down on a platform (which was 6 ½ inches high), take a normal bite, chew it as needed, and prepare to swallow. I would then rest my forearms and the backs of my hands on the floor, rest my head on my hands, and complete the swallowing process. With a little practice, I was quickly able to initiate and complete the swallowing process with my head resting on my hands on the floor. I have not attempted to determine what the optimal height of the platform might be or if indeed a height is needed.

Sixty-eight days after starting the daily LES exercises, I noticed that I could bend over at the hips and pull weeds from my garden without the acid running down the back of my throat. This was not possible the previous year. I then tried sleeping without the bed wedge, but found it was still needed. I interpreted these observations as indicating that the LES was getting louder, but still not loud enough. For about five more months, I remained ambivalent about whether exercise would completely correct my problem, and eventually sought help from the Cleveland clinic. A 24 hour pH and manometry test was performed which gave completely normal results. I then stopped using the bed wedge and no longer have any symptoms that I can attribute to gastroesophageal reflux disease. I considered the possibility that a continuous training regimen might be necessary to maintain full LES function, so rather than risk a relapse, I continued to exercise a few times a week for a few months, then less frequently. I haven’t exercised at all for the past two years without a relapse.

My elimination of gastroesophageal reflux includes benefits beyond the ability to sleep comfortably on a horizontal surface. I can again do the maintenance of the vehicle lying on my back without esophageal discomfort. On one occasion, I needed to make a minor repair to the gutter in my house where the placement of a ladder was somewhat inconvenient. I was able to complete the repair in about 10 minutes, lying on my stomach, looking down near the edge of the sloping roof, with no esophageal discomfort. Estimating from the pitch of the roof and my orientation to the edge of the roof, my stomach was about two to three inches higher than my throat when doing this repair. These observations attest once again to the rediscovered competence of my ERP.

In retrospect, I probably should have tested sleeping without the corner of the bed at regular intervals after I first noticed an improvement in LES function. But once I had determined that I no longer needed the bed wedge, I probably never would have taken the pH and manometry test, and that report, if done, would have been entirely based on my interpretation of the symptoms.

These observations clearly constitute proof of concept for the LES exercise. Hopefully others will benefit from this exercise, and their experiences can become the basis of a standardized protocol for its use. Many details, which I merely guessed at, could be optimized by systematic study. The height or need for a kneeling platform, the frequency and duration that constitute effective workouts, and a time frame in which results can be expected can all be determined. The texture and amount of food swallowed may be of some importance. It also remains to be seen if there are any contraindications to LES exercise. This exercise is probably safe enough for anyone otherwise healthy, but anyone new to this exercise should exercise reasonable caution when developing their technique to avoid discomfort.

Resistance training exercise for strengthening LES has many desirable attributes. It can eliminate the cause of gastroesophageal reflux disease rather than treating its symptoms and may well be a permanent solution to the problem. Exercise carries little or no risk or cost, and its use can benefit many people.

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