What is the relationship between Gastroesophageal Reflux Disease (GERD) and segmental dysfunction of the cervical spine or subluxation, and how does chiropractic or osteopathic stimulation of the vagus nerve affect it?

From the Guidelines

Chiropractic or osteopathic stimulation of the vagus nerve may be a complementary approach to help alleviate symptoms of Gastroesophageal Reflux Disease (GERD) associated with segmental dysfunction of the cervical spine or subluxation. However, the current evidence does not provide a clear causal relationship between GERD and segmental dysfunction of the cervical spine or subluxation 1.

Possible Extraesophageal Manifestations of GERD

The relationship between GERD and extraesophageal symptoms is complex and often controversial, leading to diagnostic and therapeutic challenges 1. Possible extraesophageal manifestations of GERD include:

• Cough
• Laryngeal hoarseness
• Dysphonia
• Pulmonary fibrosis
• Asthma
• Dental erosions/caries
• Sinus disease
• Ear disease
• Post-nasal drip
• Throat clearing

Vagus Nerve Stimulation

Gentle chiropractic or osteopathic manipulative techniques, such as cervical spine mobilization or soft tissue techniques, may be applied to stimulate the vagus nerve and help regulate digestive function. The treatment plan should be individualized, and the patient should be monitored for any changes in symptoms or adverse effects. It is recommended to start with gentle and low-force techniques, and gradually increase the intensity and frequency as needed and tolerated.

Treatment Approach

In addition to chiropractic or osteopathic care, patients with GERD may also benefit from lifestyle modifications, such as dietary changes, stress management, and weight loss, as well as medication therapy, such as antacids, histamine-2 (H2) blockers, or proton pump inhibitors (PPIs), under the guidance of a healthcare provider. The treatment duration and frequency will depend on the individual patient's response and the severity of symptoms.

From the Research

Relationship between GERD and Cervical Spine Dysfunction

• The relationship between Gastroesophageal Reflux Disease (GERD) and segmental dysfunction of the cervical spine or subluxation is complex and not fully understood 2, 3.
• Studies suggest that somatic dysfunction of the cervical spine can present a wide variety of clinical symptoms, including those related to GERD 3.
• Cervical spondylolisthesis, a condition characterized by instability of the spine, can lead to pain, radiculopathy, myelopathy, and vertebral artery stenosis, which may be related to GERD symptoms 4.

Effect of Chiropractic or Osteopathic Stimulation on GERD

• Osteopathic manual treatment has been shown to improve GERD symptoms, cervical mobility, and pressure pain threshold in patients with GERD 2.
• Chiropractic BioPhysics technique has been used to improve cervical alignment, spondylolistheses, and spinal canal diameter, which may help reduce vertebral subluxation and cervical spondylolistheses, and improve neck disability 4.
• Stimulation of the vagus nerve, which can be achieved through chiropractic or osteopathic manipulation, may also play a role in improving GERD symptoms, although more research is needed to fully understand this relationship 2, 5.

Mechanisms Underlying GERD and Cervical Spine Dysfunction

• The pathophysiology of GERD is complex and involves multiple factors, including the lower esophageal sphincter (LES) and the crural diaphragm (CD) 5.
• The CD plays a critical role in preventing esophageal reflux, and dysfunction of the CD has been associated with GERD symptoms 5.
• Cervical spine dysfunction, including segmental dysfunction and subluxation, may contribute to GERD symptoms by affecting the vagus nerve and other neural pathways 3, 6.