**Results**

• At entry into the study there were no significant differences between the three BMI groups in:

◦ TWST = SCT, PSF = LFT or VAS values

	- a. heartburn and cough were significantly more common in Groups B (moderately obese) and C (severely obese), and that
	- b. misdirected swallowing was significantly more common in Group C (severely obese).
	- all IED and GERD symptom scores were significantly improved or reduced (p < 0.001).
	- median BMI was not significantly changed.
	- self-assessed GERD symptom improvement showed no significant difference across the groups, except for heartburn, cough and misdirected swallowing which were significantly (p < 0.01) more reduced in obese patients than in normal bodyweight patients.
	- TWST = SCT and pharyngeal sling force (LFT) and VAS score, showed significant improvement (p < 0.001) in median values, with no significant difference between the BMI groups except for:
		- a. TWST values, which were significantly (p < 0.01) more improved in Group C (severely obese) than in Group A (normal weight).
		- b. pharyngeal sling force (LFT), which was significantly (p < 0.05) more improved in Group B (moderately obese) than in Group A (normal weight).

### **Statistical significance of result**

(*p* < 0.001) all IED and GERD symptom scores were significantly improved or reduced.

*Introducing an Innovative Oral Neuromuscular Treatment of the Underlying Reason… DOI: http://dx.doi.org/10.5772/intechopen.96773*

(p < 0.01) heartburn, cough and misdirected swallowing were significantly more reduced in obese patients than in normal bodyweight patients.

(*p* < 0.001) VAS score, TWST, and pharyngeal sling force (LFT) improved. (*p* < NS) no significant difference between other results across the three groups. **Conclusion**

IQoro neuromuscular training (IQNT), a non-surgical treatment for IED and other GERD symptoms in hiatal hernia patients, is equally successful in treating moderately- or severely obese patients as in treating sufferers of normal weight. Obesity in itself does not therefore seem to be a handicap in treating IED and other GERD symptoms by IQNT.

#### **9. Importance of neuromuscular treatment**

Orally administered neuromuscular treatment as described, deserves wider deployment and, where more evidence is deemed necessary, further research. Unlike medication it treats the root cause of reflux, and without the cost and inconvenience of surgical intervention. It is self-administered by the patient and instructions for use are clearly explained in the accompanying manual; in surveys 98% thought that instructions were clear, and 97% thought it was easy to start training [19]. PPI drugs should not be re-prescribed routinely but rather only after a medication review; these reviews are often planned twice per year and add a burden to primary care practices. The drugs themselves have a considerable cost over the course of a patient's lifetime. An IQoro sells singly at around €150.

The overall advantage is that it addresses and treats the underlying condition, not merely the symptoms.

#### **Figure 8.**

*(A) Sliding hiatal hernia; (B) functional anatomy (A) sliding hiatal hernia. The upper part of the stomach has slid up through the hiatal canal. This causes difficulties with opening the PES and allows gastroesophageal reflux. (B) Normal anatomy. The neck of the stomach is correctly held below the diaphragm promoting normal PES function and preventing reflux.*
