Original Contribution  |   June 2016
Correlation of Somatic Dysfunction With Gastrointestinal Endoscopic Findings: An Observational Study
Author Notes
  • From the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri (Dr K. Snider, Dr E. Snider, and Ms Johnson); the Departments of Family Medicine, Preventive Medicine, and Community Health (Dr K. Snider) and Osteopathic Manipulative Medicine (Dr Schneider, Dr E. Snider, and Dr Danto) at the A.T. Still University-Kirksville College of Osteopathic Medicine in Missouri; the Department of Family Medicine at the University of Massachusetts Medical School in Worcester (Dr Lehnhardt); Osteopathic Horizons in Belleville, Illinois (Dr Ngo); and Northeast Regional Medical Center in Kirksville, Missouri (Dr Sheneman). 
  • Support: The current study was supported by a grant from the A.T. Still Research Institute’s Strategic Research Fund. 
  •  *Address correspondence to Karen T. Snider, DO, Departments of Family Medicine, Preventive Medicine, and Community Health, A.T. Still University-Kirksville College of Osteopathic Medicine, 800 W Jefferson St, Kirksville, Missouri 63501-1143. E-mail: ksnider@atsu.edu
     
Article Information
Gastroenterology / Neuromusculoskeletal Disorders
Original Contribution   |   June 2016
Correlation of Somatic Dysfunction With Gastrointestinal Endoscopic Findings: An Observational Study
The Journal of the American Osteopathic Association, June 2016, Vol. 116, 358-369. doi:10.7556/jaoa.2016.076
The Journal of the American Osteopathic Association, June 2016, Vol. 116, 358-369. doi:10.7556/jaoa.2016.076
Abstract

Context: Gastrointestinal (GI) endoscopy provides a novel means of correlating visceral abnormalities with somatic dysfunction.

Objective: To assess the correlation of palpatory findings of somatic dysfunction with GI abnormalities determined by endoscopy and to identify which types of somatic dysfunction were most commonly correlated with GI abnormalities.

Methods: In this observational, cross-sectional study, participants who were scheduled to receive an esophagogastroduodenoscopy (EGD), colonoscopy, or both were examined by 2 osteopathic physicians immediately prior to endoscopy for the presence of vertebral tenderness, asymmetry, restricted range of motion, and tissue texture abnormalities (TART findings); tenderness of anterior Chapman reflex points; and tenderness of visceral sphincters. Each type of somatic dysfunction and the somatic dysfunction burden (sum of findings) were compared with the type of endoscopic procedure and abnormal endoscopic findings.

Results: Sixty-six adults participated: 43 received an EGD, 40 received a colonoscopy, and 17 received both. The incidence of vertebral TART findings ranged from 70% at T12 to 98% at the sacrum. Participants who received only EGD had a higher somatic dysfunction burden than those who received only colonoscopy and those who received both procedures (P=.002). The incidence of abnormal endoscopic findings ranged from 98% in the stomach to 0% at the ileocecal valve. Statistically significant positive associations were found between specific vertebral TART findings and abnormalities of the esophagus, gastroesophageal junction, pylorus, ascending colon, and sigmoid colon; specific Chapman reflex point tenderness and abnormalities of the esophagus, gastroesophageal junction, pylorus, ascending colon, descending colon, sigmoid colon, and rectum; and specific visceral sphincter tenderness and abnormalities of the duodenum, ascending colon, and sigmoid colon.

Conclusions: The current study found numerous associations between somatic dysfunction and abnormal endoscopic findings. However, the high incidence of vertebral TART findings and the lack of normal controls for many GI regions made establishing meaningful relationships between specific somatic dysfunction and specific GI abnormalities challenging. Future investigations should include more participants to ensure a higher number of normal endoscopic findings and limit the physical examination to elements of somatic dysfunction with a high level of variability between vertebrae within an individual participant and between participants, such as tenderness and tissue texture abnormalities. (ClinicalTrials.gov number NCT01394198)

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