Snider KT, Schneider RP, Snider EJ, Danto JB, Lehnardt CW, Ngo CS, Johnson JC, Sheneman TA. Correlation of Somatic Dysfunction With Gastrointestinal Endoscopic Findings: An Observational Study. J Am Osteopath Assoc 2016;116(6):358-369. doi: 10.7556/jaoa.2016.076.
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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)
a No operative reports identified visual or histological findings at the sphincter of Oddi or the duodenojejunal junction.
b Some regions biopsied were visually normal.
Abbreviations: EGD, esophagogastroduodenoscopy; NA, not applicable.
a Data are given as No. (%).
Abbreviations: AA, atlantoaxial joint; OA, occipitoatlantal joint; ROM, range of motion; TART, tenderness, asymmetry, restricted range of motion, tissue texture abnormalities.
a Classic visceral associations of Chapman reflex points were defined according to Fossum et al.12
b Sternal midline includes tenderness located anywhere along the vertical midline of the sternum.
Abbreviations: F, female; ITB, iliotibial band; M, male; NA, not applicable; NKA, no known association.
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