The “Aachen sings” study (“Aachen choir engagement study into GERD symptoms”): moderate singing and breathing exercises in a choir reduce reflux symptoms – a cohort study in non-specialist choristers

Abstract

Background The influence of singing activities and breathing exercises on the presence of gastroesophageal reflux disease (GERD) symptoms is not clear. While an Austrian study found symptom reduction, an Italian study showed more symptoms in professional opera choristers. These contradictory results may be due to differential intensity of the singing exercises. We therefore developed a questionnaire to investigate the presence of GERD typical symptoms and defined GERD in nonprofessional choristers with moderate singing activity and breathing exercises and compared the results to those from related non-singing control persons.

Methods 434 actively engaged lay-choir persons and 310 non-singing friends or relatives answered questions in a questionnaire regarding basic data, singing habits, GERD symptoms, and past or present diagnostic events and medications.

Results Non-singing control persons experienced more frequently heartburn (1.1 ± 4.1 vs. 0.5 ± 1.2 episodes/week, p = 0.001) and acid regurgitation (0.9 ± 4.1 vs. 0.5 ± 1.3 episodes/week, p < 0.001) and had more often already received the diagnosis of GERD (16.8 % vs. 10.4 %, p = 0.011). From the persons without known GERD, members of the control cohort more often fulfilled the simplified diagnostic criteria of GERD (14.3 % vs. 5.1 %, p < 0.001). A multivariate analysis identified non-singing, high body mass index, and smoking as significant risk factors for the presence of GERD symptoms.

Conclusion The frequency of reflux symptoms and GERD is probably still increasing. Moderate singing activities and breathing exercises seem to be helpful in avoiding reflux symptoms such as heartburn and acid regurgitation.

Zusammenfassung

Hintergrund Singaktivitäten und Atemübungen können über eine Kräftigung der Zwerchfellschenkel den unteren Ösophagussphinkter stärken und, wie in einer kleinen Grazer Studie gezeigt, auch Refluxsymptome lindern. Andererseits berichten zahlreiche Fallstudien und eine Kohortenstudie über vermehrten Reflux insbesondere bei professionellen Opernsängern, z. T. in Abhängigkeit von der Intensität und zeitlichen Ausdehnung der Singaktivitäten.

Methodik In einer Kohortenstudie befragten wir 434 im Laien-Chor mit Sing- und Atemübungen aktive Personen (Alter 55,1 ± 15 Jahre, 46,7 % männlich, BMI 25 ± 3,8) zu Refluxsymptomen, bekannter Refluxkrankheit (GERD) und Diagnostik und Therapie in diesem Zusammenhang. Eine Kontrollkohorte wurde aus 310 nicht-singenden Freunden und Familienangehörigen dieser Sänger gebildet (Alter 48,2 ± 17,7 Jahre, 47,9 % männlich, BMI 25,5 ± 6,3).

Ergebnisse Nicht-singende Kontrollpersonen hatten signifikant häufiger Sodbrennen (1,1 ± 4,1 vs. 0,5 ± 1,2 Ereignisse pro Woche) und saures Aufstoßen (0,9 ± 4,1 vs. 0,5 ± 1,3 Ereignisse pro Woche) und hatten häufiger bereits die Diagnose einer Refluxkrankheit erhalten (16,8 vs. 10,4 %) als singende Personen. Auch Personen ohne bekannte GERD erfüllten signifikant häufiger die rein klinisch-epidemiologische Definition der Refluxkrankheit in der Kontrollgruppe (14,3 vs. 5,1 %). Fast ein Drittel der Personen beider Kohorten wurde schon mindestens einmal gastroskopiert, zahlreiche Personen in beiden Gruppen hatten aus verschiedenen Gründen schon phasenweise Säureblocker eingenommen (20,3 % in der Chorgruppe, 29 % bei den Nicht-Sängern). In der multivariaten Analyse wurden ein Nikotinabusus, ein BMI > 25 und das Nicht-Singen als unabhängige Determinanten für das Vorliegen von Sodbrennen identifiziert.

Schlussfolgerung Regelmäßiges, nur moderates Chorsingen mit Atemübungen scheint vor Sodbrennen und saurem Aufstoßen und damit vor GERD zu schützen.

Key words

GERD - heartburn - regurgitation - breathing exercises

Schlüsselwörter

GERD - Sodbrennen - Regurgitation - Atemübungen

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