Straight Leg Raise: the new manoeuvre to diagnose gastro-oesophageal reflux disease

By Cristiano Antonino On Nov 16, 2022

How the Straight Leg Raise manoeuvre works: a group of Italian researchers demonstrated that raising the legs can be a useful additional manoeuvre to improve the diagnostic capacity of high-resolution oesophageal manometry

For a long time, specialists have known that gastro-oesophageal reflux can be promoted by a significant increase in intra-abdominal pressure, an increase due, for example, to pregnancy, obesity and causes such as coughing or physical exertion (abdominal gymnastics, weightlifting, sexual activity).

Even the simple act of raising one’s legs while lying down increases intra-abdominal pressure as a result.

The new Straight Leg Raise manoeuvre, which is quick and easy to perform, consists precisely of raising one or both legs during the manometric examination in order to increase intra-abdominal pressure and thus put the protective mechanisms of the backflow barrier under ‘stress’.

The aims of the Straight Leg Raise study

The study, conducted on an international scale and involving 12 centres specialising in the diagnosis and treatment of MRGE, aimed to define the abnormal intra-oesophageal pressure values detected during manometry and induced by the new Straight Leg Raise (SLR) manoeuvre.

The study, which was published in one of the world’s leading gastroenterology journals (Clinical Gastroenterology and Hepatology), also ascertained the excellent diagnostic accuracy of the SLR manoeuvre, which was able to identify patients with MRGE in 79% of cases and exclude healthy patients in 85% of cases.

From a practical point of view, the SLR manoeuvre performed during oesophageal manometry may improve the ability to diagnose reflux in patients with suspected MRGE on an outpatient basis, avoiding pH-impedancemetry in many cases and identifying patients who are candidates for both medical and endoscopic therapy at an early stage.

Gastro-oesophageal reflux disease: what it is

Gastro-oesophageal reflux disease (GERD) is characterised by the pathological ascending of acidic material from the stomach to the oesophagus through the oesophago-gastric junction, i.e. the cardia.

It is a widespread clinical condition, affecting around 30% of the population in industrialised countries, including Italy.

The main symptoms of MRGE are:

retrosternal heartburn, a condition that manifests as a burning sensation posterior to the sternum;
acid regurgitation, a condition in which material from the stomach rises involuntarily to the mouth.

However, about one third of patients report atypical and ‘extra-oesophageal’ symptoms such as:

cough;
hoarseness;
velvety or mucus in the throat;
angina pectoris-like chest pain, the latter manifestation of which requires specific diagnostic tests in order to exclude the possibility of ischaemia.

What are the consequences of gastro-oesophageal reflux

In addition to negatively affecting the quality of life of patients suffering from it, MRGE predisposes to the development of complications such as oesophagitis and Barrett’s oesophagus, the latter in turn being closely related to the increased incidence of the most common oesophageal cancer, adenocarcinoma.

The diagnostic pathway

For the reasons described above, diagnosing MRGE at an early stage becomes of fundamental importance: a timely diagnosis allows, in fact, intervention on those modifiable risk factors such as, for example, incorrect diet or being overweight, thus guiding the specialist in the choice of the best medical therapy to treat the symptoms and prevent complications.

The diagnostic pathway is long and often laborious for the patient and does not always lead to a precise and conclusive diagnosis, particularly in patients with extra-oesophageal symptoms, minimal cardiac dysfunction and no hiatal hernia.

The aim of the research was precisely to intervene on the diagnostic capacity of the methods available today in order to improve patients’ quality of life.

The Straight Leg Raise manoeuvre, therefore, adds to the methodologies available today to diagnose MRGE, listed below:

oesophago-gastro-duodenoscopy with biopsies, a diagnostic examination that explores the upper digestive tract;
radiography of the upper digestive tract with contrast medium;
24-hour pH-impedancemetry;
high-resolution oesophageal manometry.

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