Drinking balneotherapy in medical rehabilitation of patients with non-erosive gastroesophageal reflux disease

Background. The prevalence of gastroesophageal reflux disease (GERD) in the population is 11.5–23.5%. Despite modern pharmacotherapy options, up to 50% of GERD patients continue to experience reflux-related symptoms, which significantly impairs their quality of life and can lead to serious complications. The insufficient effectiveness of existing therapeutic strategies requires optimized approaches to managing such patients. Enhancing GERD control is possible by incorporating drinking balneotherapy into the standard treatment regimen.

Objective: To provide a rationale for and evaluate the effectiveness of including Uvinskaya mineral water in the medical rehabilitation regimen for patients with non-erosive reflux disease (NERD).

Material and methods. The study evaluated 100 NERD patients and 30 healthy controls without complaints or registered illnesses. The NERD patients were randomly divided into two subgroups of 50 each. Subgroup 1 received standard NERD therapy (omeprazole 20 mg twice daily, itopride 50 mg three times daily) in combination with Uvinskaya mineral water for 1 month; Subroup 2 received standard therapy alone for the same duration. During the 6-month follow-up, the following evaluations were performed in the compared subgroups: clinical data analysis, patient surveys using using the GastroEsopha- geal Reflux Disease Questionnaire (GERDQ) and the (Gastrointestinal Symptom Rating Scale (GSRS), 24-hour pH-impedance monitoring, esophagogastroduodenoscopy, and measurements of serum motilin and gastrin levels.

Results. After 1 month of follow-up, substantial improvements were noted in all evaluated parameters in the compared subgroups, with no significant differences. By month 3, this positive trend persisted in Subgroup 1, while the parameters in Subgroup 2 began to approach baseline values. By month 6, the outcomes in the balneotherapy subgroup converged with those in the standard therapy subgroup, with the exception of the esophageal endoscopic findings: signs of esophagitis were observed half as frequently in patients who drank Uvinskaya mineral water.

Conclusion. The inclusion of Uvinskaya mineral water in the treatment and rehabilitation program for NERD helps prolong its clinical benefits. The clinical efficacy of a course of balneotherapy with this mineral water is confirmed by persistent positive changes in 24-hour esophageal pH-impedance monitoring. Furthermore, the endoscopic improvements objectively reflect the therapeutic effectiveness of this approach.

1. Ivashkin V.T., Trukhmanov A.S., Maev I.V., et al. Diagnosis and treatment of gastroesophageal reflux disease (clinical guidelines of the Russian Gastroenterological Association, Russian Scientific Medical Society of Internal Medicine, Russian Society for the Prevention of Noncommunicable Diseases, Scientific Community for Human Microbiome Research). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2024; 34 (5): 111–35 (in Russ.). https://doi.org/10.22416/1382-4376-2024-34-5-111-135.

2. Dunbar K.B. Gastroesophageal reflux disease. Ann Intern Med. 2024; 177 (8): ITC113–28. https://doi.org/10.7326/AITC202408200.

3. Zhang D., Liu S., Li Z., Wang R. Global, regional and national burden of gastroesophageal reflux disease, 1990–2019: update from the GBD 2019 study. Ann Med. 2022; 54 (1): 1372–84. https://doi.org/10.1080/07853890.2022.2074535.

4. Gonçalves E.S., Assumpção M.S., Servidoni M.F.C.P., et al. Multichannel intraluminal impedance-pH and psychometric properties in gastroesophageal reflux: systematic review. J Pediatr. 2020; 96 (6): 673–85. https://doi.org/10.1016/j.jped.2020.01.005.

5. Frazzoni L., Fuccio L., Zagari R.M. Management of gastro-esophageal reflux disease: practice-oriented answers to clinical questions. World J Gastroenterol. 2023; 29 (5): 773–9. https://doi.org/10.3748/wjg.v29.i5.773.

6. Ivashkin V.T., Maev I.V., Trukhmanov A.S., Rumyantseva D.E. Modern achievements in the diagnosis and treatment of the refractory gastroesophageal reflux disease. Therapeutic Archive. 2018; 90 (8): 4–12 (in Russ.). https://doi.org/10.26442/terarkh20189084-12.

7. Osadchuk A.M., Davydkin I.L., Gricenko T.A., Osadchuk M.A. Gastroesophageal reflux disease and esophagitis associated with the use of drugs: the modern state of the problem. Therapeutic Archive. 2019; 91 (8): 135–40 (in Russ.). https://doi.org/10.26442/00403660.2019.08.000228.

8. Armstrong D., Pali Hungin A., Kahrilas P.J., et al. Management of patients with refractory reflux-like symptoms despite proton pump inhibitor therapy: evidence-based consensus statements. Aliment Pharmacol Ther. 2025; 61 (4): 636–50. https://doi.org/10.1111/apt.18420.

9. Olmos J.A., Pandolfino J.E., Piskorz M.M., et al. Latin American consensus on diagnosis of gastroesophageal reflux disease. Neurogastroenterol Motil. 2024; 36 (3): e14735. https://doi.org/10.1111/nmo.14735.

10. Grigoryan E.G., Maisuryan K.V., Grigoryan N.E. Efficiency of Bjni mineral water in the complex treatment of esophagogastroduodenal reflux disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020; 30 (5 Suppl. 56): 4 (in Russ.).

11. Usmanov F.F., Gilmutdinov A.R., Kunafin A.F., et al. Potable mineral water in the treatmentof patients with gastroesophageal reflux disease. Bashkortostan Medical Journal. 2013; 8 (6): 135–7 (in Russ.).

12. Beer A.M., Uebelhack R., Pohl U. Efficacy and tolerability of hydrogen carbonate-rich water for heartburn. World J Gastrointest Pathophysiol. 2016; 7 (1): 171–80. https://doi.org/10.4291/wjgp.v7.i1.171.

13. Labenz J., Anschütz M., Walstab J., et al. Heartburn relief with bicarbonate-rich mineral water: results of the randomised, placebo-controlled phase-III trial STOMACH STILL. BMJ Open Gastroenterol. 2023; 10 (1): e001048. https://doi.org/10.1136/bmjgast-2022-001048.

14. Gorbunov A.Yu., Tronina D.V. Contractile function of the gallbladder during intake of Uvinskaya mineral water. Consilium Medicum. 2024; 26 (S1): 22 (in Russ.).

15. Butorina N.V., Vakhrushev Ja.M. Evaluation of the effectiveness of comprehensive treatment strategies in the management of patients with gastroesophageal reflux disease including balneotherapy and rehabilitation in sanatoriums and health-resorts. Kremlin Medicine Journal. 2023; 4: 42–5 (in Russ.). https://doi.org/10.48612/cgma/m6pu-b2xb-nhbe.

16. Dragomiretska N., Babov K., Gushcha S., et al. Application of mineral waters in the complex treatment of patients with gastroesophageal reflux disease. Minerva Gastroenterol Dietol. 2020; 66 (3): 225–37. https://doi.org/10.23736/S1121-421X.20.02601-X.

17. Koufman J.A., Johnston N. Potential benefits of pH 8.8 alkaline drinking water as an adjunct in the treatment of reflux disease. Ann Otol Rhinol Laryngol. 2012; 121 (7): 431–4. https://doi.org/10.1177/000348941212100702.

18. Silva A., Oliveira А., Vaz С., et al. Anti-inflammatory potential of Portuguese thermal waters. Sci Rep. 2020; 10 (1): 22313. https://doi.org/10.1038/s41598-020-79394-9.

19. Dzhulai G.S., Sekareva E.V. Gastric and duodenal secretory and motor-evacuatory activity in patients with gastroesophageal reflux disease associated with different types of reflux. Therapeutic Archive. 2016; 88 (2): 16–20 (in Russ.). https://doi.org/10.17116/terarkh201688216-20.

20. Maev I.V., Samsonov A.A., Odintsova A.N., et al. Prospects for the use of a new prokinetic with a dual mechanism of action in the treatment of gastroesophageal reflux disease. Farmateka. 2009; 2: 34–9 (in Russ.).

21. Cho M.S., Park J.W., Kim J., Ko S.F. The influence of herbal medicine on serum motilin and its effect on human and animal model: a systematic review. Front Pharmacol. 2023; 14: 1286333. https://doi.org/10.3389/fphar.2023.1286333.

22. Mori H., Verbeure W., Tanemoto R., et al. Physiological functions and potential clinical applications of motilin. Peptides. 2023; 160: 170905. https://doi.org/10.1016/j.peptides.2022.170905.

23. Kuznetsova E.I., Rymareva E.A., Dicheva D.T., Andreev D.N. Gastroesophageal reflux disease and diabetes mellitus: pathophysiological mechanisms of comorbidity. Consilium Medicum. 2019; 21 (8): 23–8 (in Russ.). https://doi.org/10.26442/20751753.2019.8.190497.

24. Shklyaev A.E., Shutova A.A., Kazarin D.D., et al. Influence of blood motylin concentration on clinical symptomatics of functional dyspepsy. Experimental and Clinical Gastroenterology. 2022; 9: 58–64 (in Russ.). https://doi.org/10.31146/1682-8658-ecg-205-9-58-64.

25. Tao L., Fu J., Wang F., et al. The application of mirabilite in traditional Chinese medicine and its chemical constituents, processing methods, pharmacology, toxicology and clinical research. Front Pharmacol. 2024; 14: 1293097. https://doi.org/10.3389/fphar.2023.1293097.

26. Shklyaev A.E., Kazarin D.D., Grigoreva O.A. Balneotherapy of epigastric pain syndrome: the meaning of motilin in the implementation of the therapeutic effect. Medical Herald of the South of Russia. 2023; 14 (1): 24–30 (in Russ.). https://doi.org/10.21886/2219-8075-2023-14-1-24-30.