Estudos revelam uma prevalência do refluxo gastroesofágico (RGE) em bebês no Brasil entorno de 11,5% a 18,2%, semelhante aos dados internacionais, trazendo sintomas que podem se perpetuar até a infância e adolescência. Os protocolos de tratamento atuais são em resumo medicamentosos. Poucos estudos referem evidências sobre terapias complementares no tratamento do refluxo. A osteopatia poderia ser utilizada neste contexto para tratar as causas do refluxo, porém, estudos que determinem Protocolos Osteopáticos de Tratamento (POT) são limitados e não são específicos para este diagnóstico. Assim, o objetivo deste estudo foi avaliar a aplicação de um POT desenvolvido para bebês de zero a um ano através de um método quantitativo. Foi realizado um estudo descritivo longitudinal com 59 bebês com idade entre zero e um ano de idade diagnosticados com refluxo e em tratamento medicamentoso. Inicialmente todos foram avaliados com o questionário I-GERQ-R. Trinta e três crianças foram selecionadas para o grupo A, que foi submetido ao POT em paralelo ao tratamento farmacológico, ou durante dois meses ou até atingir um score mínimo no questionário, o que ocorresse primeiro. O grupo B foi acompanhado pelo mesmo período, sendo reavaliado após dois meses. Foram analisados os dados coletados do questionário e os sintomas associados de cólica e tosse. No grupo A, a média inicial do score I-GERQ-R foi de 14,57 ±3,65 e a final 1,39 ±2,09 pontos (p=0,001). No grupo B estes valores foram respectivamente 17,23 ±4,78 e 8,46 ±7,41, caracterizando uma permanência do grupo B no diagnóstico de refluxo (escore>7) apesar da melhora com significância estatística (p=0,043). No grupo A 13 indivíduos chegaram ao escore final zero (“0”), enquanto que no grupo B nenhum indivíduo atingiu este escore. A redução da prevalência no uso de medicação ao final do estudo no grupo A foi de 75,76% enquanto que no grupo B esta redução foi de 11,54%. A melhora no grupo A ocorreu em um tempo médio de 28,76 ± 11,43 dias, independente da idade, onde o número médio de sessões foi 3,91 ±0,80. O sintoma de vômito apresentou melhora significativa no grupo A (p=0,001) mas não no grupo B (p=0,063). O sintoma de azia apresentou uma melhora significativa em ambos os grupos A e B (p=0,001 e p=0,002 respectivamente), bem como o soluço (p=0,001 e p=0,001 respectivamente). O sintoma de choro apresentou melhora significativa para o grupo A (p=0,001), porém não para o grupo B (P=0,123). Da mesma forma, os episódios de engasgos apresentaram redução estatisticamente significativa no grupo A (p=0,001) e não no grupo B (p=0,105). A tosse no grupo A foi reduzida em 94,45% (p=0,001) e a cólica em 75% (p=0,001). No grupo B a tosse permaneceu com a mesma incidência (14 casos) (p=1,000) e o sintoma de cólica aumentou 88,89% (de nove para 17 casos) (p=0,008). Conclui-se, portanto, que o POT proposto se mostrou eficaz na redução dos sintomas do refluxo em bebês e sintomas de tosse e cólica associados, em um tempo aproximado de 29 dias a níveis próximos à zero, tempo inferior ao descrito na literatura. Entende-se que o protocolo tenha atingido os mecanismos de causa do RGE, e, portanto a associação do POT com o tratamento medicação pode ser sugerido na abordagem do RGE em bebês de zero a um ano de idade. / The prevalence of gastroesophageal reflux disease (GERD) in infants in Brazil is about 11.5% to 18,2%, similar to international data, bringing symptoms that can be perpetuated into childhood and adolescence. Current treatment protocols are medicated summary, and few studies have reported evidence for complementary therapies in the treatment of reflux. Osteopathy could be used in this context to treat the causes of reflux, however, studies evaluating Osteopathic Protocols Treatments (OPT) are limited and are not specific for this diagnosis. The objective of this study was to develop and evaluate the application of a OPT developed for infants less than one year through a quantitative method. A longitudinal descriptive study of 59 babies aged under one year of age diagnosed with reflux and in a drug treatment was performed. Initially all were evaluated with I-GERQ-R questionnaire. Thirty- three children were selected for group A, which was submitted to OPT parallel to pharmacological treatment for two months or until it reaches a minimum score on the questionnaire, whichever came first. Group B was accompanied by the same period of two months and after that being re-evaluated. Data collected from the questionnaire and the associated symptoms of colic and cough were analyzed. In group A, the initial average score I-GERQ-R was 14.57 ±3.65 and 1.39 ±2.09 points at the end (p = 0.001). In group B these values were 17.23 ±4.78 and 8.46 ±7.41 points, featuring a stay of group B in the diagnosis of reflux (score>7) despite improvement with statistical significance (p = 0.043). In group A, 13 subjects reached the final score zero ("0"), while in group B no individual reached this score. Reduced use of medication in group A was 75.76% while in group B this reduction was only 11.54%. The improvement in group A occurred at a mean time of 28.76 ±11.43 days, regardless of age, where the average number of sessions was 3.91 ±0.80. The symptom of vomiting improved significantly in group A (p = 0.001) but not in group B (p = 0.063). The symptom of heartburn showed a significant improvement in both groups A and B (p = 0.001 and p = 0.002 respectively), as well as hiccup (p = 0.001 and p = 0.001 respectively). The symptom of crying showed significant improvement in group A (p = 0.001), but not for group B (P = 0.123). Likewise, choking episodes exhibited statistically significant reduction in group A (p = 0.001) and not in group B (p = 0.105). Coughing in the group A was reduced by 94.75% (p=0,001) and 75% in colic (p=0,001). In group B the cough remained with the same incidence (14 cases) (p=1,000) and colic increased significantly from nine to 17 cases (p=0,008). Therefore, it is concluded that the proposed OPT was effective in reducing symptoms of reflux in infants and symptoms of cough and colic associated in an approximate 29 days to levels close to zero, time lower than that described in the literature. It is understood that the protocol has reached the causal mechanisms of GER, and therefore the association of OPT with a medication treatment may be suggested in the approach of GER in infants less than one year old.

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Hintergrund: Das subacromiale Schmerzsyndrom (SAPS) ist ein häufiges muskuloskelettales Krankheitsbild. Patienten haben eine eingeschränkte schmerzhafte Schulterbeweglichkeit. Der Pathomechanismus ist noch nicht ganz geklärt. Umliegende Gelenke können durch Bewegungseinschränkungen das SAPS beeinflussen. Die vorliegende Bachelorthesis soll eine Literaturübersicht über osteopathische Behandlungsmöglichkeiten beim SAPS geben. Methodik: Sieben medizinische Datenbanken wurden auf zwischen 2010 und 2023 veröffentlichte relevante Artikel durchsucht. Eingeschlossen wurden randomisierte klinische Studien (RCT), in deutscher und englischer Sprache, in denen osteopathische Techniken, bei menschlichen Probanden mit einem SAPS, eingesetzt wurden. Die Ergebnisse wurden mit einer Kontrollgruppe oder anderen Interventionen verglichen. Ergebnisse: Die Suche ergab 782 einzelne Artikel. 14 Studien erfüllten die Einschlusskriterien und wurden in der PICO Übersicht eingeschlossen. Zehn Studien verwendeten Manipulationstechniken und vier Studien Weichteiltechniken mit Heimübungen. Die Ergebnisse zeigen, dass die Techniken sich positiv auf das SAPS auswirken. Eine Signifikanz zwischen den Gruppen ist häufig nicht vorhanden. Schlussfolgerung: Alle Studien zeigen nach osteopathischen Behandlungen eine Verbesserung der Beschwerden mit SAPS. Manipulation reicht als alleinige Behandlung nicht aus, um einen Langzeiteffekt zu erzeugen. Eine individualisierte Kombinationstherapie mit verschiedenen Behandlungstechniken und Heimübungen, ist für die effektive, klinische, Patientenbehandlung besser geeignet. Zukünftige Untersuchungen sollten vermehrt osteopathische Techniken untersuchen, um das positive Bild der osteopathischen Behandlung zu festigen und das mögliche Ausmaß der Verbesserungen zu ermitteln. / Background: Subacromial pain syndrome (SAPS) is a common musculoskeletal condition. Patients have limited painful shoulder mobility. The pathomechanism has not yet been fully elucidated. Surrounding joints can affect the SAPS through movement restrictions. This bachelor thesis is intended to provide a literature review on osteopathic treatment options for SAPS. Methods: Seven medical databases were searched for relevant articles published between 2010 and 2023. Included were randomized clinical trials (RCT), in German and English, in which osteopathic techniques were used on human subjects with SAPS. The results were compared to a control group or other interven-tions. Results: The search returned 782 individual articles. 14 studies met the inclusion criteria and were included in the PICO review. Ten studies used manipulation techniques and four studies used soft-tissue techniques with home exercises. The results show that the techniques have a positive effect on the SAPS. Significance between groups is often absent. Conclusion: All studies show an improvement in symptoms with SAPS after osteopathic treatments. Manipulation alone is not enough to produce a long-term effect. An individualized combination therapy with different treatment techniques and home exercises is more suitable for the effective, clinical, patient treatment. Future investigations should examine more osteopathic techniques in order to consolidate the positive image of osteopathic treatment and to determine the pos-sible extent of the improvements.

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