Training device for reflux and dysphagia available on NHS

IQoro is a neuromuscular self-treatment device that treats the underlying cause of reflux by restoring the dysfunctional musculature in the diaphragm. Unlike other treatments, IQoro is able to strengthen muscles under the involuntary control of the autonomic nervous system.

In patients with dysphagia, it restores muscle strength and neurological control to enable a normal swallow. By enabling normal swallowing, patients with chronic dysphagia receiving enteral nutrition are able to return to an oral diet. 

Usage

IQoro is indicated for reflux-based diseases including GORD, laryngopharyngeal reflux and silent reflux, and dysphagia, drooling and facial weakness. It is suitable for children and adults, and is to be used for 30 seconds, three times a day.

The device sits between the teeth and lips and has a handle for pulling outwards. The patient must press their lips tightly together and pull forward on the device for 10 seconds, repeating the exercise three times with 3 seconds of rest between each repetition. 

To support the effective use of IQoro, the manufacturer provides a website with information, images, videos and advice for both healthcare professionals and patients. 

Significant improvement in symptoms

In 2019, NICE issued a medtech innovation briefing on IQoro as an alternative to long-term proton pump inhibitor (PPI) treatment or laparoscopic fundoplication for hiatus hernia. In three studies in patients with hiatus hernia, the manufacturer reported to NICE that 93%, 58% and 61% of patients, respectively, were able to cease all PPI medication after IQoro training and the remainder 'mostly reduced dose and intake frequency'. 

A service evaluation carried out at the Royal Devon and Exeter NHS Foundation Trust has demonstrated the effectiveness of IQoro for treating dysphagia in patients in acute and community care settings (n=21), with significant improvements in dysphagia symptoms, impact and quality of life seen over a 12-week period. In addition, 40% of participants receiving enteral feeding were able to return to an oral diet. 

Safety

IQoro is contraindicated in patients with trigeminal neuralgia, paraoesophageal hernia and achalasia cardiae. Patients with tinnitus, peripheral facial palsy and complex dysphagia may require a gradual increase in treatment intensity. 

Prescribers must warn patients that where muscles are exercised, delayed onset muscle soreness can occur. In patients with hiatus hernia, undiagnosed oesophageal irritation may manifest as oral bleeding when using the device. Incorrect use of the device may also cause gum irritation and bleeding.