Diaphragmatic Breathing Can Help Reduce GERD

Upright gastroesophageal reflux disease (GERD), also known as upright reflux, is thought to be a result of increased intragastric pressure. In turn, increases in intragastric pressure lead to transient lower esophageal sphincter relaxation that causes reflux. Small uncontrolled studies have reported that diaphragmatic breathing (DB; performing inspiratory and expiratory breaths with the abdominal muscles while keeping the chest motionless) is a modality of nonpharmacological therapy in GERD. The authors conducted a single-center, randomized controlled trial to confirm the efficacy of DB in alleviating GERD. 

A total of 23 patients (confirmed by pH impedance testing) with upright GERD (mean age, 58 years; 11 men) and 10 healthy controls (mean age, 44 years; 4 men) were randomized to DB or sham therapy. Subjects were required to undergo a manometry, perform Valsalva and abdominal hollowing (to induce reflux), and then consume a pH-neutral meal. During the subsequent 20-minute postprandial observation period, they were randomized to 10 minutes of DB or sham therapy (listening to music). 

When compared to controls at baseline, GERD patients had a higher postprandial gastric pressure (12 mm Hg vs 7 mm Hg; P=.018), but there was no significant difference in lower esophageal sphincter (LES) pressure (23 mm Hg vs 23 mm Hg; P=.993). Compared to sham therapy, the use of DB led to a significantly higher LES pressure (42.2 mm Hg vs 23.1 mm Hg; P<.001), along with a significant decrease in postprandial reflux events, both in patients (0.36 vs 2.6; P<.001) and controls (0 vs 1.75; P<.001). During a 48-hour impedance study, the researchers noted that patients and controls randomized to DB had lower reflux on day 2 (P=.049) and lower acid exposure in the 2-hour window after a meal on day 2 compared to day 1 (11.8 vs 5.2; P=.015). However, there was no difference in acid exposure in the DB and sham groups on day 2 (10.2 vs 9.4; P=.804).