Diaphragmatic Breathing Can Help Reduce GERD

Diaphragmatic Breathing Can Help Reduce GERD

Prateek Sharma, MD, FASGE, reviewing Halland M, et al. Am J Gastroenterol 2020 Sep 30.

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).

Prateek Sharma, MD, FASGE

COMMENT

Diaphragmatic breathing appears from a physiological standpoint to be a reasonable nonpharmacological option in patients with upright GERD. It can be added to our list of conservative measures for GERD management, but follow-up studies to evaluate symptom improvements with DB will need to be conducted.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Halland M, Bharucha AE, Crowell MD, Ravi K, Katzka DA. Effects of diaphragmatic breathing on the pathophysiology and treatment of upright gastroesophageal reflux: a randomized controlled trial. Am J Gastroenterol 2020 Sep 30. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000000913)

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