Breathing Exercises in Gastroesophageal Reflux Disease: A Systematic Review.
Lucie Zdrhova, Petr Bitnar, Karel Balihar and 5 others
PMID 35842548WHAT IT FOUND
Breathing exercises improved reflux symptoms, quality of life, and lower esophageal sphincter pressure across eleven small GERD studies, and some patients reduced or stopped PPI use.
The studies were unblinded and used different techniques, so the evidence is not strong.
Key findings
01Across the eleven included studies, breathing exercises were associated with improved reflux symptoms, quality of life, and lower esophageal sphincter or esophagogastric junction pressure.
02Several studies reported that patients reduced or stopped PPI medication after breathing exercise training, with one study finding 82% of the breathing group had ceased PPI use at six months compared with 6.2% of the control group.
03The studies differed in technique, sample size, and outcome measures, and most were unblinded, so the authors could not pool the data into a single estimate.
STILL TO COME
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What it does not show
Most studies enrolled small numbers of patients (21 to 60). Most studies lacked blinding and did not verify that patients actually performed the exercises at home. Each study used a different breathing technique, so no single intervention has been tested consistently. Most outcomes were measured after only a few weeks, which may underestimate the effect of regular practice. Some studies may have included patients with functional heartburn or esophageal hypersensitivity rather than true GERD, in which case improvement could reflect reduced sensitivity rather than a change in the antireflux barrier. Most studies used conventional manometry rather than high-resolution manometry, which the authors note is less sensitive for assessing diaphragmatic function. The heterogeneity in design, outcomes, and interventions made meta-analysis impossible.
Declared interests
The authors declare no conflict of interest or professional disclosures relevant to the synthesis of this paper.
The easy way to misread this
Do not read this as strong evidence that breathing exercises treat GERD. The eleven studies were small, mostly unblinded, used different techniques, and could not be pooled into a single estimate. Some patients may have had functional heartburn rather than reflux disease, in which case the improvement could reflect reduced sensitivity rather than a change in the antireflux barrier.
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